Treatment of Hypertension in Patients With Diabetes

Abstract

At least 17 million people in the United States have diabetes mellitus, and another 50 million have hypertension. These chronic diseases increasingly coexist in our aging population. Both diseases are important predisposing factors for the development of cardiovascular disease (CVD) and renal disease, and the coexistence of these risk factors is a very powerful promoter of CVD and renal disease. There is accumulating evidence that the rigorous treatment of hypertension and other risk factors such as dyslipidemia and hyperglycemia considerably lessens the burden of CVD and renal disease in patients with diabetes mellitus. There is considerable evidence that strategies addressing diet and exercise reduce the development of diabetes and are an important component of treatment in persons who have established diabetes. There are also considerable data suggesting that the treatment strategies that interrupt the renin-angiotensin system have special benefits in patients with diabetes and may prevent the development of clinical diabetes in hypertensive patients with impaired glucose tolerance. Data from a recent study indicate that the control of systolic blood pressure, using a diuretic agent as part of antihypertensive therapy, reduces the risk of stroke and other CVD end points. Recent reports indicate that angiotensin receptor-blocking agents decrease the rate of development of proteinuria and diabetic renal disease. These observations will likely have a significant impact on treatment of hypertension in patients with type 2 diabetes mellitus.

Risk of chronic kidney disease in hypertensive patients with other metabolic conditions

“…[1][2][3] Many patients with hypertension also have other metabolic conditions, such as diabetes, hyperlipidaemia and obesity, and accumulating evidence suggests that the presence of multiple metabolic conditions increases CKD risk. [2][3][4][5][6] However, prior research has not clarified the extent to which CKD risk may vary among hypertensive patients based on the specific combination of metabolic conditions that are present. We undertook a retrospective cohort study to examine this issue.…”

Biochemical and Histopathological Toxicity by Multiple Drug Administration

“…The occurrence of diabetes is continually growing and rising at a distressing rate, and it is projected that, unless successful prevention and control measures are put into practice, this disease will soon involve 300 million persons worldwide (Sowers, 2004). Globally more than 170 million people have diabetes, and this figure is expected to be more than double by the year 2030, if existing trends continue (Boden andTaggart, 2009, Hoque et al, 2009).…”

Increased heart rate variability during sleep is a predictor for future cardiovascular events in patients with type 2 diabetes

“…1,2 As hypertension and T2DM synergistically act on cardiovascular risk, special attention should be paid for controlling blood pressure (BP) in patients with T2DM. 3,4 There is an increasing body of evidence that ambulatory BP is a better predictor of future CVD than clinic BP in hypertensive patients.…”