Hypertension and Type 2 Diabetes

The relationship of type 2 diabetes (T2DM) with hypertension (HTN) has been recognized as having common causal links and relevant bidirectional consequences. The main driving mechanisms of this association are maladaptive endothelial dysfunction, renin-angiotensin-aldosterone system (RAAS) and sympathetic overactivity, abnormal sodium handling, renal dysfunction, and vascular stiffness. Blood pressure (BP) elevation in T2DM has a characteristic phenotype: predominance of systolic BP elevation with wide pulse pressure, high variability, non-dipping pattern, salt sensitivity, and refractory hypertension together with a trend of hyperkalemia. With a high prevalence, the presence of HTN largely increases the risk for CKD and ESRD, as well as cardiovascular disease (acute myocardial infarction, stroke, peripheral vascular disease, atrial fibrillation, and heart failure). To reduce the risk, it is mandatory to control BP; however, controversy exists about utilizing intensive antihypertensive treatment to reduce BP toward 120 mmHg or to the standard, with a goal of 130 mmHg. An appropriate combination of antihypertensive drugs and new glucose-lowering drugs can help to reduce BP and control CV and renal risk.