Abstract-Cardiovascular diseases (CVDs) are the major causes of mortality in persons with diabetes, and many factors, including hypertension, contribute to this high prevalence of CVD. Hypertension is approximately twice as frequent in patients with diabetes compared with patients without the disease. Conversely, recent data suggest that hypertensive persons are more predisposed to the development of diabetes than are normotensive persons. Furthermore, up to 75% of CVD in diabetes may be attributable to hypertension, leading to recommendations for more aggressive treatment (ie, reducing blood pressure to Ͻ130/85 mm Hg) in persons with coexistent diabetes and hypertension. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and "diabetic cardiomyopathy." The cardiomyopathy associated with diabetes is a unique myopathic state that appears to be independent of macrovascular/ microvascular disease and contributes significantly to CVD morbidity and mortality in diabetic patients, especially those with coexistent hypertension. This update reviews the current knowledge regarding these risk factors and their treatment, with special emphasis on the cardiometabolic syndrome, hypertension, microalbuminuria, and diabetic cardiomyopathy. This update also examines the role of the renin-angiotensin system in the increased risk for CVD in diabetic patients and the impact of interrupting this system on the development of clinical diabetes as well as CVD.
Hypertension in the Diabetic PatientThe subject of diabetes mellitus as a comorbid disease that frequently confounds hypertension, adding significantly to its overall morbidity and mortality, 1,2 will be updated in the present review. Among the complications of diabetes, cardiovascular and renal vascular diseases are among the most costly in terms of human suffering and national healthcare costs. Over the past several years, since the publication of these foregoing reviews, a number of controlled multicenter clinical trials have demonstrated the safety and efficacy of specific antihypertensive therapeutic programs that can significantly alter the outcomes of these cardiovascular and renal complications. The present report summarizes these advances as well as newer fundamental findings that add importantly to our overall knowledge of the cardiovascular complications of diabetes mellitus. In a recent, large, prospective cohort study that included 12 550 adults, the development of type II diabetes was almost 2.5 times as likely in persons with hypertension than in their normotensive counterparts. 3 This, in conjunction with considerable evidence of the increased prevalence of hypertension in diabetic persons, 1,2 suggests that these 2 common chronic diseases frequently coexist. Moreover, each pathophysiological disease entity, although independent in its own natural history, serves to exacerbate the other. 1,2 In a rec...
