Changes in Blood Pressure, Body Fluids, Circulating Angiotensin II and Aldosterone, with Improved Diabetic Control

Abstract

1.We studied 12 normotensive non-ketotic diabetic patients during poor metabolic control, with sustained hyperglycaemia, and again, after an interval of 3 weeks, when metabolic control was improved. On each occasion we measured blood pressure, total exchangeable sodium, plasma volume, transcapillary escape rate of albumin, and plasma concentrations of angiotensin 11 and aldosterone.2. With improved diabetic control there was a small but significant fall in arterial pressure. Total exchangeable sodium was normal when control was poor but rose significantly to above normal with improved control.3. Plasma volume also rose significantly with improved control, and the transcapillary escape rate of albumin fell and the intravascular mass of albumin rose. 4. Plasma angiotensin I1 and aldosterone concentrations were significantly above normal during poor metabolic control, but fell to normal with improved control. 5. These findings indicate a resetting of the relationship between blood pressure and exchangeable sodium when diabetic control improves. The association between exchangeable sodium and concentrations of angiotensin I1 and aldosterone also appears altered in diabetic patients. These changes associated with varying metabolic control must be considered when studying cardiovascular disease in diabetic patients.

Preventing end stage renal disease in diabetic patients — genetic aspect (part I)

“…51,56 However, several studies focussing on changes in systemic RAS components during different degrees of hyperglycaemia in early diabetes demonstrated an activating effect of glucose. 49,59 In agreement, elevation of ACE has been demonstrated in diabetic patients, 60 with a further increase seen in patients with complications. [60][61][62] The functional significance of the increase in circulating RAS components, in addition to the direct effect of hyperglycaemia, on systemic haemodynamic parameters is poorly understood.…”

“…Evidence supporting this theory came from population-based studies of non-diabetic children 63 and diabetic and non-diabetic adults, 64 demonstrating a direct association between blood glucose level and arterial blood pressure. Some glycaemic intervention studies have shown an increase in systemic blood pressure after days/weeks of hyperglycaemia, 59,65 whereas this was not demonstrated by others. 66 A study in early Type 2 diabetes showed dramatic increases in blood pressure in response to two hours of hyperglycaemia, but the study was performed without an euglycaemic control period.…”

Blood pressure in children, adolescents and young adults with Type 1 (insulin-dependent) diabetes

“…Others have shown that improving 279 diabetic control reduces BP slightly [22][23], though this effect was greater on SBP [23]. Alternative possibilities include transient hypoglycaemia causing hypertension by catecholamine release, but hypoglycaemia was only present in one patient (Table 4) and could not affect the data for the whole population.…”

Improvement in Hypertension in Patients With Diabetes Mellitus After Kidney/Pancreas Transplantation

“…Several studies have reported significant reductions in blood pressure after improvement in metabolic control in diabetics. 20,21 Aoki et al 22 observed a 46% reduction in antihypertensive medication dosages required to maintain baseline blood pressure in type 1 diabetics with nephropathy who were randomly assigned to 3 months of chronic, intermittent intravenous insulin in addition to maintenance subcutaneous insulin.…”