Arterial Hypertension in Diabetes: Etiology and Treatment

Abstract

Hypertension is highly prevalent among people with diabetes, especially those with type 2 diabetes. While the genesis of hypertension in diabetes is multifactorial, it is clear that early dysfunction of the vasculature, related, in part, to abnormalities in modulation of vascular tone by nitric oxide, heralds development of hypertension in such individuals. Presence of hypertension substantially increases the risk of adverse outcomes with regard to both the CV and renal systems. Once nephropathy becomes manifest, i.e. elevation in serum creatinine and macroalbuminuria, lowering of blood pressure to the recommended guideline goals slows kidney disease progression and reduces CV risk to a greater extent than does glucose control. Based on recent guidelines if systolic blood pressure is >15–20 mmHg above the goal, two drugs should be started, one of which should to be a diuretic. Clearly, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers have also demonstrated benefits in these patients when used in concert with diuretics. The positive outcomes with diuretics relates clearly to their ability to lower blood pressure, especially in volume‐expanded individuals, which is true of virtually all people with diabetes because of the effects of insulin on proximal tubular sodium reabsorption.

Control of type 2 diabetes in King Abdulaziz Housing City (Iskan) population, Saudi Arabia

“…[ 20 ] Lower BP targets (<130/80) are desired for diabetics with nephropathy and if tolerated, by younger diabetics. [ 1 24 25 ]…”