Diabetes and hypertension: a position statement by the American Diabetes Association
Open accessAbstract
Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors (1-3).Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications.ASCVDddefined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origindis the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes.Numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications in people with diabetes (4-8).Large benefits are seen when multiple risk factors are addressed simultaneously (9).There is evidence that ASCVD morbidity and mortality have decreased for people with diabetes since 1990 (10,11) likely due in large part to improvements in blood pressure control (12-14).This Position Statement is intended to update the assessment and treatment of hypertension among people with diabetes, including advances in care since the American Diabetes Association (ADA) last published a Position Statement on this topic in 2003 (3). DEFINITIONS, SCREENING, AND DIAGNOSISRecommendations c Blood pressure should be measured at every routine clinical care visit.Patients found to have an elevated blood pressure ($140/90 mmHg) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension.B c All hypertensive patients with diabetes should have home blood pressure monitored to identify white-coat hypertension.B c Orthostatic measurement of blood pressure should be performed during initial evaluation of hypertension and periodically at follow-up, or when symptoms of orthostatic hypotension are present, and regularly if orthostatic hypotension has been diagnosed.
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There is strong evidence from clinical trials of the value of treating hypertension in older adults.
“There is strong evidence from clinical trials of the value of treating hypertension in older adults (70,71), with treatment of hypertension to individualized target levels indicated in most.”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [71]
The “Meta-analyses of Trials” section says clinical-trial evidence clearly demonstrates benefits of antihypertensive treatment in people with diabetes. The “Older Adults (Aged ≥65 Years)” section recommends treatment strategies for older adults with diabetes, but the paper does not establish the same trial-evidence claim for older adults generally, regardless of diabetes status. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThere is strong evidence from clinical trials of the value of treating hypertension in older adults.
“There is strong evidence from clinical trials of the value of treating hypertension in older adults (72,73), with treatment of hypertension to individualized target levels indicated in most.”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [73]
The “Meta-analyses of Trials” section reports clear clinical-trial evidence that treating hypertension reduces adverse outcomes among people with diabetes. The “OLDER ADULTS (AGED ≥65 YEARS)” section recommends treatment strategies for older adults with diabetes, but does not present trial evidence specifically establishing the benefit for older adults generally. The claim extends the trial finding beyond the population addressed by the source. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThere is strong evidence from clinical trials of the value of treating hypertension in older adults.
“There is strong evidence from clinical trials of the value of treating hypertension in older adults”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [80]
The Meta-analyses of Trials section reports that clinical-trial evidence supports benefits from treating hypertension in people with diabetes. The Older Adults section recommends treatment strategies for older adults with diabetes, but the paper does not establish the claimed trial evidence for older adults generally, regardless of diabetes status. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAntihypertensive therapy reduces the risk of albuminuria.
“Antihypertensive therapy reduces the risk of albuminuria (67)(68)(69)(70), and among people with type 1 or 2 diabetes with established CKD (eGFR <60 mL/min/1.73m 2 and UACR $300 mg/g creatinine), ACE inhibitor or ARB therapy reduces the risk of progression to ESKD (71)(72)(73)(74)(75)(76)(77)(78)(79)(80).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [70]
For individuals with albuminuria (UACR $30 mg/g), initial treatment should include an ACE inhibitor or ARB to reduce the risk of progressive kidney disease.
“For individuals with albuminuria (urine albumin-to-creatinine ratio [UACR] $30 mg/g), initial treatment should include an ACE inhibitor or ARB to reduce the risk of progressive kidney disease (21) (Fig. 10.2).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [21]
In patients with diabetes and albuminuria, ACE inhibitor or ARB treatment reduces the risk of progressive kidney disease.
“For patients with albuminuria (urine albumin-to-creatinine ratio [UACR] $ 30 mg/g), initial treatment should include an ACE inhibitor or ARB to reduce the risk of progressive kidney disease (20) ( Fig. 10.2 ).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [20]
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“The ADA includes BP recommendations in each annual Standards of Care and published a position statement on diabetes and hypertension in 2017.(38) BP control was highlighted as a key component of comprehensive care in the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease and KDIGO…”
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- Authors
- de Boer, I. H., Bangalore, S., Benetos, A., Davis, A. M., Michos, E. D., Muntner, P., Rossing, P., Zoungas, S., & Bakris, G.
- Affiliations
- University of Washington, Seattle, WA
- New York University (US)
- Université de Lorraine, Nancy, France
- University of Chicago (US)
- Johns Hopkins University (US)
- University of Alabama at Birmingham (US)
- University of Copenhagen (DK)
- Monash University (AU)
- Corresponding author
- Bakris, George
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-08-14
- Volume
- 40
- Issue
- 9
- Pages
- 1273-1284
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2748201042
- Semantic Scholar
- 4e3c7fd3bbe3119a559b61514192347b33e3e619
- Cited by
- 714
- References
- 145
- Citations by year
- 2026: 30 · 2025: 67 · 2024: 89 · 2023: 69 · 2022: 102 · 2021: 113 · 2020: 83 · 2019: 81 · 2018: 71 · 2017: 5 · 2016: 2 · 2014: 1 · 2013: 1
- FWCI
- 9.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- Funders
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Ironwood Pharmaceuticals, Incorporated
- Medicines Company
- Steno Diabetes Center Copenhagen (SDCC 3.A Complications)
- Novo Nordisk
- Astellas Pharma
- Novo Nordisk Fonden (NNF14OC0013659)
- Servier
- Sanofi Australia
- Abbott Vascular
- Defense Acquisition Program Administration
- Relypsa
- National Heart, Lung, and Blood Institute
- Cilag
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- hypertension, diabetes mellitus, atherosclerotic cardiovascular disease, heart failure, microvascular complications, antihypertensive therapy, blood pressure screening, home blood pressure monitoring, white coat hypertension, orthostatic hypotension, blood pressure control, risk factors
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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