Endocrinology · MOHFW

Hypertension in diabetes

MOHFW

Source:API-ICP Consensus Guidelines: Management of Hypertension in Patients with Type 2 Diabetes Mellitus (2024)

Verified Apr 2026

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Red Flags

BP ≥180/120 with diabetes and end-organ involvement — hypertensive emergency; immediate parenteral therapy^[1]
Albuminuria progression on optimised RAAS blockade — investigate non-diabetic glomerular disease; nephrology referral^[1]
Symptomatic orthostatic hypotension with autonomic neuropathy — modify regimen; gentle BP titration^[1]
Pregnancy with diabetes plus hypertension — stop ACE-i/ARB; switch to labetalol or methyldopa; obstetric medicine input^[1]

First-line treatment

Interventions

BP target <130/80 in diabetes^[1]
API-ICP recommends <130/80 mmHg in most diabetic adults; <140/90 acceptable in elderly or frail with high adverse-effect burden
Lifestyle modification^[1]
Salt <5 g/day, weight reduction if BMI ≥25, ≥150 min/week aerobic activity, alcohol limitation, smoking cessation

First-line drug therapy

Drug	Class	Adult	Paediatric	Notes
Telmisartan or losartan (ARB)^[1]	Angiotensin receptor blocker	Telmisartan 40–80 mg PO daily; losartan 50–100 mg PO daily	—	First-line in HTN with diabetes; renal and cardiovascular protection beyond BP lowering, especially with albuminuria
Enalapril or ramipril (ACE-i)^[1]	ACE inhibitor	Enalapril 5–40 mg PO daily; ramipril 2.5–10 mg PO daily	—	Alternative first-line; switch to ARB if dry cough develops
Amlodipine^[1]	CCB (DHP)	5–10 mg PO once daily	—	Combine with RAAS blockade when BP not at target
Indapamide or chlorthalidone^[1]	Thiazide-like diuretic	Indapamide 1.5 mg sustained-release once daily	—	Third agent; preferred over hydrochlorothiazide
Empagliflozin or dapagliflozin^[1]	SGLT2 inhibitor	Empagliflozin 10–25 mg or dapagliflozin 10 mg PO once daily	—	Modest BP reduction plus cardio-renal protection independent of glycaemic effect

Telmisartan or losartan (ARB)^[1]

Angiotensin receptor blocker

Adult: Telmisartan 40–80 mg PO daily; losartan 50–100 mg PO daily
Paediatric: —

First-line in HTN with diabetes; renal and cardiovascular protection beyond BP lowering, especially with albuminuria

Enalapril or ramipril (ACE-i)^[1]

ACE inhibitor

Adult: Enalapril 5–40 mg PO daily; ramipril 2.5–10 mg PO daily
Paediatric: —

Alternative first-line; switch to ARB if dry cough develops

Amlodipine^[1]

CCB (DHP)

Adult: 5–10 mg PO once daily
Paediatric: —

Combine with RAAS blockade when BP not at target

Indapamide or chlorthalidone^[1]

Thiazide-like diuretic

Adult: Indapamide 1.5 mg sustained-release once daily
Paediatric: —

Third agent; preferred over hydrochlorothiazide

Empagliflozin or dapagliflozin^[1]

SGLT2 inhibitor

Adult: Empagliflozin 10–25 mg or dapagliflozin 10 mg PO once daily
Paediatric: —

Modest BP reduction plus cardio-renal protection independent of glycaemic effect

Safety-net

Take BP and diabetes medications every day; missing doses worsens both conditions^[1]
Monitor for low blood sugar especially with beta-blockers — they can mask hypoglycaemia warning signs^[1]
Sudden severe headache, chest pain, vision changes, or weakness — call emergency services immediately^[1]

Referral criteria

BP ≥180/120 with end-organ involvementEmergency department for parenteral antihypertensive^[1]
Resistant hypertension uncontrolled on triple therapyHypertension or cardiology clinic^[1]
Albuminuria progression despite optimised RAAS blockadeNephrology^[1]
Pregnancy with diabetes + hypertensionObstetric medicine; stop ACE-i/ARB^[1]

Clinical summary

API-ICP consensus on hypertension management in T2DM — ACE-i/ARB anchored therapy with target BP <130/80 in most patients.

References

1.API-ICP Consensus Guidelines: Management of Hypertension in Patients with Type 2 Diabetes Mellitus (2024) (2024)

Drug

Class

Adult

Paediatric

Notes