oa SA Pharmaceutical Journal - Management issues in hypertensive diabetics : review
Diabetes mellitus (DM) and hypertension are common clinical conditions that often co-exist. This combination has been called the deadly duet to emphasise the increased cardiovascular risk when the two conditions co-exist. Hypertension occurs more commonly in diabetics than in comparable non-diabetics, as the prevalence of hypertension in diabetics is about two times higher than that of hypertension as observed in the general population. In type 2 diabetes mellitus, hypertension is often present as part of a possible common underlying metabolic abnormality, such as insulin resistance. However, in type 1 diabetes mellitus, hypertension is often due to the onset of diabetic nephropathy.
Hypertensive people are 2.5 times more likely to develop diabetes mellitus within five years. This may be due to the presence of an underlying metabolic syndrome, and made worse by the type of antihypertensive drug used, e.g. high-dose thiazides combined with high-dose beta blockers.
The co-existence of hypertension and diabetes mellitus greatly increases the risk for macrovascular and microvascular diabetes complications. The presence of hypertension causes a 7.2-fold increase and a 37-fold increase in mortality in diabetic patients and in diabetic nephropathy respectively.
Hypertension exacerbates all the vascular complications of diabetes, including coronary artery disease, renal disease, stroke, peripheral artery disease, leg amputations and retinopathy. Diabetes increases the risk of coronary artery disease two fold in men and four fold in women, putting women in particular, at risk.
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