Advertisement

Diabetes and Hypertension

  • James R. Sowers
Part of the Contemporary Cardiology book series (CONCARD)

Abstract

Type 2 diabetes mellitus is increasing significantly in westernized, industrialized societies as the populations become more obese, sedentary, and older (1–5). Four of five persons with type 2 diabetes will die of cardiovascular diseases (CVDs) (1, 2, 5–7). Many factors contribute to increased CVD in persons with diabetes. These include hypertension, dyslipidemia, platelet hyperactivity, endothelial abnormalities, and hypercoagulability, as well as hyperglycemia, microalbuminuria, and hyperinsulinemia (1–9). The Multiple Risk Factor Intervention Trial (4) (MRFIT) followed over 5000 diabetic persons were followed for 12 year and compared them with over 350,000 persons without diabetes. The risk of cardiovascular death at the 12-year follow-up was approximately three times higher in diabetic men as compared with their nondiabetic controls, regardless of age, ethnic group, cholesterol level, systolic blood pressure, or tobacco use. When patients had optimal control of systolic blood pressure and were nonsmokers, the relative risk of CVD was still 2.5 times higher in the diabetic men. The MRFIT study confirmed that diabetes is a strong independent risk factor for CVD mortality above the risk incurred from hypercholesterolemia, systolic hypertension, and cigarette use. In addition, it confirmed that hypercholesterolemia, systolic hypertension, and cigarette smoking are also important independent predictors of mortality in men with and without diabetes. The presence of one or more of these risk factors had a greater impact on increasing CVD risk in diabetics than in nondiabetics.

