Comorbidity of diabetes mellitus and hypertension in the clinical setting: A review of prevalence, pathophysiology, and treatment perspectives

Background: Diabetes mellitus (DM) is now one of the most common noncommunicable diseases worldwide. It is the fourth or fifth leading cause of death in most developed countries, and substantial evidence points to an epidemic of DM in many developing and newly industrialized. nations. In addition, the concordance of hypertension and DM is increased in the general population. Objective: The goal of this, article was to review the prevalence, pathophysiology, and treatment perspectives of DM and hypertension. Methods: Materials for this article were gathered during a search of MEDLINE (1991-2006) using the following search terms: diabetes, hypertension, metabolic syndrome, and obesity. Results: The diabetic pandemic is also called "globesity," to emphasize the globality of the disease and its common background-obesity. The latest data show that nearly 2 in 3 adults in the United States are overweight, and nearly 1 in 3 is obese; similar trends are emerging worldwide. The burden of uncontrolled DM results from microvascular disease (eg, neuropathy, retinopathy, renal disease) and from macrovascular complications. The prevalence of hypertension is increased in patients with DM, while nondiabetics with elevated blood pressure are 2.5 times more likely to develop DM within 5 years than individuals with normal blood pressure levels. Furthermore, the same increase in blood pressure values translates into higher rates of cardiovascular events in diabetic patients compared with nondiabetic patients, due to the synergistic effects between DM and hypertension. The coexistence of hypertension and DM substantially increases the risk of macrovascular complications, including stroke, coronary heart disease, congestive heart failure, and peripheral vascular disease, and it is responsible for excessive cardiovascular mortality. Hypertension also accelerates the development and progression of diabetic nephropathy and retinopathy. Nondiabetic patients with hypertension frequently exhibit the metabolic syndrome. Research clearly indicates that ambulatory 24-hour blood pressure measurements in diabetic patients are a more accurate predictor of microvascular and macrovascular complications than conventional blood pressure measurements. When choosing a treatment strategy for both diabetic and nondiabetic patients with hypertension, the metabolic action of the antihypertensive drug should be considered. The link between DM and hypertension may influence response to different drugs. Conclusions: The coexistence of hypertension and DM increases the risk of macrovascular complications and is responsible for a high cardiovascular mortality. Early and aggressive antihypertensive treatment is therefore mandatory in diabetic and prediabetic groups.