The Goal of Blood Pressure Control for Prevention of Early Diabetic Microvascular Complications

Abstract

Lowering blood pressure may confer a benefit to diabetic microvascular complications comparable with glycemic control. Hypertension is causally related to kidney outcomes and is a risk factor for the development of diabetic retinopathy. The prevalence of hypertension increases as kidney disease progresses, so that it coexists with diabetes in up to 80% of those with overt nephropathy. A significant number of patients have hypertension or rising blood pressures in earlier stages, or even before microvascular complications appear. Because microalbuminuria markedly increases the risk of overt nephropathy as well as of cardiovascular complications, primary prevention (i.e., preventing or delaying the onset of microalbuminuria) continues to be explored, predominantly through use of renin-angiotensin blockade. Available data reviewed suggest that primary prevention through blood pressure reduction is more likely to benefit select groups (those with hypertension, cardiovascular risks, or old age). This review discusses the relationship between hypertension, diabetes, and kidney disease, the rationale for primary prevention, and the data that led to that conclusion.

Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications

“…This may affect the wider applicability of study findings to the normotensive group who have tended to be neglected. Although our study was not designed for establishing a threshold of systolic BP below which the risk of DR no longer decreased [ 33 ], our findings suggest that the extent to which systolic BP levels in T2DM patients without hypertension were associated with the presence of DR were similar to that in those with concurrent hypertension.…”

“…From a multimorbidity perspective, hypertension is approximately twice as common in patients with diabetes compared to those without it [ 33 ]. The association between elevated BP levels and poor microvascular outcomes such as DR is considered unequivocal and independent of other confounding risk factors in diabetic patients, as the evidence indicated an involvement of chronic inflammation and oxidative stress caused by hypertension [ 34 ].…”

Perceptions and practices related to diabetes reported by persons with diabetes attending diabetic care clinics: The India 11-city 9-state study

“…Hypertension is a modifiable risk factor and studies show that reduction of blood pressure reduces the risk of vascular complications in diabetes mellitus. [ 18 19 ] It is thus prudent to encourage good blood pressure control in persons with diabetes so that the risk of complications like retinopathy can be reduced.…”

Diabetic Renal-Retinal Syndrome and Inflammatory Markers of Acute Phase

“…Even glycosylated hemoglobin (HbA 1C ) is an accepted standard on Glycemic Control in diabetic patients, microvascular complications can occur in patients with HbA 1C < 7% [4]. Also, it is showed that high blood pressure has a causal relationship with kidney disease and it is a risk factor for the progression of diabetic retinopathy [5]. In fact, research has been conducted on the relationship of microvascular complications in diabetic patients by using excretion of urinary albumin together with C-reactive protein of high-sensitivity and creatinine among others variables [6].…”