Are low target blood pressure goals justified in persons with diabetes mellitus?

Hypertension is common in patients with diabetes and is a major risk factor for development and progression of the macro- and microvascular complications seen in diabetes. The Joint National Committee VI recommendation for goal blood pressure is less than 130/85 mm Hg in diabetics--a more aggressive target than in nondiabetic patients. Data over the past decade support these aggressive goals, especially for cardiovascular and renal outcomes and overall mortality. In addition, in diabetics, blood pressure appears to be a continuous risk factor for these outcomes without evidence of a J-point effect. While these goals are rarely obtained in diabetic patients, studies demonstrate that they are achievable with attention to detail and use of multiple antihypertensive agents.