Epidemiologic studies have shown that hypertension and type 2 diabetes mellitus (T2DM) are global public health issues and become the major cause of disease burden and mortality [
1,
2]. The World Health Organization estimated that 40% of adults worldwide have hypertension (about 90% are classified with essential hypertension) [
3], and approximately 422 million adults were living with diabetes(more than 90% are T2DM) [
4]. In addition, hypertension is present in more than half of type 2 diabetic patients and contributes significantly to macro- and micro-vascular complications [
5]. The development of T2DM is often asymptomatic and subclinical for a long period, and before diagnosis of T2DM, individuals can reside in the high-risk state of prediabetes, defined as impaired fasting glucose or impaired glucose tolerance [
6,
7]. Recently, the prevalence of hypertension and T2DM is increasing in many Asian countries, with a number of countries with blood pressure (BP) and glucose above the global average [
7‐
12]. The Chinese National Report of Cardiovascular Disease 2018 pointed out that the prevalence of hypertension and diabetes reaches 23.2% and 10.9%, respectively, leading to an estimate of about 290 million of adult people suffering from cardiovascular disease in China [
9]. The major goal for cardiovascular care is to prevent morbidity and mortality by controlling glucose, normalizing BP, and reducing other cardiovascular risk factors. Data frequently suggest an existence of the relationship between BP and cardiovascular risks as low as 110–115 mmHg for systolic BP and 70–75 mmHg for diastolic BP. Every 20 mmHg systolic and 10 mmHg diastolic BP increase above the threshold has shown to double the risk of mortality from ischemic heart disease and stroke [
10]. For decades, clinical practice guidelines vary in determining the optimal BP target in patients with T2DM. Whereas several guidelines recommend a BP goal of < 140/90 mmHg [
13,
14], some recommend a lower target of systolic and diastolic BP in certain diabetic population [
15,
16]. The newly released American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High BP in adults supports a more aggressive diagnostic and treatment approach, recommending hypertensive patients to maintain their BP < 130/80 mmHg [
17]. Although the adoption of new guideline is expected to increase the prevalence of hypertension, endorsing the aggressive approach including lifestyle change and medical treatment would lead to reduced risk of major adverse cardiac events and improvement in overall clinical outcome [
10,
17]. However, controversies exist regarding the optimal level of BP attained with therapeutic interventions that is safe and provides cardiovascular protection, especially in patients with T2DM and coexistent coronary artery disease [
18,
19]. Furthermore, the class of drugs most appropriate for the treatment of hypertensive diabetics is also unclear and different guidelines emphasize use of different classes for anti-hypertensive treatment in type 2 diabetic patients [
16]. Particularly, several new glucose-lowering agents for the treatment of diabetes have been found to lower BP as well, making the interaction between BP and T2DM even more complex [
20]. In this review, we will outline the possible optimal BP levels based upon recommendations on the management of hypertension by the current guidelines, in combination with our research findings, for type 2 diabetic patients with coronary artery disease.