Hypertension and diabetes

Abstract

Hypertension is seen in most people with diabetes mellitus and accentuates cardiovascular risk and accelerates development of kidney function decline. In most cases there is a genetic predisposition to develop hypertension in people with diabetes compounded by the presence of obesity and high sodium intake. While reduction in weight and sodium intake ameliorates elevations in blood pressure in most cases medications are needed. With proper control of blood pressure to levels below 140/90 mmHg, there has been a marked reduction in cardiovascular events and a slowing of kidney disease progression from 10–12 mL/min/year before decline in estimated glomerular filtration rate before 1985 to 2–4 mL/min/year decline currently. Moreover, those born after 1980 with type 1 diabetes have a 40% lower risk of developing end stage kidney disease than those born previously. Treatment of hypertension depends on stage of kidney disease. A low sodium, i.e., <2300 mg/day, diet, at least 6–7 h of uninterrupted sleep, and weight loss are the cornerstones of therapy. Drug treatment will be much less effective if these lifestyle issues are not in place. Those with macroalbuminuria, i.e., greater than 300 mg/day and a blood pressure ≥140/90 mmHg, must be treated with an angiotensin-converting enzyme inhibitor as part of the regimen. In all others it is important to lower blood pressure to <140/90 mmHg and either a renin-angiotensin system blocker, thiazide-type diuretic, or calcium channel antagonist may be used alone or in combination.