Diabetes and Hypertension: Clinical Update

Abstract

The presence of hypertension in individuals with type 2 diabetes augments the risk for cardiovascular morbidity and mortality. In this regard, data support that management of hypertension in this high-risk population is a critical risk reduction strategy. In recent years, a number of work groups have redefined hypertension, management strategies, and targets. In this context, there is still considerable discussion on an appropriate target for blood pressure in the diabetic population. However, despite this discussion on target blood pressure, it is widely recognized that there is considerable residual risk for heightened cardiovascular events in the hypertensive, diabetic population despite widespread awareness and treatment. There has been increasing interest in management strategies for blood pressure reduction in this high-risk population that complement traditional antihypertensive agents. Large-scale clinical trials have shown that hypoglycemic agents can complement blood pressure reduction and have a favorable effect on cardiovascular outcomes such as the sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. In the diabetic population, consideration should be given to the blood pressure lowering effects of the newer hypoglycemic agents when working toward additional glycemic control in patients with hypertension.

Patient Preferences for Pharmacological Diabetes Treatment Among People with Diabetes in Spain: A Discrete Choice Experiment

“…It is noteworthy that blood pressure reduction was above exclusively glycaemic targets in DM, including hypoglycaemia. High blood pressure (HBP) is one of the main cardiovascular risk factors due to both its high prevalence and its impact [ 35 , 36 ]. The prevalence of HBP in patients with DM is between 1.5 and 2 times higher compared to non-diabetic individuals with the same characteristics [ 37 , 38 ].…”

“…The prevalence of HBP in patients with DM is between 1.5 and 2 times higher compared to non-diabetic individuals with the same characteristics [ 37 , 38 ]. In addition, the coexistence of HBP and DM multiplies the risk of macrovascular disease (cardiac death, ischaemic heart disease, congestive heart failure, and cerebral and peripheral vascular disease) and microvascular disease (retinopathy, nephropathy and neuropathy) [ 35 , 36 ]. This result could support the progressive abandonment from a pure glucocentric view of DM.…”

Single-Pill Combination to Improve Hypertension Treatment: Pharmaceutical Industry Development

“…It is estimated that approximately 50% of DM2 patients also have high blood pressure. It is estimated that diabetes doubles the risk of cardiovascular disease [ 68 , 69 ]. In developed countries, approximately 10% of cardiovascular events are due to diabetes [ 70 ].…”

Dapagliflozin induces vasodilation in resistance-size mesenteric arteries by stimulating smooth muscle cell KV7 ion channels

“…These diabetic-hypertensive patients are considered a high-risk group for developing fatal cardiovascular complications and require special medical attention. There is a growing consensus among clinicians that antidiabetic drugs with inherent vasodilatory action may greatly complement the management of hypertension and related cardiovascular diseases in this population [ 4 ]. In this regard, several members of the new class of sodium-glucose cotransporter 2 (SGLT2) inhibitors such as dapagliflozin, empagliflozin and canagliflozin were found to be promising, as they all lower systemic blood pressure [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ], an effect that is believed to be independent of their glucose lowering action.…”