Antihypertensive treatment in the prevention of atherosclerosis in diabetic patients

Overview

Hypertension is the main risk factor (RF) for the development of ischemic heart disease (about 50%), heart failure, cerebrovascular (about 60%) and peripheral arterial disease, kidney failure, atrial fibrillation and all-cause mortality. Also diabetes (T2D) is an important RF for the development of cardiovascular (CV) disease and most patients suffer also from severe and resistant hypertension. Atherosclerotic vascular disease in T2D is about 2–4 times more frequent: due to hyperglycemia, AGEs and insulin resistance, due to vascular inflammation, but also due to hypertension supporting endotelial dysfunction and structural and functional changes of vascular matrix. Intensive antihypertensive treatment reduces the occurrence of major CV events: stroke, myocardial infarction and heart failure. In T2D we start with the antagonists of RAAS (HOPE and EUROPA studies), but due to severe or resistant hypertension present often in these patients we usually add-on also thiazide and calcium channel blockers (dihydropyridines). If we need still to add antihypertensive, it usually is spironolactone. Beta-blockers are used only if there is also another indication: arrhythmias, heart failure or recent acute myocardial infarction.

Keywords:

atherosclerotic vascular disease – cardiovascular events – diabetes mellitus type 2 – hypertension