rss
Heart 99:577-585 doi:10.1136/heartjnl-2012-302029
  • Education in Heart
  • Hypertension

Blood pressure and diabetes: vicious twins

  1. Franz H Messerli1
  1. 1Division of Cardiology, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
  2. 2Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
  1. Correspondence to Professor Franz H Messerli, Division of Cardiology, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1000 Tenth Avenue, New York, NY, 10019, USA, messerli.f{at}gmail.com

Epidemiology

Hypertension (HTN) and diabetes mellitus (DM) have become increasingly prevalent globally. As of the year 2000, an estimated 972 million individuals worldwide (26%) had HTN—a number that is projected to rise to 1.56 billion (29%) by 2025.w1 DM affects an estimated 285 million individuals (6%) globally with a projection of 439 million adults (8%) being affected by 2030.w2 HTN is more common in individuals with DM than in the general population, with estimates of the prevalence of HTN in DM ranging from 40–80%.w3 Patients with DM are more likely to develop HTN with the incidence of HTN being twofold higher in those with DM relative to similar aged individuals without DMw4 (see summary in figure 1).

Figure 1

A summary of the incidence of diabetes, hypertension, and clinical manifestations. BP, blood pressure; CHD, coronary heart disease; CHF, congestive heart failure; DM, diabetes mellitus; HTN, hypertension; LVH, left ventricular hypertrophy.

Patients with DM carry a risk of cardiovascular (CV) death similar to that of patients with a previous myocardial infarction.1 In a recent study based on the Framingham cohort, the population attributable risk from HTN in patients with DM was 30% for all cause death and 25% for any CV event. Conversely, after adjusting for HTN, the population attributable risk from DM was 7% for all cause death and 9% for any CV event in the group. The findings reaffirmed those of previous studies that the presence of HTN is likely the strongest driver of CV outcomes in diabetic patients.2

Despite increasing evidence of the contribution of blood pressure (BP) to CV risk in DM, diabetic patients are less likely to achieve target BPs relative to non-DM patients.3

Clinical manifestations

BP characteristics in DM

Patients with diabetes have more isolated systolic HTN and, because of autonomic neuropathy, experience less reduction in …