The Dreaded Combination of Diabetes Mellitus and Hypertension

Diabetes  Mellitus and  Hypertension are very common diseases , often inter- related. Hypertension is about twice as frequent in people with Diabetes Mellitus(DM). There is substantial overlap between diabetes and hypertension in etiology and disease mechanisms. Obesity, inflammation, oxidative stress, and insulin resistance are thought to be the common pathways. Recent advances in the understanding of these pathways have provided new insights and perspectives. Physical activity plays an important protective role in both of the two diseases. Knowing the common causes and disease mechanisms allows a more effective and comprehensive approach in disease prevention and treatment.

Data suggests that about 4 % of deaths attributed to diabetes mellitus were in fact due to hypertension and 10% of deaths attributed to hypertension  were due to DM.

 Although  hypertension and diabetes are independent  risk factors for ischaemic heart disease ,insulin resistance  and hyperinsulinemia associated  with Hypertension and Diabetes Mellitus are also likely  to contribute  to accelerated  atherogenesis.

It is estimated that 35 to 70 % of diabetic cardiovascular and renal complications can be attributed  to hypertension.

In patients with both diabetes and hypertension coexistent, there is increased risk of stroke, dyslipidemia and hyper uricemia compared to patients with either of the two diseases.

It has been proved that Hypertension contributes to diabetic retinopathy which is the most common cause of newly diagnosed blindness.

Hypertension   often antedates, and very likely contributes to diabetic nephropathy.  Uncontrolled diabetes and/or uncontrolled high blood pressure can lead to chronic kidney disease (CKD)

Although the optimal blood pressure levels during anti hypertensive treatment in diabetic patients with or without nephropathy has not been well- defined, a review of relationship between fall in GFR (Glomerular filtration rate) and blood pressure during anti HT treatment, indicates that one should strive for lower BP than recommended by current guidelines. Goal of BP in diabetes  with HT can be divided  into two parts:

• Systolic blood pressure

Target  systolic BP should be less than or equal to 140mm Hg. but in cases of young patients with albuminuria and/ or those with HT and one or more additional  cardio vascular  risk factors target, systolic BP should be less than 130 mm of Hg.

• Diastolic blood pressure

Target should be less than or equal to 90mm Hg  and less than 80 in young patients, patients with  albuminuria  and or those with HT  and one or more additional cvs risk factors.