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Hypertension, hyperkalaemia and abnormalities of the renin-angiotensin system in diabetes mellitus

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BLOOD pressure levels are higher and hypertension is commoner among diabetics, compared with the nondiabetic population. Hypertension further increases mortality in diabetes, although it is not clear whether the effect is more marked than in normoglycaemic hypertensive subjects. Hypertension in the diabetic patient requires effective treatment.

High levels of renin and angiotensin II occur in ketoacidosis, while low levels are seen in advanced diabetic nephropathy. There are conflicting data on renin levels in other diabetic conditions, including uncomplicated diabetes and diabetes associated with hypertension. We have shown that plasma angiotensin II falls with improved blood sugar control, and varying control might explain some of the differences between series.

Isolated hypoaldosteronism in adults commonly results from a decreased production of renin and angiotensin II. Hypoaldosteronism presents with unexplained hyperkalaemia and appears to be associated with diabetes mellitus, especially in cases where renal function has been impaired, although a few such patients with normal renal function have been described. Our data indicate that overt hypoaldosteronism is rare among diabetics.

In normal subjects plasma potassium usually falls following a glucose load. However, in some diabetic patients plasma potassium rises and this paradoxical response has been attributed to combined insulin-aldosterone deficiency. We report paradoxical hyperkalaemia in insulin-requiring diabetics without evidence of aldosterone deficiency. We also report paradoxical hyperkalaemia in a diabetic patient subsequently controlled by dietary restriction alone.

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Ferriss, J.B., Sullivan, P.A., Gonggrijp, H. et al. Hypertension, hyperkalaemia and abnormalities of the renin-angiotensin system in diabetes mellitus. IJMS 148, 17 (1979). https://doi.org/10.1007/BF02938136

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  • Diabetic Patient
  • Renin
  • Aldosterone
  • Plasma Renin Activity
  • Plasma Renin