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<p>Hypertension is one of the most frequent and consequential comorbidities in people with diabetes, yet its management remains less straightforward than guideline tables might suggest. Epidemiological evidence confirms the high prevalence and the disproportionate burden of cardiovascular and renal complications in this dual condition. The pathophysiology is complex: insulin resistance, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system (RAAS) interact, often with cumulative effects. Most recommendations endorse a blood pressure (BP) target below 130/80 mmHg, but whether strict numerical thresholds should dominate practice remains debated. Therapies such as RAAS inhibitors and sodium–glucose cotransporter-2 inhibitors demonstrate consistent benefits, extending beyond BP reductions. Given this multifactorial background, combination therapy carries a strong rationale, as it allows simultaneous targeting of multiple pathophysiological abnormalities.&#xa0;This article argues that success should be judged not only by BP values but by the outcomes that alter prognosis.</p>

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Hypertension in Diabetes: Numbers or Outcomes?

  • 期刊论文

  • 发表日期：

    2026年1月12日

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  • Theocharis Koufakis,
  • Michael Doumas

摘要

Hypertension is one of the most frequent and consequential comorbidities in people with diabetes, yet its management remains less straightforward than guideline tables might suggest. Epidemiological evidence confirms the high prevalence and the disproportionate burden of cardiovascular and renal complications in this dual condition. The pathophysiology is complex: insulin resistance, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system (RAAS) interact, often with cumulative effects. Most recommendations endorse a blood pressure (BP) target below 130/80 mmHg, but whether strict numerical thresholds should dominate practice remains debated. Therapies such as RAAS inhibitors and sodium–glucose cotransporter-2 inhibitors demonstrate consistent benefits, extending beyond BP reductions. Given this multifactorial background, combination therapy carries a strong rationale, as it allows simultaneous targeting of multiple pathophysiological abnormalities. This article argues that success should be judged not only by BP values but by the outcomes that alter prognosis.