The coexistence of diabetes and hypertension drives the cardio-kidney-metabolic system into a vicious cycle. Therefore, intensive blood pressure control (IBP) is crucial for diabetic patients complicated with hypertension.
Studies have shown that diabetic patients with hypertension have a significantly higher risk of adverse cardiovascular events compared to normotensive diabetic individuals. These two conditions jointly accelerate the vicious cycle of the cardio-kidney-metabolic system, increasing the risk of chronic kidney disease (CKD) progression, rendering atherosclerotic plaques more prone to rupture, and exacerbating water-sodium retention and blood volume overload imbalance [2].
Evidence-based medicine confirms that IBP significantly reduces cardiovascular mortality and the incidence of end-stage kidney disease (ESKD). Chinese guidelines recommend a blood pressure target below 130/80 mmHg for most non-pregnant adult diabetic patients. In recent years, novel medications including SGLT2 inhibitors (SGLT2i), mineralocorticoid receptor antagonists (MRA), and GLP-1 receptor agonists (GLP-1RA) have demonstrated favorable synergistic organ-protective effects, reducing urinary albumin excretion rate, slowing CKD progression, and improving cardiovascular outcomes.
In clinical practice of IBP, individualized blood pressure targets should be set, with a recommended goal below 130/80 mmHg for high-risk populations. For pharmacotherapy, multi-target synergistic regimens are preferred, such as RAAS inhibitors combined with SGLT2i. Finerenone may be added when necessary to further reduce cardiovascular risk. Additionally, research indicates that GLP-1RA concurrently improves blood glucose, blood pressure, lipid profiles, and uric acid levels.
Comprehensive monitoring and intervention technologies should be integrated during management: regularly testing relevant biomarkers, calculating cardiovascular risk scores, and optimizing treatment plans via AI-assisted decision support systems. In the future, genetic testing, exosome/stem cell therapy, and probiotic supplementation are promising novel therapeutic modalities, though further clinical trials are required to validate their practical value.