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Hypertension, Vol 19, 403-418, Copyright © 1992 by American Heart Association
M Epstein and JR Sowers
Diabetes mellitus and hypertension are common diseases that coexist at a
greater frequency than chance alone would predict. Hypertension in the
diabetic individual markedly increases the risk and accelerates the course
of cardiac disease, peripheral vascular disease, stroke, retinopathy, and
nephropathy. Our understanding of the factors that markedly increase the
frequency of hypertension in the diabetic individual remains incomplete.
Diabetic nephropathy is an important factor involved in the development of
hypertension in diabetics, particularly type I patients. However, the
etiology of hypertension in the majority of diabetic patients cannot be
explained by underlying renal disease and remains "essential" in nature.
The hallmark of hypertension in type I and type II diabetics appears to be
increased peripheral vascular resistance. Increased exchangeable sodium may
also play a role in the pathogenesis of blood pressure in diabetics. There
is increasing evidence that insulin resistance/hyperinsulinemia may play a
key role in the pathogenesis of hypertension in both subtle and overt
abnormalities of carbohydrate metabolism. Population studies suggest that
elevated insulin levels, which often occurs in type II diabetes mellitus,
is an independent risk factor for cardiovascular disease. Other
cardiovascular risk factors in diabetic individuals include abnormalities
of lipid metabolism, platelet function, and clotting factors. The goal of
antihypertensive therapy in the patient with coexistent diabetes is to
reduce the inordinate cardiovascular risk as well as lowering blood
pressure.
ARTICLES
Diabetes mellitus and hypertension
Medical Services, Department of Veterans Affairs Medical Center, Miami, FL 33125.
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