Diabetes and Hypertension

The prevalence of hypertension is increasing worldwide, with an estimated 972 million adults with hypertension in 2000 that is predicted to grow to 1.56 billion by 2025, while diabetes worldwide prevalence is estimated as 382 million in 2012 projected to reach 592 billion in 2030. Diabetes mellitus and hypertension are interrelated diseases that strongly expose patients to increased risk of atherosclerotic cardiovascular and kidney disease. The prevalence of coexisting hypertension and diabetes appears to be increasing in industrialized nations because populations are aging and both hypertension and T2DM (type2 diabetes mellitus) incidence increases with age. A number of possible reasons have been adduced for this coexistence and it is postulated that both diseases share common pathogenetic factors such as insulin resistance, aging, obesity, chronic subclinical inflammatory processes beside the use of thiazide diuretics in subjects initially with hypertension and the development of nephropathy in those initially with diabetes, especially type 1. Diabetes may also be associated with systolic hypertension secondary to atherosclerosis. In addition both conditions show familiar clustering, which makes it likely to be polygenic in origin. In Diabetics, increased plasma viscosity, stiffness of large arteries, increased production of oxidative radicals and excessive AGEs formation (Advanced Glycation End products) are relevant factors for the development of hypertension. Data from clinical trials emphasize the need for vigilant blood pressure control in patients with diabetes and hypertension. A target blood pressure goal < 140/90 mmHg is recommended by some guidelines while others still recommend more tight control of <130/80. Evidence shows that, to achieve the set goal, use of multiple- drug antihypertensive therapy is required. Agents should be used that have been shown to reduce cardiovascular risk, while not worsening concomitant conditions. It is appropriate that an agent that can block RAAS, such as an ACE inhibitor or an ARB should be the first choice in monotherapy and should be one of the partner drugs used in combination in hypertensive patients with diabetes or glucose intolerance.