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Diabetes mellitus and hypertension
1Division of Endocrinology, Department of Veteran's Affairs Medical Center, Baltimore, MD 21218.
Summary
Hypertension and diabetes mellitus often coexist, with obesity potentially linking them. Newer medications like ACE inhibitors offer better outcomes for managing high blood pressure in diabetic patients, potentially improving kidney function and insulin sensitivity.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Hypertension and diabetes mellitus are prevalent chronic conditions that frequently coexist, affecting millions in the United States.
- Obesity may act as a precipitating factor for both hypertension and non-insulin-dependent diabetes mellitus.
- Insulin-dependent diabetes mellitus patients often develop hypertension with the onset of nephropathy.
Purpose of the Study:
- To review the complex relationship between hypertension and diabetes mellitus.
- To discuss the challenges and strategies in managing hypertension in diabetic patients.
- To evaluate the role of newer antihypertensive agents in this population.
Main Methods:
- Review of existing literature on hypertension and diabetes.
- Discussion of the Working Group on Hypertension in Diabetes's modified stepped-care approach.
- Analysis of the effects of various antihypertensive medications on diabetic complications.
Main Results:
- Hyperinsulinemia, insulin resistance, and glucose intolerance are common in essential hypertension and can be worsened by certain therapies (diuretics, beta-blockers).
- Newer agents like angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers have no adverse effects on carbohydrate metabolism and are better tolerated.
- Antihypertensive therapy, particularly ACE inhibitors, can slow diabetic nephropathy progression, reduce albuminuria, and potentially improve insulin sensitivity.
Conclusions:
- Management of hypertension in diabetes is complex due to associated complications like neuropathy and dyslipidemia.
- Nonpharmacologic measures (weight reduction, sodium restriction) are important, but medication is often necessary.
- ACE inhibitors represent a significant advancement in treating hypertension in diabetic patients, offering benefits for blood pressure control and renal protection, though long-term trials are still needed.