The Treatment of Hypertension in Adult Patients With Diabetes
- 1Department of Internal Medicine, the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and the Department of Geriatrics and Aging, George Washington University Medical Faculty Associates, Washington, DC.
Hypertension is an extremely common comorbidity of diabetes, affecting 20–60% of people with diabetes. Hypertension is also a major risk factor for cardiovascular events, such as myocardial infarction and stroke, as well as for microvascular complications, such as retinopathy and nephropathy. Cardiovascular disease is the most costly complication of diabetes and is the cause of 86% of deaths in persons with diabetes (1). However, until recently, little research had been done specifically in patients with diabetes and hypertension. In reviewing the literature on diabetes and hypertension, the authors searched MEDLINE for English language articles using keywords “hypertension,” “diabetes mellitus,” “diabetic nephropathy,” and “coronary artery disease/prevention” starting from 1966. Before 1996, most available data come from secondary analysis from studies done in the general population of people with hypertension, observing a subset with diabetes. Recent studies have demonstrated the effectiveness of blood pressure treatment versus placebo in reducing complications of diabetes (2,3), helped to define the optimal level of blood pressure control (4,5,6), and compared treatment strategies based on different drug classes (7,8,9,10,11,12,13). The results of these studies support an aggressive approach to the diagnosis and treatment of hypertension in patients with diabetes in order to substantially reduce the incidence of both macrovascular and microvascular complications.
SECTION I: DEFINITION, PREVALENCE, AND PATHOPHYSIOLOGY
Definition of hypertension in diabetic populations
Epidemiological studies and therapeutic trials have often used different criteria to define hypertension in diabetic patients. Studies in the general population indicate an increased risk of cardiovascular disease with an increase in the level of blood pressure. Thus, an increase in diastolic or systolic blood pressure of 5 mmHg is associated with a concomitant increase in cardiovascular disease of 20–30% (14). Studies in diabetic populations have shown a markedly higher frequency of the progression of diabetic retinopathy …