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Abstract-Cardiovascular diseases (CVDs) are the major causes of mortality in persons with diabetes, and many factors, including hypertension, contribute to this high prevalence of CVD. Hypertension is approximately twice as frequent in patients with diabetes compared with patients without the disease. Conversely, recent data suggest that hypertensive persons are more predisposed to the development of diabetes than are normotensive persons. Furthermore, up to 75% of CVD in diabetes may be attributable to hypertension, leading to recommendations for more aggressive treatment (ie, reducing blood pressure to Ͻ130/85 mm Hg) in persons with coexistent diabetes and hypertension. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and "diabetic cardiomyopathy." The cardiomyopathy associated with diabetes is a unique myopathic state that appears to be independent of macrovascular/ microvascular disease and contributes significantly to CVD morbidity and mortality in diabetic patients, especially those with coexistent hypertension. This update reviews the current knowledge regarding these risk factors and their treatment, with special emphasis on the cardiometabolic syndrome, hypertension, microalbuminuria, and diabetic cardiomyopathy. This update also examines the role of the renin-angiotensin system in the increased risk for CVD in diabetic patients and the impact of interrupting this system on the development of clinical diabetes as well as CVD. Hypertension in the Diabetic PatientThe subject of diabetes mellitus as a comorbid disease that frequently confounds hypertension, adding significantly to its overall morbidity and mortality, 1,2 will be updated in the present review. Among the complications of diabetes, cardiovascular and renal vascular diseases are among the most costly in terms of human suffering and national healthcare costs. Over the past several years, since the publication of these foregoing reviews, a number of controlled multicenter clinical trials have demonstrated the safety and efficacy of specific antihypertensive therapeutic programs that can significantly alter the outcomes of these cardiovascular and renal complications. The present report summarizes these advances as well as newer fundamental findings that add importantly to our overall knowledge of the cardiovascular complications of diabetes mellitus. In a recent, large, prospective cohort study that included 12 550 adults, the development of type II diabetes was almost 2.5 times as likely in persons with hypertension than in their normotensive counterparts. 3 This, in conjunction with considerable evidence of the increased prevalence of hypertension in diabetic persons, 1,2 suggests that these 2 common chronic diseases frequently coexist. Moreover, each pathophysiological disease entity, although independent in its own natural history, serves to exacerbate the other. 1,2 In a rec...

Our investigation indicates that a state of reduced natriuretic peptide level exists in the obese individual with heart failure.

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Abstract-Recent reports of selected observational studies and a meta-analysis have stirred controversy and have become the impetus for calls to abandon recommendations for reduced sodium intake by the US general population. A detailed review of these studies documents substantial methodological concerns that limit the usefulness of these studies in setting, much less reversing, dietary recommendations. Indeed, the evidence base supporting recommendations for reduced sodium intake in the general population remains robust and persuasive. The American Heart Association is committed to improving the health of all Americans through implementation of national goals for health promotion and disease prevention, including its recommendation to reduce dietary sodium intake to Ͻ1500 mg/d. (Circulation. 2012;126:2880-2889.)Key Words: AHA Scientific Statements Ⅲ sodium Ⅲ diet Ⅲ prevention I n almost every country that has established guidelines for the prevention and treatment of cardiovascular disease (CVD) and stroke, national health agencies and professional societies recommend a reduction in dietary sodium as a means to lower blood pressure (BP) and to prevent CVD and stroke. The American Heart Association (AHA) currently recommends a sodium intake Ͻ1500 mg/d for the entire US population. 1 The US Department of Agriculture and US Department of Health and Human Services joint 2010 Dietary Guidelines for Americans calls for no more than 1500 mg/d in AfricanAmericans, people Ͼ51 years of age, and people with hypertension, diabetes mellitus, or chronic kidney disease, and no more than 2300 mg/d in all others. 2 Guideline recommendations far exceed adequate intake for sodium in some age groups, especially in children; the adequate intake for children aged 1 to 3 years is 1000 mg/d, and for children aged 4 to 8 years is 1200 mg/d. 3 The scientific rationale for the AHA recommendation was documented in an AHA presidential advisory published in 2011. 4 The principal basis for the recommendation was the strength of the evidence relating excess sodium intake to high BP, CVD, and stroke and the capacity of reduced intake of sodium to prevent and treat hypertension and to reduce the risk of adverse CVD and stroke events. High BP, both prehypertension and hypertension, is a leading cause of preventable morbidity and mortality worldwide. 5 Excess sodium intake has also been linked to kidney stones, asthma, osteoporosis, and gastric cancer. 3,6 Various local, state, federal, and global initiatives are focused on efforts to meet sodium reduction guidelines. 7 Even a modest reduction in sodium intake is likely to result in substan-The opinions expressed in this article are not necessarily those of the editors. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Discl...