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[Modern principles of therapy of hypertension in diabetic patients]
1Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Institut za interne bolesti, Medicinski fakultet, Novi Sad.
Insights
Arterial hypertension is a common complication in diabetes. Effective management involves lifestyle changes and specific antihypertensive drugs like ACE inhibitors and calcium channel blockers, which are preferred for their efficacy and safety.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Context:
- Arterial hypertension is a frequent cardiovascular complication in patients with diabetes mellitus.
- Diabetes mellitus type-1 (30% of cases) is linked to diabetic nephropathy.
- Diabetes mellitus type-2 (70% of cases) is associated with accelerated atherosclerosis.
Purpose:
- To outline the specific therapeutic approaches for arterial hypertension in diabetic patients.
- To discuss the role of lifestyle modifications and pharmacotherapy in managing hypertension in diabetes.
Summary:
- Therapy for arterial hypertension in diabetics is tailored to the type of diabetes and co-existing complications.
- Non-pharmacological interventions include weight reduction, and restrictions in sodium chloride, protein, and alcohol intake, alongside smoking cessation.
- Pharmacological treatment involves various antihypertensive agents, with angiotensin-converting enzyme inhibitors and calcium channel antagonists being the most preferred due to their effectiveness and favorable side-effect profiles.
Impact:
- Highlights the importance of individualized treatment strategies for hypertension in diabetic populations.
- Emphasizes the selection of antihypertensive medications with minimal adverse metabolic and systemic effects.
- Provides guidance on managing a critical comorbidity in diabetes, potentially improving cardiovascular and renal outcomes.
Abstract:
Arterial hypertension is the most frequent cardiovascular complication of diabetes mellitus. Diabetes mellitus-type-1 occurs in about 30% of patients and it is connected to development of diabetic nephropathy, while type-2 occurs in as much as 70% of cases, having fast atherosclerosis as a base in its etiopathogenesis. The therapy of arterial hypertension in diabetic patients is specific and in some ways different depending on the type of diabetes mellitus as well as other complications characteristic for diabetes. Apart from drug therapy, it includes: body weight reduction in obese patients, restriction of sodium chloride, proteins and alcohol drinking, as well as other risk factors (smoking, for example). Drug therapy means application of different groups of antihypertensive agents (selective beta-blockers, diuretics, angiotensin-converting enzyme inhibitors, calcium channel antagonists and postsynaptic alpha-1 blockers). Some of them have adverse effects on metabolism of lipids, while some have other adverse effects which must be taken into account when determining therapy. However, angiotensin-converting enzyme inhibitors and calcium channel antagonists are the most preferred today as the most effective and with least adverse effects.