The Association of Physicians of India (API) in collaboration with the Indian College of Physicians (ICP) have released the Guidelines on the Management of Hypertension in Indian Patients with Type 2 Diabetes Mellitus (T2DM). These guidelines address the pressing need for a detailed, region-specific protocol to manage the growing dual burden of hypertension and diabetes in India.
Hypertension and diabetes are among the leading lifestyle diseases in India, contributing significantly to morbidity and mortality. Studies indicate that over 50 per cent of hypertensive patients in India are also diagnosed with T2DM, highlighting a significant overlap that poses unique challenges in patient care. The co-occurrence of these conditions amplifies the risk of cardiovascular complications and accelerates the progression of renal disease, making effective management strategies critical. Also, majority of these diseases are diagnosed and managed at the primary care level in India and thus there is a need for detailed guidelines charting out the entire management protocol, especially in Indian patients.
“While global guidelines provide a framework for managing hypertension in T2DM, the Indian and Southeast Asian populations differ significantly from Western populations in terms of ethnicity, clinical challenges, and drug responses. Recognising this gap, the API and ICP have collaborated with leading physicians, cardiologists, diabetologists, and endocrinologists to develop a management protocol specifically for Indian patients. The guidelines emphasise the importance of early detection, comprehensive assessment, and a multi-faceted treatment approach” said Dr Jyotirmoy Pal, President Elect (2025), API
Given the high cardiovascular risk in T2DM, the guideline recommends a treatment of dual antihypertensive therapy, specifically combining Angiotensin Receptor Blockers (ARBs) with Calcium Channel Blockers (CCBs) for their effectiveness in reducing BP and safeguarding against cardiovascular complications
The 2024 guidelines recommend using newer CCBs, particularly Cilnidipine, which has shown benefits in reducing blood pressure and protecting organs like the kidneys. Combining Cilnidipine with ARBs and considering patient-specific factors is advised. RAS blockers are emphasised for managing diabetic kidney complications, while newer anti-diabetic agents such as SGLT2 inhibitors and GLP-1 receptor agonists are recommended for glycemic control and vascular protection.
The guidelines also stress using multiple methods for detecting hypertension, including home BP monitoring, to enhance patient engagement and treatment adherence. For the first time, yoga is recommended as an adjunct therapy for hypertension in T2DM, alongside lifestyle modifications to improve health outcomes.
“Healthcare practitioners across India and beyond are encouraged to adopt these guidelines to enhance patient care and ensure the effective management of hypertension in diabetic patients. The guidelines are now available for reference in the Journal of Association of Physicians of India (JAPI), providing a valuable resource for clinicians striving to deliver the highest standard of care,” informed the statement.