Type diabetes and hypertension

The prevalence of hypertension in the diabetic population is 1.5 to 3 times higher than that of the non-diabetic age-matched population (Wingard, 1995). In type 2 diabetes, hypertension may be present at the time of the diagnosis or precedes the development of hyperglycaemia (HDS, 1993) and is implicated in development of both micro- and macrovascular complications. Epidemio-logical studies indicate that diabetic individuals with hypertension have greatly increased risks of cardiovascular disease, renal inefficiency and retinopathy. In UKPDS, every 10-mm rise in systolic blood pressure was associated with a 15 per cent increase in risk of coronary artery disease. Both systolic and dias-tolic hypertension markedly accentuate the progression of diabetic nephropathy and aggressive antihypertensive management will decrease the rate of fall of glomerular filtration rate (UKPDS, 1998).

Hypertension is also implicated as a risk factor for diabetic retinopathy resulting in increasing hard exudate, hemorrhage and progression of diabetic retinopathy. Studies in the diabetic population have shown a markedly higher frequency of progression of diabetic retinopathy when diastolic blood pressure is in excess of 70 mm (Janka et al., 1989).

The pathophysiology of hypertension in diabetes is postulated to be related to hyperinsulinaemia. (for mechanisms, see Obesity and hypertension) (De Fronzo et al., 1975; Moan et al., 1995; Reaven et al., 1996). Apart from the functional changes, diabetes can cause arterial wall structural changes. This may be due to non-enzymatic glycation of proteins including collagen and other matrix proteins to form AGEs (Bucala et al., 1991).

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