The Dual Disease Burden of Hypertension and Diabetes

Abstract

Hypertension and diabetes are among the most common non-communicable diseases worldwide with a global prevalence of 22% and 9%, respectively. In Singapore, the prevalence of both diseases is higher at 23.5% and 11.3%, respectively, and similar trends are evident in much of Asia. There is an even higher prevalence of hypertension among diabetics, likely contributed to by inappropriate activation of the renin-angiotensin-aldosterone system (RAAS), altered sodium transport, a complex interaction of hyperinsulinemia and insulin resistance with obesity, RAAS, arterial baroreceptor reflex impairment, leading to an activated sympathetic nervous system, and the coexistence of kidney damage accelerated by hypertension. While angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers remain the mainstay of treatment for the comorbidities of hypertension and diabetes, various guidelines are inconsistent with blood pressure thresholds and treatment goals. Shared lifestyle factors in the etiology of hypertension and diabetes do provide further opportunities for non-pharmacologic intervention. Taken together, strategies that incorporate early diagnosis of diabetes and hypertension and its complications, disease self-management and education, and optimal medical and lifestyle management will reduce the burden of complications from these dual conditions.