Treatment of hypertension in diabetes: a contemporary approach with a focus on improving cardiovascular outcomes

Khangura, Darshan; Kurukulasuriya, L. Romayne; Sowers, James R.

doi:10.1586/17446651.2016.1130620

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…Although it was initially illustrated that among all antidiabetic medications with effect on hypertension (DPP4 inhibitors, GLP-1RAs, and SGLT2-i), the most significant decrease was observed in patients treated with GLP-1 RAs [ 71 ], a recent meta-analysis indicated that SGLT2-i have a more considerable effect [ 72 ].…”

Section: Current Antidiabetic Drugs and The Influence Of Hypertensionmentioning

confidence: 99%

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

et al. 2023

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Hypertension poses a significant burden in the general population, being responsible for increasing cardiovascular morbidity and mortality, leading to adverse outcomes. Moreover, the association of hypertension with dyslipidaemia, obesity, and insulin resistance, also known as metabolic syndrome, further increases the overall cardiovascular risk of an individual. The complex pathophysiological overlap between the components of the metabolic syndrome may in part explain how novel antidiabetic drugs express pleiotropic effects. Taking into consideration that a significant proportion of patients do not achieve target blood pressure values or glucose levels, more efforts need to be undertaken to increase awareness among patients and physicians. Novel drugs, such as incretin-based therapies and renal glucose reuptake inhibitors, show promising results in decreasing cardiovascular events in patients with metabolic syndrome. The effects of sodium-glucose co-transporter-2 inhibitors are expressed at different levels, including renoprotection through glucosuria, natriuresis and decreased intraglomerular pressure, metabolic effects such as enhanced insulin sensitivity, cardiac protection through decreased myocardial oxidative stress and, to a lesser extent, decreased blood pressure values. These pleiotropic effects are also observed after treatment with glucagon-like peptide-1 receptor agonists, positively influencing the cardiovascular outcomes of patients with metabolic syndrome. The initial combination of the two classes may be the best choice in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors because of their complementary mechanisms of action. In addition, the novel mineralocorticoid receptor antagonists show significant cardio-renal benefits, as well as anti-inflammatory and anti-fibrotic effects. Overall, the key to better control of hypertension in patients with metabolic syndrome is to consider targeting multiple pathogenic mechanisms, using a combination of the different therapeutic agents, as well as drastic lifestyle changes. This article will briefly summarize the association of hypertension with metabolic syndrome, as well as take into account the influence of antidiabetic drugs on blood pressure control.

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Section: Current Antidiabetic Drugs and The Influence Of Hypertensionmentioning

confidence: 99%

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

et al. 2023

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“…According to a research conducted, the prevalence of obstructive sleep apnea has been estimated to be more than two-thirds of patients with resistant hypertension 35 . Also, diabetes mellitus have been grately associated with resistant hypertension [36][37][38] .…”

Section: Resistant Hypertension Comorbiditiesmentioning

confidence: 99%

“…Uncommon secondary causes include Cushing's disease, intracranial tumour, pheochromocytoma, hyperparathyroidism and aortic coarctation. Diabetes is also a secondary cause of resistant hypertension 36,37 .…”

Section: Secondary Causesmentioning

confidence: 99%

Resistant hypertension

Moke

Ekuerhare

Enaohwo

et al. 2022

J. Drug Delivery Ther.

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Background: Resistant hypertension is a common medical challenge facing clinicians and specialists. Although, the prevalence is currently unknown but various clinical trials have suggested that this problem is not rare. Resistant hypertension is blood pressure that remains above goal despite the use of at least three antihypertensive agents including a diuretic. It is a subtype of hypertension that increases the risk of cardiovascular, cerebrovascular and kidney disease. However, it is important to distinguish between pseudo-resistant hypertension and apparent hypertension from true resistant hypertension as they are often misdiagnosed. Objectives: This review focuses on resistant hypertension, its pathophysiology and established therapy. Methodology: Relevant articles used for this review covered a period of 2008-2022 using search engines and databases including PubMed, Scopus, Web of Science, and Google Scholar. Main observation: Evaluation of patients with true resistant hypertension includes appropriate blood pressure measurement, screening for causes of secondary hypertension and screening for interfering medications. Management of resistant hypertension that has proved successful includes non-pharmacological approach like lifestyle modification and optimization of pharmacological agents, often including the use of mineralocorticoid receptor antagonist. Conclusion: Considering the future management of resistant hypertension, a bunch of new device-based therapies are under effective development. Of these, renal denervation and carotid baroreflex activation are two potential devices for the significant reduction of blood pressure. However, further study is necessary before these devices can be approved for the routine treatment of resistant hypertension. Keywords: Aldosterone; Cardiovascular disease; Resistant Hypertension; Therapy.

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Diabetes and Hypertension: Clinical Update

Khangura

Kurukulasuriya

Whaley‐Connell

et al. 2018

American Journal of Hypertension

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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.

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Treatment of hypertension in diabetes: a contemporary approach with a focus on improving cardiovascular outcomes

Cited by 4 publications

References 39 publications

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

Resistant hypertension

Diabetes and Hypertension: Clinical Update

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