Blood pressure disturbance in diabetes mellitus

Zanella, Maria Teresa; Freire, Maria-Beatriz S.; Milagres, Rosangela; Ferreira, Sandra Roberta Gouvêa; Bonomo, Pedro-Paulo; Kohlmann, Osvaldo; Ribeiro, Artur Beltrame

doi:10.1097/00004872-199212007-00007

Cited by 7 publications

(8 citation statements)

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“…1,2 In contrast with hypertension in type 1 diabetes, 3 hypertension in type 2 diabetes develops even without renal involvement. The risk of type 2 diabetes and hypertension are strongly related to obesity and central distribution of fat.…”

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confidence: 99%

Treatment of Obesity Hypertension and Diabetes Syndrome

2001

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Abstract-Obesity has been shown to be an independent risk factor for coronary heart disease. The insulin resistance associated with obesity contributes to the development of other cardiovascular risk factors, including dyslipidemia, hypertension, and type 2 diabetes. The coexistence of hypertension and diabetes increases the risk for macrovascular and microvascular complications, thus predisposing patients to cardiac death, congestive heart failure, coronary heart disease, cerebral and peripheral vascular diseases, nephropathy, and retinopathy. Body weight reduction increases insulin sensitivity and improves both blood glucose and blood pressure control. Metformin therapy also improves insulin sensitivity and has been associated with decreases in cardiovascular events in obese diabetic patients. Antihypertensive treatment in diabetics decreases cardiovascular mortality and slows the decline in glomerular function. However, pharmacological treatment should take into account the effects of the antihypertensive agents on insulin sensitivity and lipid profile. Diuretics and ␤-blockers are reported to reduce insulin sensitivity and increase triglyceride levels, whereas calcium channel blockers are metabolically neutral and ACE inhibitors increase insulin sensitivity. For the high-risk hypertensive diabetic patients, ACE inhibition has proven to confer additional renal and vascular protection. Because hypertension and glycemic control are very important determinants of cardiovascular outcome in obese diabetic hypertensive patients, weight reduction, physical exercise, and a combination of antihypertensive and insulin sensitizers agents are strongly recommended to achieve target blood pressure and glucose levels.

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confidence: 99%

Treatment of Obesity Hypertension and Diabetes Syndrome

2001

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“…4,7 On the other hand, nephropathy, the strongest predictor of premature death and cardiovascular diseases in diabetic patients, occurs in only 40% of diabetic patients, even in cases of long diabetes duration. 6 In general, the progression and intensity of retinopathy are related to poor metabolic control, 14,28,33 smoking, 7 systemic pressure levels 4.34 (especially diastolic blood pressure) 35 and genetically determined immunopathic mechanisms. 36 The degree of metabolic control achieved in both groups studied was the same, and it can be considered good because glycosylated hemoglobin levels remained no more than 1.5% above the upper limit for normality (6.2 and 6.8 vs. 5.3%).…”

Section: Discussionmentioning

confidence: 99%

“…40,41 In the classical evolution of nephropathy in type 1 diabetes, the main associated factor is the presence of hypertension, 7,10,35,42,43 as well as the metabolic control. 1,9,34 However, hypertension was associated with nephropathy in the iDM1 group, as expected, but not in the OSAD group.…”

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confidence: 99%

Microangiopathic complications in type 1 diabetes mellitus: differences in severity when isolated or associated with autoimmune polyendocrinopathies

et al. 1998

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Context: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease. Objective: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1). Patients: OSAD (n=17) and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 ± 8.2 and 13.2 ± 5.9 years, respectively) and metabolic control (HbA1c: 6.4 ± 1.9 and 6.8 ± 1.4%). Main Outcome Measures: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. Results: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 ± 2.5 vs. 17.3 ± 9.2 µg/min; p< 0.05). Nephropathy was detected in 12% of the OSAD (none of them macroproteinuric) and in 39% of the iDM1 . The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p< 0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29% of the OSAD and in 46% of the iDM1. Conclusions: OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1 , the increase in UAE of OSAD was not associated with reductions in GFR.Uniterms: Microangiopathy. Type 1 diabetes mellitus. Autoimmune poliendocrinopathies.

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“…Whether 234 Edwards/McHale/Newstead/Ballardie Diabetic Nephropathy: Function Stability developing accelerated hypertension specifically worsens the prognosis of diabetic nephropathy is unknown. There is agreement, however, that regardless of the drugs used, tight control of blood pressure slows down to decline in glomerular filtration rate in diabetic nephropathy [10,11]. Use of enalapril may be associated with complete resolution of proteinuria up to 2 g [12].…”

Section: Discussionmentioning

confidence: 99%

Renal Function Does Not Always Predictably Deteriorate in Blind Insulin-Dependent Diabetics with Nephropathy

Edwards

McHale²,

Newstead³

et al. 1994

Am J Nephrol

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Two insulin-dependent diabetic women with severe retinopathy who were referred for the management of nephrotic syndrome are presented. On the basis of clinical risk factors, such as retinopathy and severe hypertension, both patients were expected to develop progressive end-stage renal failure. One woman has shown a gradual decline in creatinine clearance over 7 years while the plasma creatinine of the other has remained normal for 11 years. The unexpectedly good outcome of both these patients may be related to maintaining a normal blood pressure despite neither patient receiving a prolonged course of an angiotensin-converting enzyme inhibitor. Because of the efficacy of current antihypertensive therapy, the outcome of diabetic nephropathy cannot be so easily predicted and needs to be formally reassessed.

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Blood pressure disturbance in diabetes mellitus

Cited by 7 publications

References 0 publications

Treatment of Obesity Hypertension and Diabetes Syndrome

Treatment of Obesity Hypertension and Diabetes Syndrome

Microangiopathic complications in type 1 diabetes mellitus: differences in severity when isolated or associated with autoimmune polyendocrinopathies

Renal Function Does Not Always Predictably Deteriorate in Blind Insulin-Dependent Diabetics with Nephropathy

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