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How useful are hypertension guidelines for diabetes?

Peter M Nilsson

Millions of patients all over the world suffer from a combination of hypertension and diabetes mellitus. During the last decade, national and international guidelines have advocated a blood pressure goal of less than 130/80 mmHg in these patients, even if the evidence has largely been lacking from randomized trials. This has led to critical discussion and the proposal from European scientific organizations to return to a somewhat higher blood pressure goal, less than 140/80–90 mmHg, in order to avoid potential side effects in susceptible patients who may not tolerate extensive blood pressure lowering due to, for example, coronary heart disease. My own interpretation of the data is that a systolic blood pressure goal of 130–135 mmHg is based on the totality of evidence right now. However, more than half of all patients with diabetes do not have a systolic blood pressure of less than 140 mmHg despite treatment.