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Clinical features and therapeutic perspectives on hypertension in diabetics
Shigehiro Katayama1, Masako Hatano2, Masashi Issiki2
1Kawagoe Clinic, Saitama Medical University, Saitama, Japan. skataya@saitama-med.ac.jp.
Insights
Over half of diabetes patients develop hypertension, increasing cardiovascular disease and kidney disease risks. New diabetes drugs offer blood pressure benefits but require careful use to avoid hypoglycemia and manage nocturnal hypertension.
Area of Science:
- Endocrinology
- Nephrology
- Cardiology
Background:
- Diabetes mellitus (Type 1 and 2) frequently leads to hypertension, significantly increasing risks of cardiovascular disease (CVD) and diabetic nephropathy.
- Arteriosclerosis is a common, early complication in diabetic hypertension, necessitating assessment for effective treatment strategies.
Purpose of the Study:
- To review the management of hypertension in diabetic patients, focusing on the impact of arteriosclerosis and the role of newer antihypertensive agents.
- To highlight the cardiovascular and nephroprotective benefits of SGLT2 inhibitors and GLP-1 receptor agonists in this patient population.
Main Methods:
- Literature review of studies on diabetes, hypertension, arteriosclerosis, and cardiovascular/renal outcomes.
- Analysis of pharmacological properties of antihypertensive agents, particularly newer classes like SGLT2 inhibitors and GLP-1 receptor agonists.
- Consideration of patient-specific factors including age, blood glucose control, and risk of hypoglycemia.
Main Results:
- Over 50% of diabetic patients develop hypertension, exacerbating CVD and nephropathy.
- SGLT2 inhibitors and GLP-1 receptor agonists show promise in suppressing CVD and diabetic nephropathy progression, alongside glucose-lowering effects.
- Careful selection of antihypertensive agents is crucial to avoid worsening insulin resistance and manage diurnal blood pressure variations, especially in an aging population.
Conclusions:
- Effective management of hypertension in diabetes requires a holistic approach, balancing blood glucose control with blood pressure reduction.
- Newer agents like SGLT2 inhibitors and GLP-1 receptor agonists offer dual benefits for glucose and cardiovascular/renal health in diabetic hypertension.
- Lifelong, integrated management of blood pressure and glucose is essential for improving long-term outcomes in patients with coexisting diabetes and hypertension.
Abstract:
Over 50% of patients with diabetes mellitus, either type 1 or 2, ultimately develop hypertension as a complication. In diabetics, this further increases the incidence of cardiovascular disease (CVD) by 2- to 3-fold and accelerates the progression of diabetic nephropathy. Arteriosclerosis, a clinical feature of hypertension in diabetics, develops and advances from a young age. Therefore, in providing treatment, it is necessary to evaluate the degree of arteriosclerosis. Diabetic patients are encouraged to strictly control their blood glucose levels. Recently developed drugs, such as GLP-1 receptor agonists, DPP-4 inhibitors and SGLT2 inhibitors, also have hypotensive actions, making them ideal for use in diabetics with hypertension. SGLT2 inhibitors and GLP-1 receptor agonists reportedly suppress the onset and progression of CVD, as well as diabetic nephropathy. The possibility of hypoglycemia triggering blood pressure elevation and arrhythmia has been noted, so a key point here is not to cause hypoglycemia. In selecting hypotensive agents, we must choose types that do not aggravate insulin resistance and engage in hypotensive treatment that also considers both nocturnal and morning hypertension. In addition, facing the onset of an aging society, there is a growing need for treatments that do not cause excessive blood pressure reduction or hypoglycemia. Favorable lifelong blood pressure and glucose control are increasingly important for the treatment of diabetes accompanied by hypertension.
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