[Individualizing antihypertensive therapy in diabetes mellitus. Guidelines of the Austrian Diabetes Association...

Hypertension is one of the most important comorbidities of diabetes, significantly contributing to increased mortality and leading to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. In the present review practical approaches to hypertension in diabetes, including individualized targets for preventing specific complications are discussed according to the current evidence and guidelines. Blood pressure values of 120-129/70-79 mm Hg are associated with the best outcome; most importantly, at least blood pressure values < 140/90 mm Hg should be achieved in most patients. Most patients with diabetes require combination therapy to achieve blood pressure goals; agents with clear evidence of cardiovascular risk reduction should be used (including, besides angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, dihydropyridine calcium channel antagonists and thiazide diuretics), preferable in single pill combinations. Once the target is achieved, antihypertensive drugs should be continued. The use of SGLT‑2 inhibitors and GLP‑1 receptor agonists contribute to blood pressure lowering in diabetes. This also holds true für the newly available combined GLP-1/GIP receptor agonist tirzepatide. Since the last release of these guidelines evidence from clinical trials has become available that supports more stringent blood pressure control in diabetes, which is reflected in international guidelines and has also been adopted in these recommendations. The individualization of blood pressure management, however, remains a core recommendation of the Austrian Diabetes Association.