Consensus on the management of hypertension in individuals with diabetes by Asian-Pacific Society of hypertension (APSH) & Diabetes Asia Study Group (DASG).

Hypertension and diabetes commonly coexist, sharing mechanisms such as insulin resistance, obesity, and endothelial dysfunction, which together amplify cardiovascular, renal, and cerebrovascular risk. This dual burden is particularly pronounced in the Asia-Pacific region, where rapid demographic and lifestyle transitions have led to a surge in non-communicable diseases. The Asian-Pacific Society of Hypertension (APSH) and the Diabetes Asia Study Group (DASG) have jointly developed this consensus to provide region-specific, evidence-based recommendations for managing hypertension in individuals with diabetes. A multidisciplinary panel from 15 countries formulated these recommendations using a modified Delphi approach, incorporating evidence from randomized controlled trials, meta-analyses, and international and regional guidelines published between 2015 and 2025, graded according to the GRADE framework. The consensus underscores lifestyle modification as the cornerstone of therapy, emphasizing sodium restriction, weight control, regular physical activity, and avoidance of tobacco and alcohol. Pharmacologic management should be individualized, prioritizing renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, and thiazide-like diuretics as first-line options, with single-pill combinations preferred for adherence. Emerging therapies such as sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists offer added cardio-renal protection and are recommended where appropriate. A target blood pressure of <130/80 mmHg is advised for most, with ≤140/90 mmHg for older or frail individuals. Home blood pressure monitoring is preferred for ongoing management. This consensus offers a practical, patient-centered framework to optimize cardiovascular and renal outcomes in people with diabetes and hypertension across the Asia-Pacific region.