title: Hypertension and diabetes: a toxic combination.
abstract: OBJECTIVE
  To assess the relationship of diabetes and hypertension and the effect on cardiovascular outcomes.
  
  
  METHODS
  A review of the English-language literature regarding the effects of diabetes and hypertension published between January 1, 1980, and April 30, 2008, was performed.
  
  
  RESULTS
  In type 2 diabetes, the prevalence of hypertension due to both hyperglycemia and insulin resistance is increased. High insulin levels are associated with left ventricular hypertrophy and decreased ventricular function. The growth factor effects of insulin on the myocardium are worsened by hypertension. The diabetic hypertensive patient is exquisitely sensitive to blood pressure lowering as it relates to cardiac events and mortality. Because of this, the blood pressure goals for diabetic hypertensive patients are lower than those for their nondiabetic hypertensive peers. Cardiac events have a stronger association with systolic hypertension and the pulse pressure than with diastolic hypertension. The presence of microalbuminuria not only signifies a higher risk of developing diabetic nephropathy, but also increased mortality and incidence of cardiovascular events. Thus, when microalbuminuria is detected, intensification of hypertensive therapies, especially suppression of the renin-angiotensin-aldosterone system, is essential.
  
  
  CONCLUSIONS
  The effects of hypertension in persons with diabetes increase the frequency and severity of cardiac events, especially when microalbuminuria is present.
authors.affiliation: University of Alabama Medical School, Birmingham, AL 35205, USA. dshbell@yahoo.com
authors.forename: David S H
authors.initials: DS
authors.lastname: Bell
mesh_terms: D000419:Albuminuria / Q000150:complications; D002318:Cardiovascular Diseases / Q000209:etiology*; D048909:Diabetes Complications; D006801:Humans; D006973:Hypertension / Q000150:complications*