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Combination therapy and target organ protection in hypertension and diabetes mellitus
F H Messerli1, E Grossman, L Michalewicz
1Department of Internal Medicine, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Insights
Essential hypertension and diabetes mellitus significantly damage major organs, particularly the vascular system. Certain medications like ACE inhibitors and calcium antagonists may help prevent or reverse this target organ damage.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Essential hypertension and diabetes mellitus share common target organ damage, primarily affecting the vascular tree.
- Both conditions are established risk factors for atherogenesis, leading to increased coronary artery disease prevalence.
Purpose of the Study:
- To investigate the impact of combined hypertension and diabetes on major target organs.
- To evaluate the efficacy of different antihypertensive medications in managing hypertensive diabetic patients.
Main Methods:
- Comparative analysis of target organ damage in patients with hypertension, diabetes, or both.
- Review of existing literature on the effects of various antihypertensive drug classes on metabolic risk factors in diabetic patients.
Main Results:
- Combined hypertension and diabetes accelerate renal function decline, worsen diabetic retinopathy, and increase risks of cerebral vascular events.
- Diabetic hypertensive hearts exhibit more degenerative changes and hypertrophy than non-diabetic hypertensive hearts.
- Diuretics and beta-blockers may negatively impact metabolic profiles in diabetics, while ACE inhibitors, calcium antagonists, and alpha-blockers show neutral or beneficial effects.
Conclusions:
- Reducing hemodynamic and glycemic burden is crucial for managing hypertensive diabetic patients.
- Combination therapy with a heart rate-lowering calcium antagonist (e.g., verapamil) and an ACE inhibitor shows promise in preventing or reversing target organ damage.
Abstract:
Both essential hypertension and diabetes mellitus affect the same major target organs-the brain, the fundi, the heart, and the kidneys. The common denominator of hypertensive/diabetic target organ disease is the vascular tree. Both hypertension and diabetes are well identified risk factors for atherogenesis. Coronary artery disease is much more common in diabetic hypertensive patients than in patients suffering from hypertension or diabetes alone. Typical for the diabetic hypertensive heart are extensive degenerative changes and a greater degree of hypertrophy compared with the nondiabetic hypertensive heart. The combined presence of hypertension and diabetes concomitantly affects glomerular filtration rate and renal blood flow, thereby greatly accelerating a decrease in renal function. Hypertension accelerates the development of diabetic retinopathy; hypertensive/diabetic cerebral disease leads to vascular dementia, transient ischemic attacks, and strokes. A decrease in the hemodynamic and glycemic burden is the primary goal in the management of the hypertensive diabetic patients. Both diuretics and beta-blockers have been reported to adversely affect the overall risk factor profile in the diabetic patient. In contrast, the postsynaptic alpha-blockers, the calcium antagonists, and the angiotensin-converting enzyme inhibitors have been reported to be either neutral or beneficial with regard to the overall metabolic risk factor profile. The combination of a heart rate lowering calcium antagonist, particularly verapamil, with an ACE inhibitor offers some potential to either prevent or reverse target organ disease associated with hypertension and diabetes.