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Diabetic hypertensive patients. Is this a group in need of particular care and attention?
1Steno Diabetes Center, Gentofte, Denmark.
Insights
Managing hypertension in diabetes is crucial for preventing vascular complications. Effective blood pressure control significantly reduces cardiovascular disease and mortality, delaying kidney failure and improving survival in diabetic patients.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Diabetes mellitus leads to significant morbidity and mortality primarily through microvascular and macrovascular complications.
- Diabetic nephropathy and retinopathy are key indicators of microangiopathy, potentially causing end-stage renal failure and blindness.
- Cardiovascular complications in diabetes include accelerated atherosclerosis and a high prevalence of systemic hypertension, including nocturnal and capillary hypertension.
Purpose of the Study:
- To investigate the impact of hypertension on vascular complications in diabetes.
- To evaluate the effectiveness of antihypertensive treatment in reducing cardiovascular events and mortality in diabetic patients.
- To assess the role of blood pressure management in preventing diabetic nephropathy progression and improving survival.
Main Methods:
- Analysis of prospective observational studies identifying risk factors for mortality in type 1 and type 2 diabetes.
- Review of a randomized, double-blind, parallel study on antihypertensive treatment efficacy.
- Examination of data on the effects of blood pressure reduction on albuminuria and nephropathy progression.
Main Results:
- Abnormal urinary albumin excretion, hypertension, smoking, poor metabolic control, and social class predict increased all-cause and cardiovascular mortality.
- Antihypertensive treatment in diabetic patients lowered the 5-year major cardiovascular disease rate by 34% compared to placebo.
- Effective blood pressure reduction, particularly with ACE inhibitors and diuretics, reduces albuminuria, delays nephropathy, and improves survival.
Conclusions:
- Arterial hypertension is a critical risk factor for both micro- and macrovascular complications in diabetes.
- Diabetes, hypertension, and smoking are major contributors to stroke risk.
- Aggressive blood pressure management is essential for improving outcomes and survival in diabetic patients, especially those with nephropathy.
Abstract:
Morbidity and mortality in diabetes are caused mainly by its vascular complications, both in the microcirculation and in the large vessels. Diabetic nephropathy and retinopathy are the clinical hallmarks of microangiopathy, which may lead to end-stage renal failure and blindness. The cardiovascular complications in diabetes consist mainly of an accelerated form of atherosclerosis. Systemic hypertension is an early and frequent phenomenon. Nocturnal hypertension is also more frequent in people with diabetes compared with the nondiabetic population. Capillary hypertension has been demonstrated in type 1 diabetic patients. Poor metabolic control may induce elevation in blood pressure, but data are conflicting. The prevalence of white-coat hypertension in the diabetic population is comparable with that in the nondiabetic population. Prospective observational studies in type 1 and type 2 patients have revealed that abnormally increased urinary albumin excretion and other potentially modifiable risk factors--such as hypertension, smoking, poor metabolic control, and social class--predict increased all-cause mortality and cardiovascular mortality. Arterial hypertension is a risk factor in the initiation and progression of diabetic micro- and macroangiopathy. Diabetes, hypertension, and smoking are the three most important risk factors for fatal and nonfatal stroke. A randomized, double-blind, parallel study has revealed that the 5-year major cardiovascular disease rate was lowered by 34% for antihypertensive treatment compared with placebo. Furthermore, the study found a trend for lower all-cause mortality for low-dose antihypertensive-treated diabetic patients. Effective blood pressure reduction with ACE inhibitors and/or non-ACE inhibitors, frequently in combination with diuretics, reduces albuminuria, delays the progression of nephropathy, postpones end-stage renal failure, and improves survival in diabetic nephropathy.