Diabetes Mellitus and Vascular Disease

Abstract

Obesity, impaired glucose tolerance, and diabetes mellitus are associated with a substantially increased prevalence of hypertension, cardiovascular (CVD), and chronic renal disease. The prevalence of hypertension in patients who have type 2 diabetes mellitus is up to 3 times higher than in patients without diabetes mellitus. Further, the coexistence of hypertension in diabetic patients greatly enhances their likelihood of developing CVD and chronic kidney disease.1–4 Indeed, studies conducted in the Framingham population with diabetes mellitus1 indicated that the presence of hypertension in these participants was a resulting risk factor for the presence of CVD. This data and other studies suggest a 2-fold increased risk of CVD events and deaths in diabetic persons with hypertension compared with those with normal blood pressures. The increased association between hypertension and diabetes mellitus can be explained, in part, by the presence of a maladaptive interaction of factors, such as excessive caloric intake/decreased activity and associated insulin resistance (IR), chronic activation of the renin–angiotensin (Ang II)–aldosterone system (RAAS), the sympathetic nervous system, and abnormalities of innate immunity, inflammation, and oxidative stress1–21 (Figure). The epidemic of obesity and sedentary lifestyle, and the aging of populations worldwide have contributed to the current high prevalence of diabetes mellitus and hypertension. Figure. Systemic and metabolic factors that promote coexistent diabetes mellitus, hypertension, cardiovascular, and chronic kidney disease. Hypertension is more common in diabetic patients than in the general population.1–4 In the Strong Heart Study, baseline measurements which independently predicted incident hypertension, included waist circumference, elevations in baseline systolic blood pressure, and left ventricular mass and diabetes mellitus.2 Further, a recent longitudinal Japanese study of 5198 subjects showed that parental hypertension has an age-independent impact on both male and female offspring in elevations in blood pressure, plasma glucose, and triglyceride …