Hypertension in diabetes

Hypertension is strongly associated with type 2 diabetes.6 The added comorbidity of hypertension in diabetes leads to a higher risk of cardiovascular disease (CVD), stroke, renal disease, and diabetic retinopathy leading to greater health care costs.7... 

Based on the weight of all evidence, ACE inhibitors/ARBs are preferred first-line agents for controlling hypertension in diabetes. The need for combination therapy should be anticipated, and thiazide diuretics should be the second agent added in most patients to lower BP. Based on scientific evidence, /3-blockers and CCBs are useful evidenced-based agents in this population but are considered add-on therapies to the aforementioned agents. 

Initial therapy choices for hypertension in diabetes mellitus usually include angiotensin-converting enzyme inhibitors or an angiotensin receptor blocker due to their well documented renoprotective effects. Currently, angiotensin receptor blockers have less robust data to support cardiovascular reduction compared to other therapeutic choices, yet the data that exists appears to be positive in patients with type 2 DM. Also, diuretics have shown superior results to an ACE inhibitor in the ALLHAT trial. The ADA currently recommends the use of any class (ACE inhibitors, angiotensin receptor blockers, /3-blockers, diuretics, or calcium channel blockers) of antihypertensive medication that has shown benefit in prevention of poor cardiovascular outcomes. Choice of monotherapy may not be important, as an average of two to three antihypertensive medications are needed to reach blood pressure goals. 

Diabetes is linked to hypertension in several important ways. Obesity predisposes patients to hypertension as well as to type 2 diabetes, so many patients suffer from both diseases. Both diseases can damage the kidney and both predispose patients to coronary artery disease. A large clinical trial of patients with type 2 diabetes suggests that poorly controlled hypertension exacerbates the microvascular disease caused by long-standing diabetes. Because of these links, it is important to think about the treatment of hypertension in diabetic patients. 

This is the first demonstration of the new physiologic function, hypotensive effect, of CLA and its isomer. Feeding a CLA mixture enhanced the plasma adiponectin level, alleviated hyperinsulinemia, and prevented the development of hypertension in diabetic Zucker rats. The lOr, 12abdominal adipose tissues in obese OLETF rats. Although we are awaiting the data on the hypotensive effect of CLA in non-obese hypertensive animals, clinical and epidemiologic research in humans will also be required. 

In the interstitium, angiotensin II induces proliferation of mesangial cells and fibroblasts and the synthesis of collagen and other matrix molecules by these cells via the ATI receptor. Moreover, by the concomitant stimulation of chemoattractant cytokines, inflammation is induced. These processes are mediated by endothelin, transforming growth factor(3, and reactive oxygen species, and finally lead to interstitial fibrosis and glomerulosclerosis observed in hypertension and diabetes. 

A major component of any IHD treatment plan is control of modifiable risk factors, including dyslipidemia, hypertension, and diabetes. Treatment strategies for dyslipidemia and hypertension in the patient with IHD are summarized in the following paragraphs. Visit chapters in this textbook on the management of hypertension and dyslipidemia for further information. 

Bakris GL, Williams M, Sworkin L, et al. for the National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Preserving renal function in adults with hypertension and diabetes a consensus approach. Am J Kidney Dis... 

If one were to imagine the ideal drug-delivery system, two prerequisites would be required. First, it would be a single dose for the duration of treatment, whether it be for days or weeks, as with infection, or for the lifetime of the patient, as in hypertension or diabetes. Second, it should deliver the active entity directly to the site of action, thereby minimizing or eliminating side effects. This may necessitate delivery to specific receptors, or to localization to cells or to specific areas of the body. 

The filtration coefficient is determined by the surface area and permeability of the filtration barrier. An increase in the filtration coefficient leads to an increase in GFR if the filtration coefficient decreases, then GFR decreases. However, this factor does not play a role in the daily regulation of GFR because its value is relatively constant under normal physiological conditions. On the other hand, chronic, uncontrolled hypertension and diabetes mellitus lead to gradual thickening of the basement membrane and therefore to a decrease in the filtration coefficient and GFR, and impaired renal function. 

There is no doubt that the eating patterns and physical activity of the adult have a direct effect on the prevalence of nontransmittable chronic illnesses. In recent decades, the prevalence of cardiovascular disease, obesity, cancer, hypertension, and diabetes, among others, has steadily increased, making these diseases the priority for health care systems in many countries, especially in developed countries. 

Progression factors hasten decline in kidney function after initiation of kidney damage. Progression factors include glycemia in diabetics, hypertension, proteinuria, and smoking. 

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