Arterial hypertension and diabetes mellitus

Abstract

The pathogenesis of arterial hypertension in patients with diabetes is a complicated process and involves a complex of biological and ecological factors, as well as genetic predisposition; as a result, the elevated blood pressure (BP) in patients with diabetes mellitus (DM) creates a higher risk of adverse events. Morbidity and mortality increase in diabetic patients who do not effectively control their BP to the targeted values of less than 140/90 (130/80) mm Hg. Large randomized trials and meta-analyses of large randomized controlled studies showed that the pharmacological reduction of BP is the most effective single way for reduction of mortality and of target organs damage in patients with DM, especially the related cardiovascular risk. Frequently, a combination of two or more medications (diuretics, angiotensin converting enzyme inhibitors, β-blockers, calcium channel blockers, angiotensin receptor blockers, spironolactone, etc.) is needed for effective pharmacotherapy, mostly in patients with difficult BP control. However, the costs of the health care to intensively lower BP are significantly lower than the expenditures to treat the hypertension complications, and the latter may be even prevented with BP reduction.