Diabetes, hypertension, and cardiovascular derangements: pathophysiology and management.
Hypertension frequently coexists with diabetes mellitus, occurring twice as frequently in diabetic as in nondiabetic persons. It accounts for up to 75% of added cardiovascular disease (CVD) risk in people with diabetes, contributing significantly to the overall morbidity and mortality in this high-risk population. Patients with hypertension are two times more prone to have diabetes than are normotensive persons. Hypertension substantially increases the risk for coronary heart disease (CHD), stroke, retinopathy, and nephropathy. In patients with type 2 diabetes, hypertension usually clusters with the other components of the cardiometabolic syndrome, such as microalbuminuria, central obesity, insulin resistance, dyslipidemia, hypercoagulation, increased inflammation, and left ventricular hypertrophy (LVH). In type 1 diabetes, hypertension often occurs subsequent to the development of diabetic nephropathy. Hypertension in people with diabetes is characterized by volume expansion, increased salt sensitivity, isolated systolic blood pressure (BP) elevation, loss of the nocturnal dipping of BP and pulse, and increased propensity toward orthostatic hypotension and albuminuria. Among the treatment strategies tested in hypertensive diabetic persons, low-density lipoprotein (LDL)-cholesterol lowering to less than 100 mg/dL and aggressive BP control to less than 130/80 mm Hg have proven effective in CVD risk reduction. The combination of two or more drugs is usually necessary to achieve the target BP.
El-Atat
Fadi
F
Department of Internal Medicine, University of Missouri-Columbia, MA410 Health Science Center, One Hospital Drive, Columbia, MO 65212, USA.
McFarlane
Samy I
SI
Sowers
James R
JR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D003920:Diabetes Mellitus / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006946:Hyperinsulinism / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D006973:Hypertension / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D011945:Receptors, Angiotensin / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D007004:Hypoglycemic Agents; D011945:Receptors, Angiotensin