What blood pressure goals do the ADA guidelines recommend for type 2 diabetes mellitus (DM)?

Updated: Dec 04, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

The role of hypertension in increasing microvascular and macrovascular risk in patients with diabetes mellitus has been confirmed in the UKPDS and Hypertension Optimal Treatment (HOT) trials. [284, 285]

In a 2017 update to its recommendations for hypertension management in diabetes, the ADA states that the goal in most patients with diabetes and hypertension should be a systolic blood pressure (SBP) of below 140 mm Hg and a diastolic blood pressure (DBP) of under 90 mm Hg. For patients with a high risk of cardiovascular disease, however, the recommendations say that it may be appropriate to target a lower SBP/DBP, such as below 130/80 mm Hg, if the goal can be met “without undue treatment burden.” [286, 287]

In patients with greater than 1 g/day proteinuria and renal insufficiency, a more aggressive therapeutic goal (ie, 125/75 mm Hg) has been advocated. According to the Veterans Affairs Diabetes Trial, however, a diastolic blood pressure of less than 70 mm Hg increases the risk of cardiovascular disease in patients with diabetes, even when systolic blood pressure is within the current guidelines (recommended range, < 140 mm Hg). [288]

The ADA recommendations endorse blood pressure measurement “at every routine clinical care visit” and state that patients whose blood pressure is found to be elevated (at or above 140/90 mm Hg) should undergo multiple readings to confirm hypertension, including blood pressure assessment on a separate day. [286, 287]


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