Treatment of diabetic hypertension

Abstract

Insulin resistance and hyperglycaemia combine to make hypertension more prevalent in the type 2 diabetic patient. Blood pressure goals below those for the non-diabetic subject have been shown to be more effective in lowering mortality and cardiovascular events in the diabetic patient. To achieve these goals in most cases, three to five antihypertensives from different therapeutic groups need to be utilized. Suppression of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors, angiotensin 2 receptor blockers or a renin inhibitor should be the primary therapy. A second goal should be suppression of the sympathetic nervous system utilizing a beta-blocker that does not increase insulin resistance. The addition of a diuretic, calcium channel blocker or a vasodilator to suppressors of the RAS and sympathetic nervous system aid in achieving hypertensive goals in the diabetic patient. Achieving hypertensive goals with suppression of the RAS and sympathetic nervous system should result in a decrease in mortality and cardiovascular events in the diabetic hypertensive patient. In this review article, the benefits and disadvantages of the different antihypertensive therapies in the diabetic patient are discussed.

Factors Associated With Hypertension Prevalence and Control Among Lebanese Type 2 Diabetic Patients

“…For example, in a study conducted between 2005 and 2006 in 26 countries, the overall BP control rate was 33.6% in men and 30.6% in women and was lower in diabetic as compared to non-diabetic patients [23]. Another study carried out in the United States by Grant et al also reported similar prevalence of BP control (33%) [24].…”

Efficacy and safety of triple-combination therapy with olmesartan, amlodipine, and hydrochlorothiazide in study participants with hypertension and diabetes: a subpopulation analysis of the TRINITY study

“…[23][24][25][26] Initiation or addition of an antihypertensive agent with a different pharmacologic action can result in SBP reductions of 10 to 15 mm Hg. 27 Multiple antihypertensive drugs with different and complementary pharmacologic actions can be used to successfully treat hypertension in patients with diabetes. 27 Additionally, fixed-dose combinations may increase compliance compared with freedose combinations through simplification of treatment regimens.…”

“…27 Multiple antihypertensive drugs with different and complementary pharmacologic actions can be used to successfully treat hypertension in patients with diabetes. 27 Additionally, fixed-dose combinations may increase compliance compared with freedose combinations through simplification of treatment regimens. Two meta-analyses demonstrated that fixed-dose combination therapy for hypertension increased compliance; in one meta-analysis, compliance was increased by 29%, 28 and in another, the risk of noncompliance was decreased by 24%.…”

Opposing Effects of Particle Pollution, Ozone, and Ambient Temperature on Arterial Blood Pressure

“…Further lowering of BP in these circumstances could lead to adverse events. Patients with diabetes tend to have depressed heart rate variability and autonomic dysfunction and frequently are already taking beta blockers (Bell 2009). Particularly if their glucose levels are not well controlled, they also may become fluid depleted and hypovolemic during periods of concurrent high temperature and high ozone concentrations.…”

“…Diabetes itself increases the risk of hypertension and orthostatic hypotension because of chronic autonomic dysregulation, endothelial dysfunction, atherosclerosis, and dysregulation of fluid balance and the renin-angiotensin system (Pop-Busui 2010; Ribeiro-Oliveira et al 2008). Common medications, such as beta blockers, may further block appropriate compensatory autoregulatory vascular responses (Bell 2009). We have shown that elevated PM pollution exposure adds to autonomic dysregulation, endothelial dysfunction (O’Neill et al 2005), and inflammation (Dubowsky et al 2006), particularly in persons with diabetes.…”