Abstract
Individuals with diabetes mellitus have cardiovascular disease (CVD) mortality comparable to nondiabetics who have suffered a myocardial infarction or stroke. Aggressive management of risk factors such as hypertension, dyslipidemia, and platelet dysfunction in persons with diabetes has been shown to reduce morbidity and mortality in prospective randomized controlled clinical trials. Accordingly, there are national mandates to lower blood pressure to less than 130/85 mm Hg, reduce low-density lipoprotein cholesterol to less than 100 mg/dL, and institute aspirin therapy in adult patients with diabetes. Although not definitively shown to reduce CVD, there are also recommendations to control the level of glycemia, as well. This article discusses CVD risk factors in the diabetic patient with hypertension.
Similar content being viewed by others
References and Recommended Reading
Sowers JR, Epstein M, Frohlich ED: Diabetes, hypertension, and cardiovascular disease: An update. Hypertension 2001, 37:1053–1059. Reviews clinical trial data indicating the benefits of treating blood pressure rigorously, including the use of ACE therapy, if tolerated.
Sowers JR: Hypertension in type 2 diabetes: update on therapy. J Clin Hypertens 1999, 1:41–47.
Muggeo M, Verlate 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.
Berger M, Jorgens V, Flatten G: Healthcare for persons with non-insulin dependent diabetes mellitus. The German experience. Ann Intern Med 1996, 124:153–155.
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.
Mykkünen L, Küsiste J, Pyorala K, et al.: Increased risk of noninsulin dependent diabetes in elderly hypertensive subjects. J Hypertens 1994, 2:1425–1432.
Flegal KM, Caroll MD, Kuczarski RJ, et al.: Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord 1998, 22:39–47.
Sowers JR: Obesity and cardiovascular disease. Clin Chem 1998, 44:1821–1825.
Klein R: Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 1995, 18:258–268.
Stamler J, Vaccaro O, Neaton JD, et al.: Diabetes, other risk factors and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diab Care 1993, 263:2335–2340.
Gress TW, Nieto FJ, Shahar E, et al.: Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 2000, 342:905–912. Demonstrates the significantly increased propensity of hypertensive patients to develop type 2 diabetes, particularly if they are being treated with a β blocker.
Curb JD, Pressel MS, Cutler JA, et al.: Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated hypertension. JAMA 1996, 276:1886–1892.
Grimm RH Jr, Flack JM, Grandits GA, et al.: Long-term effects on plasma lipids of diet and drugs to treat hypertension. Treatment of Mild Hypertension Study (TOMHS) Research Group. JAMA 1996, 275:1549–1556.
Lindholm LH: The outcome of STOP-Hypertension-2 in relation to the 1999 WHO/ISH hypertension guidelines. Blood Press Suppl 2000, 2:21–24.
Hansson L, Lindholm LH, Niskanen L, et al.: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomized trial. Lancet 1999, 353:611–616.
Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.
Sowers JR, Bakris GL: Antihypertensive therapy and the risk of type 2 diabetes mellitus. N Engl J Med 2000, 342:969–970. Reviews potential mechanisms by which hypertension and β-blocker therapy may predispose to the development of type 2 diabetes.
Consentino F, Hishikawa K, Kutusic C, et al.: High glucose increases nitric oxide synthase expression and superoxide anion generation in human aortic endothelial cells. Circulation 1997, 96:25–28.
Muniyappa R, Srinivas PR, Ram J, Sowers JR: Calcium and protein kinase C mediate high glucose-induced inhibition of inducible nitric oxide synthase in vascular smooth muscle cells. Hypertension 1998, 31:289–295.
Griendling K, Masuko UF: NADH/NADPH oxidase and vascular function. Trends Cardiovasc Med 1997, 7:301–307.
Adler AI, Stratton IM, Neil HAW, et al.: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS36): prospective observational study. BMJ 2000, 321:412–419. This analysis from the UKPDS study documents the critical role of systolic blood pressure elevations in the promotion of CVD and renal disease in patients with type 2 diabetes.
Ravid M, Lang R, Rachmani R, Lishner M: Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus. A 7-year follow-up study. Arch Intern Med 1996, 156:286–289.
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy [no authors listed]. Lancet 2000, 355:253–259.This substudy of the HOPE reports the striking benefits of ramapril therapy in reducing cardiovascular and microvascular events in patients with diabetes.
Hansson L, Zanchetti A, Carruthers SG, et al., for the HOT Study Group: Effects of intensive blood pressure-lowering and lowdose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998, 351:1755–1762.
Tuomilehto J, Rastenyte D, Birkenhager WH, et al., for the Systolic Hypertension in Europe Trial Investigators: Effects of calcium channel blockers in older patients with diabetes and systolic hypertension. N Engl J Med 1999, 340:677–684.
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.
UKPDS Group: Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 29. BMJ 1998, 317:713–720.
Sowers JR, Read J: Clinical advisory treatment of hypertension in diabetes. J Clin Hypertens 2000, 2:132–133.
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.
Sowers JR: Comorbidity of hypertension and diabetes: the Fosinopril versus Amlodipine Cardiovascular Events Trial (FACET). Am J Cardiol 1998, 82:15R-19R.
Colwell JA: Aspirin therapy in diabetes. Diabetes Care 1997, 20:1767–1771.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Winer, N., Sowers, J.R. Cardiovascular risk factors in diabetic patients with hypertension. Curr Diab Rep 2, 263–266 (2002). https://doi.org/10.1007/s11892-002-0093-3
Issue Date:
DOI: https://doi.org/10.1007/s11892-002-0093-3