Anyaogu Christy N, Momodu Paul A, Okobi Okelue E, Amadi Adaora T, Okechukwu Judah K, Polna Oksana, Adeola Dorcas A, Dike Olamma A, Nwachukwu Ebere M, Akudinobi Ogechi K, Gabriel Hannatu
Medicine, Richmond Gabriel University, Kingstown, VCT.
Medicine, International University of the Health Sciences, Basseterre, KNA.
Cureus. 2025 Jul 29;17(7):e88984. doi: 10.7759/cureus.88984. eCollection 2025 Jul.
Hypertension (HTN) is a well-acknowledged and modifiable risk factor that significantly increases the risk of cardiovascular disease. Left uncontrolled, HTN may result in severe complications, including myocardial infarction and stroke. Also, when HTN coexists with diabetes, the adverse effects on cardiovascular health are amplified as a result of the combined vascular and metabolic effects. This narrative review synthesizes evidence from large observational cohorts, randomized clinical trials (e.g., Systolic Blood Pressure Intervention Trial or SPRINT, Action to Control Cardiovascular Risk in Diabetes or ACCORD), and contemporary guideline recommendations to assess these outcomes. The coexistence of diabetes mellitus with hypertension may further worsen vascular health through combined metabolic and endothelial effects, increasing rates of myocardial infarction and stroke. While pharmacological blood pressure (BP) lowering and lifestyle interventions (e.g., sodium restriction, exercise) generally reduce risk, overly aggressive diastolic BP reduction (< 60 mmHg) can pose hazards in older adults or patients with chronic kidney disease. Current strategies adjust systolic and diastolic targets based on individual factors, age, comorbidity burden, and baseline cardiovascular risk and may include combined drug regimens, dietary counseling, or device‑based therapies. Further studies should prospectively evaluate optimal BP targets in under‑represented populations (e.g., elderly ≥ 75 years, chronic kidney disease stages 3-5, sub‑Saharan cohorts) and compare pharmacologic versus lifestyle‑only strategies, particularly in patients with multiple comorbidities.
高血压（HTN）是一个公认的且可改变的风险因素，它会显著增加心血管疾病的风险。若不加控制，高血压可能导致严重并发症，包括心肌梗死和中风。此外，当高血压与糖尿病并存时，由于血管和代谢的综合作用，对心血管健康的不良影响会加剧。这篇叙述性综述综合了来自大型观察性队列、随机临床试验（如收缩压干预试验或SPRINT、糖尿病心血管风险控制行动或ACCORD）以及当代指南建议的证据，以评估这些结果。糖尿病与高血压并存可能通过代谢和内皮的综合作用进一步恶化血管健康，增加心肌梗死和中风的发生率。虽然药物降压和生活方式干预（如限钠、运动）通常会降低风险，但过度积极地降低舒张压（<60mmHg）可能对老年人或慢性肾病患者构成危害。当前的策略根据个体因素、年龄、合并症负担和基线心血管风险来调整收缩压和舒张压目标，可能包括联合药物治疗方案、饮食咨询或基于设备的治疗。进一步的研究应前瞻性地评估代表性不足人群（如75岁及以上老年人、慢性肾病3 - 5期、撒哈拉以南队列）的最佳血压目标，并比较药物治疗与仅采用生活方式干预的策略，特别是在患有多种合并症的患者中。
