[Pathogenesis of arterial hypertension in diabetes mellitus]

Area of Science:

• Cardiovascular Medicine
• Endocrinology
• Nephrology

Background:

• Arterial hypertension is a common complication of diabetes mellitus.
• The pathogenesis of hypertension in diabetic patients is complex and multifactorial.
• Understanding the specific hemodynamic and hormonal profiles associated with different hypertension types in diabetes is crucial.

Purpose of the Study:

• To investigate the pathogenesis of arterial hypertension in the context of diabetes mellitus.
• To analyze hemodynamic parameters and the activity of the renin-angiotensin-aldosterone and kallikrein-kinin systems in relation to hypertension subtypes.
• To differentiate the pathophysiological characteristics of essential (EH), atherosclerotic (AH), and nephrogenic (NH) hypertension in diabetic individuals.

Main Methods:

• Measurement of central and peripheral hemodynamic parameters.
• Assay of basal renin levels, angiotensin, aldosterone.
• Evaluation of the kallikrein-kinin system activity.
• Analysis of results stratified by hypertension type (EH, AH, NH).

Main Results:

• Essential hypertension (EH) and atherosclerotic hypertension (AH) in diabetes are characterized by hypokinetic circulation, impaired vascular elasticity, and activation of the renin-angiotensin-aldosterone system (RAAS).
• Hypoactivity of the kallikrein-kinin system (KKS) is also observed in EH and AH.
• Nephrogenic hypertension (NH) exhibits the most significant alterations in peripheral hemodynamics and pronounced hypoactivity of the depressor kallikrein-kinin system.

Conclusions:

• Arterial hypertension in diabetes mellitus is associated with specific hemodynamic and neurohormonal dysregulations.
• EH and AH share common pathophysiological features involving RAAS activation and KKS hypoactivity.
• NH presents with distinct and severe hemodynamic disturbances and a markedly suppressed kallikrein-kinin system, suggesting a significant role in its pathogenesis.