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Hypertension is a cardiovascular disease which has been with man for a long time. Most people in the medical palance view hypertension as a twin of diabetes. Hypertension is twice as common in diabetes as in the general population and affects some 10 – 30% of type 1 and 30 – 50% of type 2 diabetic patients. It is also present in about 20 – 40% of people with impaired glucose tolerance.
The World Health organization(WHO) and International Society for Hypertension (ISH) considers lower target range in people with diabetes to be below 130 -140/85mmHg and Lower (<125/80mmHg) in people with nephropathy.
There are several ways which insulin resistance or hyperinsulinaemia which is mainly found in type 2 diabetes could lead to hypertension.
- Blunting of the vasodilator effect of insulin an action mediated by the release of nitric oxide from endothelium.
- Insulin can act in other ways to raise blood pressure and this can be supported by hyperinsulinaemia that accompanies insulin resistance. Insulin stimulates sodium and water absorption at the distal renal tubule, insulin also stimulates the cell membranes Na+ K+ ATPase, which can raise intracellular Na+ and Ca+ in vascular smooth muscles and therefore enhance contractility and peripheral resistance. Several components of the augmented cytokine induced, acute phase inflammatory response associated with type 2 diabetes may cause hypertension including cytokine stimulation of ACTH and glucocorticoid secretion and activation of the sympathetic nervous system.
In type 1 diabetes, hypertension is obviously associated with diabetic nephropathy. Blood pressure begins to rise when albumin excretion rate enters the microalbuminuric range (>30mg/24hrs).
Control of hypertension in diabetes is important because hypertension worsens both macrovascular and microvascular complications. The effect of blood pressure on the risk of fatal coronary heart disease is 2 – 5 times greater in diabetic than in non-diabetics.