Naslov
DIABETES MELLITUS AND ARTERIAL HYPERTENSION

Autori
Suresh Reddy, V.V. ; Duvnjak, L ; Metelko, Ž

Izvornik
Diabetologia Croatica (0351-0042) 29 (2000), 3; 121-132

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, pregledni rad, stručni

Ključne riječi
diabetes mellitus; arterial hypertension

Sažetak
In western societies, established hypertension according to World Health Organization criteria is found in 10%-30% of patients with type 1 and in 30%-50% of patients with type 2 diabetes mellitus. The presence of hypertension in both groups of patients markedly enhances the development of macrovascular and microvascular disease. In type 1 diabetes mellitus, hypertension appears to be very closely associated with diabetic nephropathy and tends to be a relatively late finding, while in type 2 diabetes mellitus it is dominantly essential and occurs before the onset of overt nephropathy. Different factors contribute to the pathogenesis of hypertension in diabetic patients: obesity, hyperinsulinism, sodium retention, inappropriate suppression of the renin-angiotensin-aldosterone system, increased cardiovascular reactivity to catecholamines and angiotensin II, and increased resistance of the arteriolar system. The close association between diabetic nephropathy and hypertension in type 1 diabetes mellitus may be partially explained by susceptibility to both hypertension and nephropathy, conferred to genetic factors, manifested by increased sodium-lithium countertransport activity in red blood cells, family history of hypertension, and insertion/deletion of angiotensin converting enzyme gene polymorphism. The introduction of ambulatory blood pressure measurement in clinical practice, representing a simple, noninvasive and precise method for measuring blood pressure during patient usual activities, has allowed sophisticated investigation of some problems like the effects of smoking in diabetics, the loss of well established lower blood pressure in diabetic compared to healthy women, and the significance of blunted nocturnal blood pressure decrease in diabetic patients. The goal of therapy should be not only to reduce morbidity and mortality but also to avoid adverse effects on the functional wellbeing of the patients. The choice of drug treatment will depend on the type of diabetes and etiology of hypertension, e.g., nephropathic versus essential hypertension, and response to nonpharmacological measures, which is particularly relevant for patients with mild hypertension and type 2 diabetes. First line drugs include diuretics, beta adrenergic blockers, calcium channel blockers and angiotensin converting enzyme inhibitors, while second line drugs consist of alpha 1 receptor blockers, central adrenergic inhibitors and vasodilators.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA