Managing hypertension in diabetes

Hypertension is a well-recognised comorbidity in people with diabetes, with a prevalence up to three times greater than in those without diabetes. This association is particularly strong in type 2 diabetes, where activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system leads to vasoconstriction mediated by angiotensin II and catecholamines. A further contributor to hypertension generated by RAAS activation is aldosterone, which promotes sodium and hence water reabsorption osmotically.¹

It has been estimated that the risk of myocardial infarction (MI) in people with diabetes without previous MI is equivalent to patients without diabetes who have already had an MI.² Patients with both diabetes and hypertension have a cardiovascular (CV) risk approximately three times that of patients with either diabetes or hypertension alone.³ It seems clear that hypertension is a key factor in the predisposition of those with diabetes to MI. The combination of diabetes and hypertension also further increases the risk of stroke.³