Diabetes and Hypertension

Hypertension and diabetes show a strong epidemiologic association. About 75% of adults with diabetes have blood pressure levels =130/80 mmHg or use antihypertensive medication and this percentage goes up to 90% if microalbuminuria is also present. On the other hand, individuals with hypertension are 2.5 times more likely to develop diabetes within 5 years of diagnosis. The presence of hypertension in patients with diabetes substantially increases the risk for both cardiovascular and renal diseases and is associated with a 7.2-fold increase in mortality, whereas in those with diabetes and diabetic nephropathy, hypertension causes a 37-fold increase in mortality. Hypertension in type 1 diabetes generally results from the underlying nephropathy and in type 2 diabetes it usually occurs in the context of the cardio- metabolic syndrome. Understanding the pathophysiological context and the overall cardiovascular risk assessment together with the current therapeutic modalities for people with diabetes and hypertension is a sine qua non for effective management of this growing patient population. In this book we present to the primary care providers as well as to the sub-specialists an integrative approach to hypertension and diabetes including lifestyle and pharmacological approaches, focusing on overall cardiovascular risk reduction with special emphasis on high- risk population. We also provide an overview of the preventive measures for both hypertension and diabetes in the light of the most recent clinical trials. Finally, we discuss the future outlook for the epidemic and the ongoing clinical studies together with the various innovative diagnostic modalities.