From the Guidelines
Yes, diabetes can cause hypertension (HTN). The relationship between diabetes and hypertension is complex and bidirectional, with diabetes increasing the risk of developing high blood pressure. This occurs through several mechanisms: insulin resistance promotes sodium retention and increases sympathetic nervous system activity; diabetes damages blood vessels, reducing their elasticity; and diabetic kidney disease impairs the kidneys' ability to regulate blood pressure. Additionally, both conditions share common risk factors like obesity and physical inactivity.
Key Points
- When diabetes and hypertension coexist, the risk of cardiovascular complications significantly increases.
- For diabetic patients, blood pressure targets are typically stricter (below 130/80 mmHg) than for the general population, with a systolic blood pressure (SBP) goal of 130 mmHg and a diastolic blood pressure (DBP) target of <80 mmHg, but not <70 mmHg 1.
- Management often includes both lifestyle modifications (weight management, reduced sodium intake, regular exercise, limited alcohol) and medications such as ACE inhibitors or ARBs, which provide both blood pressure control and kidney protection for diabetic patients.
- The use of a renin-angiotensin-aldosterone system (RAAS) blocker, such as an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB), is recommended in the treatment of hypertension in patients with diabetes 2.
- Dual therapy with a RAAS blocker and a calcium channel blocker or diuretic is recommended as first-line treatment for patients with diabetes and hypertension 1.
- Home blood pressure self-monitoring should be considered in patients with diabetes on antihypertensive treatments to check that their blood pressure is appropriately controlled 2.
From the Research
Relationship Between Diabetes and Hypertension
- Diabetes and hypertension are closely linked due to similar risk factors, such as endothelial dysfunction, vascular inflammation, arterial remodelling, atherosclerosis, dyslipidemia, and obesity 3.
- Hypertension is twice as frequent in patients with diabetes compared to those without diabetes, and patients with hypertension are at greater risk of developing diabetes 3.
Pathophysiological Mechanisms
- Common mechanisms, such as upregulation of the renin-angiotensin-aldosterone system, oxidative stress, inflammation, and activation of the immune system, contribute to the close relationship between diabetes and hypertension 3, 4.
- Insulin resistance, obesity-induced hyperinsulinemia, activation of the sympathetic nervous system, chronic inflammation, and changes in adipokines are factors that induce both type 2 diabetes and hypertension 5.
Vascular Complications
- Vascular complications resulting from type 2 diabetes and hypertension include endothelial dysfunction, vasodilation/constriction dysfunction of peripheral vessels, increased peripheral vascular resistance, arteriosclerosis, and chronic kidney disease 5, 6.
- In patients with diabetes, increased peripheral artery resistance caused by vascular remodeling and increased body fluid volume associated with insulin resistance-induced hyperinsulinemia and hyperglycemia elevate systemic blood pressure 6.
Molecular Mechanisms
- Molecular mechanisms promoting hypertension in diabetes include inappropriate activation of the renin-angiotensin-aldosterone system and sympathetic nervous system, mitochondria dysfunction, excessive oxidative stress, and systemic inflammation 7.
- Enhanced activation of epithelial sodium channels, alterations in extracellular vesicles and their microRNAs, abnormal gut microbiota, and increased renal sodium-glucose cotransporter activity collectively predispose to hypertension in association with diabetes 7.