Blood pressure lowering in patients with diabetes--one level might not fit all.

Hypertension and diabetes mellitus frequently occur together, leading to increased complications and mortality in patients with both these conditions. Blood pressure (BP) goals for patients with diabetes have consistently been more aggressive than for patients without diabetes. Although the benefits of lowering BP are well documented, data to support this more aggressive goal are lacking. In fact, lowering BP might not always be better. We review the available evidence regarding BP treatment in patients with hypertension and diabetes from randomized clinical trials, as well as available observational data. We also consider evidence related to the J-shaped curve, which reflects the relationship between BP and outcomes in patients with diabetes, and make recommendations for treatment of BP on the basis of a patient's individual risk, as opposed to on the basis of aggressive BP targets recommended by global guidelines. In the future, a personalized approach will maximize the benefits from treatment.