Keywords

Systolic Hypertension Multiple Risk Factor Intervention Trial Hypertension Optimal Treatment Stand Blood Pressure Diabetic Person 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sowers JR. Diabetes mellitus and cardiovascular disease in women. Arch Intern Med 1998;158:617–621.PubMedCrossRefGoogle Scholar
  2. 2.
    Muggeo M, Verlato G, Bonora E, et al. The Verona Diabetes Study: a population based survey on known diabetes mellitus prevalence and 5–year all cause mortality. Diabetologia 1995;38:318–325.PubMedCrossRefGoogle Scholar
  3. 3.
    Sowers JR, Reed J. Clinical advisory treatment of hypertension and diabetes. J Clin Hypertens 2000;2: 132–133.Google Scholar
  4. 4.
    Stamler J, Vaccaro O, Neaton JD, Wentworth D. The Multiple Risk Factor Intervention Trial Group: diabetes, other risk factors and 12–year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993;16:434–444.PubMedCrossRefGoogle Scholar
  5. 5.
    Lehto S, Ronnemaa T, Haffner SM, Pyorala K, Kallio V, Laakso M. Dyslipidemia and hyperglycemic predict coronary heart disease events in middle–aged patients with NIDDM. Diabetes 1997;48:1354— 1359.Google Scholar
  6. 6.
    Abraira C, Colwell J, Nuttall F, et al. (Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes [VACSDM] Group). Cardiovascular events and correlates in the Veterans Affairs diabetes feasibility trial. Arch Intern Med 1997;157:181–188.PubMedCrossRefGoogle Scholar
  7. 7.
    Wei M, Gaskil SP, Haffner SM, Stern MP. Effects of diabetes and level of glycemia on all–cause and cardiovascular mortality: The San Antonio Heart Study. Diabetes Care 1998;21:1167–177.PubMedCrossRefGoogle Scholar
  8. 8.
    Kuusisto J, Mykkanen L, Pyorala K, et al. Hyperinsulinemia and microalbuminuria: a new risk indicator for coronary heart disease. Circulation 1995;90:831.CrossRefGoogle Scholar
  9. 9.
    Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non–insulin–dependent diabetes mellitus. A systematic overview of the literature. Arch Intern Med 1997;157:1413–1418.PubMedCrossRefGoogle Scholar
  10. 10.
    Sixth Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC–VI). Arch Intern Med 1997;157:2413–2446.CrossRefGoogle Scholar
  11. 11.
    Chen JW, Jen SL, Lee WL, et al. Differential glucose tolerance in dipper and nondipper essential hypertension. Diabetes Care 1998;21:1743–1748.PubMedCrossRefGoogle Scholar
  12. 12.
    Peles E, Goldstein DS, Akselrod S, et al. Interrelationships among measures of autonomic activity and cardiovascular risk factors during orthostasis and the oral glucose tolerance test. Clin Auton Res 1995; 5:271–278.PubMedCrossRefGoogle Scholar
  13. 13.
    Sowers JR, Farrow SL. Treatment of elderly hypertensive patients with diabetes, renal disease and coronary heart disease. Am J Geriatr Cardiol 1996;5:57–70.PubMedGoogle Scholar
  14. 14.
    Sowers JR. Obesity and cardiovascular disease. Clin Chem 1998;44:1821–1825.PubMedGoogle Scholar
  15. 15.
    Consentino F, Hishikawa K, Kutusic C, Luscher TF. High glucose increases nitric oxide synthase expression and superoxide anion generation in human aortic endothelial cells. Circulation 1997;96:25–28.CrossRefGoogle Scholar
  16. 16.
    Muniyappa R, Srinivas PR, Ram J, Sowers JR. Calcium and protein kinase C mediate high glucoseinduced inhibition of inducible nitric oxide synthase in vascular smooth muscle cells. Hypertension 1998;31:289–295.PubMedCrossRefGoogle Scholar
  17. 17.
    Griendling K, Masuko UF. NADH/NADPH oxidase and vascular function. Trends Cardiovasc Med 1997;7:301–307.PubMedCrossRefGoogle Scholar
  18. 18.
    American Diabetes Association. Aspirin therapy in diabetes. Diabetes Care 1998;21(Suppl):45–46.Google Scholar
  19. 19.
    Antiplatelet Trialists Collaboration. Collaborative overrun of randomized trials of antiplatelet therapy–1: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994;308:81–106.CrossRefGoogle Scholar
  20. 20.
    Pyorzla K, Pederson TR, Kjeksjus J. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 1997;20:614–420.CrossRefGoogle Scholar
  21. 21.
    Sacks FM, Pfeffer MA, Moye LA, et al. (Cholesterol and Recurrent Events Trial Investigators). The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996;335:1001–1009.PubMedCrossRefGoogle Scholar
  22. 22.
    National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 1994;23:145–158.CrossRefGoogle Scholar
  23. 23.
    UKPDS Group. UK Prospective Diabetes Study 38: tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ 1998;317:703–713.CrossRefGoogle Scholar
  24. 24.
    UKPDS Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 39. BMJ 1998;317:713–720.CrossRefGoogle Scholar
  25. 25.
    Tatti P, Pahor M, Byington RP, et al. Outcome results of the Fosinopril versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998;21:579–603.CrossRefGoogle Scholar
  26. 26.
    Sowers JR. Comorbidity of hypertension and diabetes: the Fosinopril versus Amlodipine Cardiovascular Events Trial (FACET). Am J Cardiol 1998;82:15R–19R.CrossRefGoogle Scholar
  27. 27.
    Tuomilehto J, Rastenyte D, Birkenhager WH, et al. Effects of calcium–channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999;340:677–684.PubMedCrossRefGoogle Scholar
  28. 28.
    Curb JD, Pressel MS, Cutler JA, et al. Effect of a diuretic–based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated hypertension. JAMA 1996;276:1886– 1892.Google Scholar
  29. 29.
    Bakris GL. Progression of diabetic nephropathy. A focus on arterial pressure level and methods of reduction. Diabetes Res Clin Pract 1998;39:S35–S42.CrossRefGoogle Scholar
  30. 30.
    Hansson L, Zanchetti A, Carruthers S, et al for the HOT Study Group. Effects of intensive blood pressure–lowering and low–dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998;351:1755–1762.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • James R. Sowers

There are no affiliations available

Personalised recommendations