Antihypertensive Treatment in Type 2 Diabetic Patients

Abstract

Hypertension is an heterogeneous disease in which both genetic and environmental factors play a relevant role. Among the major environmental determinants of essential hypertension are high alcohol consumption, physical inactivity, overweight, smoking and dietary factors, in particular animal fats, salt, and potassium intake (Binder A, 2007; Staessen et al, 2003). Worldwide prevalence estimates for hypertension may be as much as 1 billion individuals, and approximately 7.1 million deaths per year may be attributable to hypertension (World Health Report, 2002). Hypertension is a highly prevalent risk factor for cardiovascular diseases throughout the industrialized world; data from several studies show that Hypertension plays a relevant etiologic role in the development of cerebrovascular attack, ischemic heart disease, cardiac and renal failure (Yusuf et al., 2001). The relationship between high blood pressure and cardiovascular events is continuous, consistent, and independent of other risk factors. It is becoming an increasingly common health problem worldwide because of growing longevity and prevalence of contributing factors such as obesity, physical inactivity and an unhealthy diet. High blood pressure often coexists with other cardiovascular risk factors, such as obesity, dyslipidemia, impaired glucose tolerance, and type 2 diabetes, which compound the cardiovascular risk attributable to hypertension. The concordance of hypertension and type 2 diabetes is increased in the population; hypertension is disproportionately higher in diabetics, while persons with elevated blood pressure are two and a half times more likely to develop diabetes within 5 years (Gress et al., 2000; Sowers & Bakris, 2000). The present chapter focuses on the most recent and significant literature that explored the possible pathogenetic links between essential hypertension and type 2 diabetes, and it reviews the evidences for "optimal" antihypertensive treatment in type 2 diabetic patients and concomitant hypertension, discussing in detail some areas of uncertainty, such as the selection of antihypertensive drugs of choice in these patients.