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Diabetes, hypertension, and cardiovascular disease: an update
J R Sowers1, M Epstein, E D Frohlich
1SUNY Downstate Medical Center and VAMC, Brooklyn, NY, USA. jsowers@netmail.hscbklyn.edu
Insights
Hypertension significantly increases cardiovascular disease (CVD) risk in diabetes patients, necessitating aggressive blood pressure management. Diabetic cardiomyopathy also independently contributes to CVD mortality.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Cardiovascular diseases (CVDs) are the leading cause of mortality in individuals with diabetes.
- Hypertension is highly prevalent in diabetic patients and is a major contributor to CVD.
- Diabetic cardiomyopathy is a distinct cardiac condition contributing to CVD in this population.
Purpose of the Study:
- To review current knowledge on CVD risk factors in patients with diabetes and hypertension.
- To emphasize the role of hypertension, microalbuminuria, and diabetic cardiomyopathy.
- To examine the renin-angiotensin system's impact on CVD and diabetes development.
Main Methods:
- Review of current literature on cardiovascular risk factors in diabetes.
- Emphasis on hypertension management, microalbuminuria, and diabetic cardiomyopathy.
- Analysis of the renin-angiotensin system's role and therapeutic interventions.
Main Results:
- Hypertension is approximately twice as common in diabetes and accounts for up to 75% of CVD in these patients.
- Aggressive blood pressure control (<130/85 mm Hg) is recommended for patients with diabetes and hypertension.
- Obesity, dyslipidemia, microalbuminuria, endothelial dysfunction, and diabetic cardiomyopathy are significant CVD risk factors.
Conclusions:
- Effective management of hypertension and other risk factors is crucial for reducing CVD in diabetic patients.
- Diabetic cardiomyopathy is an independent risk factor for CVD morbidity and mortality.
- Targeting the renin-angiotensin system may offer benefits in preventing both clinical diabetes and CVD.
Abstract:
Cardiovascular diseases (CVDs) are the major causes of mortality in persons with diabetes, and many factors, including hypertension, contribute to this high prevalence of CVD. Hypertension is approximately twice as frequent in patients with diabetes compared with patients without the disease. Conversely, recent data suggest that hypertensive persons are more predisposed to the development of diabetes than are normotensive persons. Furthermore, up to 75% of CVD in diabetes may be attributable to hypertension, leading to recommendations for more aggressive treatment (ie, reducing blood pressure to <130/85 mm Hg) in persons with coexistent diabetes and hypertension. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and "diabetic cardiomyopathy." The cardiomyopathy associated with diabetes is a unique myopathic state that appears to be independent of macrovascular/microvascular disease and contributes significantly to CVD morbidity and mortality in diabetic patients, especially those with coexistent hypertension. This update reviews the current knowledge regarding these risk factors and their treatment, with special emphasis on the cardiometabolic syndrome, hypertension, microalbuminuria, and diabetic cardiomyopathy. This update also examines the role of the renin-angiotensin system in the increased risk for CVD in diabetic patients and the impact of interrupting this system on the development of clinical diabetes as well as CVD.