Myocardial disease in hypertensive-diabetic patients.
Experimental and clinical evidence points to the existence of a cardiomyopathy associated with diabetes mellitus that is not due to coronary atherosclerosis. The condition is characterized by distinct clinical presentations and physiologic and biochemical abnormalities. Potential mechanisms for the development of diabetic cardiomyopathy are complex but are probably associated, in part, with hyperglycemia and hyperlipidemia. Primary hypertension is also associated with the development of myocardial abnormalities. Many of these changes are similar to those seen in diabetic cardiomyopathy. It is now clear that the co-existence of hypertension and diabetes mellitus produces a more severe cardiomyopathy than that produced by hypertension or diabetes alone. Potential mechanisms for interaction are numerous. Treatment of hypertension in diabetic patients must be targeted to more specific needs. Antihypertensive drugs should not worsen cardiac risk factors or glucose control and should have favorable effects on left ventricular function. The calcium antagonists and angiotensin-converting enzyme inhibitors have pharmacologic profiles that make them attractive as monotherapy for diabetic patients.
Giles
T D
TD
Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana 70122.
Sander
G E
GE
D000818:Animals; D009202:Cardiomyopathies / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology / Q000628:therapy