Comorbidities of Diabetes and Hypertension: Mechanisms and Approach to Target Organ Protection
Open Access
- 5 April 2011
- journal article
- review article
- Published by Wiley in The Journal of Clinical Hypertension
- Vol. 13 (4), 244-251
- https://doi.org/10.1111/j.1751-7176.2011.00434.x
Abstract
Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance. Thus, hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications. These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease. Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy. The familial predisposition to diabetes and hypertension appears to be polygenic in origin, which militates against the feasibility of a “gene therapy” approach to the control or prevention of these conditions. On the other hand, the shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for nonpharmacologic intervention. Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification. Interestingly, lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders. In addition to lifestyle modification, most patients will require specific medications to achieve national treatment goals for hypertension and diabetes. Management of hyperglycemia, hypertension, dyslipidemia, and the underlying hypercoagulable and proinflammatory states requires the use of multiple medications in combination. J Clin Hypertens (Greenwich). 2011;13:244–251.Keywords
This publication has 70 references indexed in Scilit:
- Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trialsThe Lancet, 2009
- Glucose Control and Vascular Complications in Veterans with Type 2 DiabetesThe New England Journal of Medicine, 2009
- Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive ProteinThe New England Journal of Medicine, 2008
- 10-Year Follow-up of Intensive Glucose Control in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Insulin Therapy, Hyperglycemia, and Hypertension in Type 1 Diabetes MellitusJAMA Internal Medicine, 2008
- Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 DiabetesThe New England Journal of Medicine, 2008
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Effect of a Multifactorial Intervention on Mortality in Type 2 DiabetesThe New England Journal of Medicine, 2008
- High-Density Lipoprotein as a Therapeutic TargetJama-Journal Of The American Medical Association, 2007
- Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS 64)Kidney International, 2003