Hypertension and Diabetes Mellitus
The Chicken and Egg Problem
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See related article, pp 879–891
According to the Centers for Disease Control and Prevention, 29 million Americans had diabetes mellitus and 86 million adults were prediabetic in 2014. If the current trend continues, it is predicted that 1 in 3 US adults could have diabetes mellitus by 2050. Hypertension often affects people with type 2 diabetes mellitus and the combination of diabetes mellitus and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease.1,2
In this issue of the Hypertension, Wang et al3 explored interactions of hypertension and diabetes mellitus, and their contribution to kidney injury. This study is highly significant from both conceptual and technical perspectives. Most of the available animal models for studies of diabetes mellitus have other cardiovascular complications. Typically, these animals, as is the case in the human condition, exhibit increased blood pressure (BP) and diabetes mellitus in the same model, which makes it impossible to determine whether the renal injury is a consequence of hyperglycemia or is more determined by the elevation of renal perfusion pressure in the hypertensive state. The authors developed a novel experimental model, which allowed them to study the mechanisms of kidney injury in diabetes mellitus under the condition of normal and elevated BP. Hypertension to 1 kidney was induced either in diabetic Goto-Kakizaki (GK) or control Wistar rat by aorta constriction (AC) between the renal arteries. Therefore, both kidneys were exposed to the same levels of hyperglycemia, circulating hormones, neural activity, and other factors but the right kidney above the AC was exposed to elevated BP compared with the left kidney below the AC.
Using this approach, the authors compared the kidney …