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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e159 systems, including the heart, vasculature, kidneys, brain, and retina due to hypertension.1,2 Common forms of target organ damage include left ventricular hyper trophy, HF, subclinical and clinical atherosclerosis, CKD (ie, reduced eGFR or albuminuria), and cerebrovascular disease (eg, stroke, dementia, retinopathy).3 Numerous studies demonstrate an association between hyperten sion and target organ damage,4–9 and longitudinal data indicate at least 1 form of hypertension-related target organ damage is present in >50% of individuals with hypertension.1 Recent studies also demonstrate rela tionships between the severity of hypertension and the number of organs affected by hypertension,10 as well as the number of affected organs and increased CVD risk.11 Although there are strong data linking hyper tension to target organ damage, recommendations on screening and management of different types of tar get organ damage beyond hypertension treatment are lacking.12 The goals of preventing target organ damage and its progression from asymptomatic to symptomatic target organ damage can be achieved by focusing on hypertension control.13 Future studies are needed to inform how hypertension-related target organ damage should be diagnosed and managed among patients with hypertension. 5.3.1 Diabetes Recommendations for Diabetes Referenced studies that support the recommendations are summarized in the Evidence Table. COR LOE Recommendations 1 A 1 In adults with T2D and hypertension, antihyperten sive drug treatment should be initiated at an SBP of ≥130 mm Hg with a treatment goal of <130 mm Hg, with encouragement to achieve an SBP <120 mm Hg to reduce CVD morbidity and mortality.1–5 1 C-LD 2 In adults with T2D and hypertension, antihyperten sive drug treatment should be initiated at a DBP of ≥80 mm Hg with a treatment goal of <80 mm Hg to reduce CVD morbidity and mortality.6 1 A 3 In adults with T2D and hypertension, all first-line classes of antihypertensive agents (ie, thiazidetype diuretics, long-acting CCB, ACEi, and ARB) are useful and effective for BP lowering.1,7–9 1 A 4 In adults with diabetes and hypertension, ACEi or ARB are recommended in the presence of CKD as identified by eGFR <60 mL/min/1.73 m2 or albu minuria ≥30 mg/g and should be considered when mild albuminuria (<30 mg/g) is present to delay progression of diabetes-related kidney disease.10–12 Synopsis More than 80% of adults with T2D also have hyperten sion. The prevalence rate of hypertension in adults with Table 17. Pharmacodynamic Drug–Drug Interactions With Antihypertensive Medications Drug Combinations Clinical Effect Cautionary interactions Any antihypertensive medication NSAIDs Reduced BP lowering via sodium retention Sympathomimetic (eg, pseudoephedrine, dextroam phetamine) Reduced BP lowering Venlafaxine Reduced BP lowering Nondihydropyridine CCB Beta blockers Bradycardia or atrioventricular block ACEi ARBs AKI, hyperkalemia Potassium-sparing diuretics (Spironolactone, eplerenone, triamterene, amiloride) Hyperkalemia Sulfamethoxazole/trimethoprim Hyperkalemia Potassium supplements Hyperkalemia NSAIDs (eg, ibuprofen, naproxen) AKI Clonidine, methyldopa, guanfacine CNS depressants (eg, zolpidem, alprazolam) Sedation Clonidine Noncardioselective BB (eg, nadolol or propranolol) Unopposed alpha agonism upon BB withdrawal leading to hypertensive crisis Advantageous interactions Dihydropyridine CCB RAS inhibitor Reduced risk of dihydropyridine CCB-induced lower leg swelling RAS inhibitors Diuretics Balanced effects on serum potassium levels with diminished pos sibility for hypokalemia (with diuretic) or hyperkalemia (with RAASi) RAS inhibitors Potassium binder Lowers risk of hyperkalemia from the RAS inhibitor Diuretic Potassium supplement Lowers risk of hypokalemia from the diuretic Modified with permission from Fravel et al.1 Copyright 2021 Springer Nature. ACEi indicates angiotensin-converting enzyme inhibitors; AKI, acute kidney injury; ARB, angiotensin receptor blockers; BB, beta blocker; BP, blood pressure; CCB, calcium channel blocker; CNS, central nervous system; NSAIDs, nonsteroidal anti-inflammatory drugs; RAASi, renin-angiotensin aldosterone inhibitor; and RAS, reninangiotensin system. Downloaded from http://ahajournals.org by on October 7, 2026