Vnitr Lek 1999, 45(11):655-660

[Hypertension and diabetes mellitus--pathophysiology and risk].

H Rosolová: Centrum preventivní medicíny, II. interní klinika FN a LF UK, Plzen.

The author submits a review on the combined prevalence of diabetes and hypertension which increases with age and is a basic risk factor of vascular cardiac and cerebral complications. It is associated with a higher incidence of obesity, hypertriglyceridaemia and reduced HDL-cholesterol. It is part of the metabolic syndrome X, the syndrome of insulin resistance. Hypertension is found in 60-80% type 2 diabetics and in 40% type 1 diabetics. Obesity is found on average in 40% type 1 diabetics and 85% type 2 diabetics. Macroangiopathy leads to ischaemic heart disease, cerebrovascular episodes and ischaemia of the lower extremities. British investigations revealed that long-term intensive control of the blood sugar level and hypertension reduced in particular the incidence of microvascular complications. A marked decline of the morbidity and mortality of diabetics was recorded after effective treatment of hypertension maintaining blood pressure readings below 130/80 mm Hg. The author discusses also contemporary views on the etiopathogenesis of hypertension in diabetic subjects who may suffer from different types of hypertension. The combination of diabetes and hypertension has obviously a multifactorial etiology--genetic predisposition and several external mechanisms. In the pathogenesis of hypertension an important part is played by insulin resistance and enhanced activity of the sympathetic nervous system. Reaven's hypothesis of metabolic syndrome X was supplemented in recent years by the role of the sympathoadrenal system. From the therapeutic aspect effective reduction of hypertension by correct selection of antihypertensives is most important.