Author: Bongiovanni, Cheryl M.

Source: Journal for Vascular Ultrasound, Volume 32, Number 1, March 2008 , pp. 17-20(4)

Publisher: Society for Vascular Ultrasound

Abstract:

We are all certainly aware that the incidence and prevalence of type II diabetes mellitus are increasing despite aggressive public education efforts and an ever-increasing array of drug therapies. Most recent estimates indicate that the total number of people with diabetes will increase from the 2000 level of 171 million to 366 million by 2030. The number of adults with hypertension is expected to reach 1.6 billion by 2025. Approximately 70% of all diabetic patients also have clinically significant hypertension, a rate that is about twice the incidence of hypertension in nondiabetics. Of greatest importance, the presence of hypertension in diabetic patients produces an increased risk of vascular complications in this patient cohort and further increases the incidence of renal disease. The coexistence of diabetes and hypertension in patients elevates the risk of ischemic cerebrovascular disease, retinopathy, and coronary artery disease.

Although nephropathy is the most frequent cause of hypertension in patients with type I diabetes, hypertension in type II diabetics often occurs in the presence of normal renal function and is commonly associated with central obesity. The combination of insulin resistance and diabetes can produce hypertension via sympathetic nervous stimulation, activation of the reninangiotensin system, and sodium retention with osmotically committed water. More directly, diabetes increases proliferation of vascular smooth muscle cells and impairs endothelial cell function, thus causing oxidative stress. Vascular reactivity is also enhanced in patients with diabetes.

To prevent, or reduce, the associated vascular morbidity and mortality, both hypertension and diabetes require early detection and aggressive management. Researchers from the United Kingdom Prospective Diabetes Study have determined that blood pressure control can avoid cardiovascular complications in diabetics. In this study, each 10-mmHg decrease in mean systolic blood pressure resulted in a 12% reduction in all complications related to diabetes. The same reduction also resulted in 15% reduction of diabetic mortality, 11% reduction in the incidence of myocardial infarction, and a 13% reduction in microvascular complications. These findings were supported by those reported by The Heart Outcomes Prevention Evaluation study, which showed that administration of angiotensin-converting enzyme inhibitors to hypertensive diabetics reduced the overall risk of vascular complications.

Beyond the documented, severe effects on clinical care, quality of life, and public health, the coexistence of diabetes and hypertension has caused health care costs to skyrocket. In the United States alone, more than a third of the entire healthcare budget is spent on diagnosis and treatment of diabetes. More than two-thirds of that budget is consumed by the presence of hypertension in diabetics and the morbid conditions thus produced.

Hypertension in patients with diabetes has several pathophysiological modalities. Hypertension in the presence of diabetic nephropathy is one type of renal hypertension and is characterized by sodium and fluid retention, increased peripheral vascular resistance and increased cardiac output. Systolic hypertension is more common in diabetics than in the nondiabetics and can occur at any age. Supine hypertension accompanied by orthostatic hypotension may occur in patients with neuropathy and is difficult to treat. In most diabetics with hypertension, elevated peripheral vascular resistance is characteristic of coexisting hypertension.

Document Type: Research article

Publication date: 2008-03-01

More about this publication?

• The Journal for Vascular Ultrasound (JVU) is the official journal of the Society for Vascular Ultrasound. It consists of original scientific and educational articles, case studies, book reviews, technical reviews, ultrasound principle reviews, viewpoints, letters to the editor, and CME tests. Regular reading of JVU, published quarterly, will keep you current in your field and provide essential information that can be applied in your practice.
  
  Previously known as the Journal of Vascular Technology - View Volumes 16-26 here
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