Comorbidities of Diabetes and Hypertension: Mechanisms and Approach to Target Organ Protection

Abstract

Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance. Thus, hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications. These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease. Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy. The familial predisposition to diabetes and hypertension appears to be polygenic in origin, which militates against the feasibility of a “gene therapy” approach to the control or prevention of these conditions. On the other hand, the shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for nonpharmacological intervention. Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification. Interestingly, lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders. In addition to lifestyle modification, most patients will require specific medications to achieve national treatment goals for hypertension and diabetes. Management of hyperglycemia, hypertension, dyslipidemia and the underlying hypercoagulable and proinflammatory states requires the use of multiple medications in combination.

The Effect of Dietary Supplementation of Green Tea Catechins on Cardiovascular Disease Risk Markers in Humans: A Systematic Review of Clinical Trials

“…Additionally, EGCG has been identified to possess the potential to inhibit pancreatic lipase, contributing to the development of natural lipase inhibitors to prevent human obesity and dyslipidemia [55]. In particular, significant LDL-C reduction [9,10,13,15] is a remarkable finding, as LDL-C promotes chronic inflammation of arterial blood vessels by white blood cells [56]. In addition, GTCs are expected to prevent this vascular inflammation by suppressing leukocyte adhesion ability to the endothelium, thereby indicating the potential to inhibit progression of atherosclerotic lesions and thrombogenesis [38] However, despite these findings, the reviewed studies showed varying degrees of hypocholesterolemic and hypolipidemic activity in participants, with some studies indicating insignificant change for both parameters in the group supplemented with GTCs [11,12,14].…”

Evaluation of Prescribing Trends in Ambulatory Cardiac Patients above 50 Years of Age in Lahore, Pakistan

“…Cardiovascular diseases occur with other co-morbid conditions, e.g. Diabetes mellitus (Long AN, 2011). Pakistan is at number six in terms of number of diabetic patients up till 2009 but it is assumed to be at 4 th rank up till 2020 and according to the report of health survey of Pakistan prevalence rate of diabetes was more in patients above 50 years of age (Wasay M, 2009 …”

The Good, the Bad, and the Different: A Primer on Aspects of Heterogeneity of Treatment Effects

“…For example, individuals with type 2 diabetes may also have hypertension. 20 Third, summary scores or prediction models are typically limited to predicting a single outcome for certain types of patients. For example, the CHADS2 score described earlier only predicts the risk of stroke, while the HEMORR2HAGES, 21 HAS-BLED, 22 and ATRIA 23 models only predict the risk of bleeding, despite the relevance of both stroke and bleeding outcomes to atrial fibrillation.…”