**6.5 Strategies in people with diabetes to reduce the risk of HF**

The 2019 ESC-EASD guidelines recommend regular microalbuminuria and eGFR screening to identify patients at high risk of renal dysfunction or future CVD. On the other hand, the Standards of Care 2021 from the ADA [126], and the 2019 ESC-EASD guidelines [114] recommend a BP target of <130/80 mmHg (but not <120 mmHg).

Moreover, even though the 2021 ESC guidelines [91] do not recommend a target, the 2022 AHA/ACC/HFSA guidelines [120] do recommend a more stringent target of systolic BP of <120 mmHg in individuals with diabetes at CV risk since hypertension control is associated with a lower HF risk. It is worth noting that masked hypertension (meaning only home, but not office BP levels are hypertensive) [127] is common in T2D patients [128], making out-of-office BP monitoring a viable screening method for this clinical condition [129, 130]. Diabetic and hypertensive patients should have their ECGs checked at rest to identify silent MI, which happens in 4% of diabetic patients and adds an insult to HF [114]. Additionally, for pre-diabetics and hypertensive patients with diabetes, lifestyle adjustments and the use of RAAS blockers as first-line therapy for BP management are advised [114]. RAAS blockers also diminish the incidence of new-onset diabetes and the risk of sudden cardiac death in HFrEF patients [114]. Aside from hypertension, a higher body mass index is thought to be a risk factor for HF, which is why the ESC recommendations for 2021 [91] propose that obesity should be controlled to avoid or delay the onset of HF.
