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Managing hypertension in diabetes

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Treatment targets may need to be individualised in Treatment targets may need to be individualised in older patients to avoid side-effects such as postural hypotension

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

The incidence of microvascular complications of retinopathy and nephropathy are also raised by this dual comorbidity, with a seven-fold higher risk of progression to end-stage renal disease if hypertension is present.1

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