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Resistant hypertension in diabetes mellitus
George Bayliss1, Larry A Weinrauch, John A D'Elia
1Division of Kidney Diseases and Hypertension, Rhode Island Hospital, APC 9, 593 Eddy St., Providence, RI, 02906, USA, gbayliss@lifespan.org.
Current Diabetes Reports
|June 27, 2014
Summary
Resistant hypertension in diabetic patients leads to poor cardiovascular and renal outcomes. This review explores its definitions, epidemiology, and contributing factors like the sympathetic nervous system, obesity, sleep apnea, and aldosterone.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Resistant hypertension (RH) in diabetes mellitus (DM) is linked to adverse cardiovascular and renal events.
- Understanding RH is crucial for managing diabetic patients with complex hypertension.
Purpose of the Study:
- To review the definitions and epidemiology of RH in diabetic populations.
- To differentiate between apparent RH and true refractory hypertension.
- To explore key pathophysiological mechanisms contributing to RH in diabetes.
Main Methods:
- Literature review focusing on resistant hypertension, diabetes, and related comorbidities.
- Analysis of the role of the sympathetic nervous system, obesity, leptin resistance, obstructive sleep apnea, and aldosterone.
- Brief mention of interventional therapies like renal nerve ablation.
Main Results:
- RH in diabetes is a significant predictor of poor outcomes.
- Sympathetic nervous system overactivity, obesity-related leptin resistance, obstructive sleep apnea, and aldosterone excess are implicated in RH.
- Distinguishing true RH from pseudoresistance is clinically important.
Conclusions:
- RH in diabetes is multifactorial, involving neurohormonal and sleep-related factors.
- Targeting these mechanisms may improve blood pressure control and patient outcomes.
- Renal nerve ablation is a potential therapeutic option.
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