Abstract :
Type 2 diabetes mellitus and hypertension are comorbid clinical conditions that synergize to create a vascular environment that significantly increases the risk of macrovascular disease (eg, myocardial infarction, stroke, and cardiovascular mortality) and microvascular disease (eg, nephropathy and retinopathy). Given the prevalence of this comorbid association, the large majority of patients with newly diagnosed Type 2 diabetes are hypertensive. The co-management of diabetes, through glucose control (targeting a hemoglobin A1c<7.0% in current clinical practice guidelines), and of hypertension, through blood-pressure (BP) control (systolic BP/diastolic BP <130/80 mm Hg), has become central to the treatment of macrovascular and microvascular disease in diabetic patients. These BP goals, however, are rarely attained in these patients, and a treatment that combines ≥2 drugs is needed in most individuals. With the aim of attaining a synergistic benefit from the simultaneous lowering of hemoglobin A1c and BP, treatment strategies that combine multiple hypertensive agents and glucose-controlling agents are being investigated. Treatments that include an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker may be of particular value, because these drug classes inhibit the renin-angiotensin system, which mediates the increase in renovascular resistance and intraglomerular pressure observed in diabetic kidneys. Inhibition of the renin-angiotensin system, which protects the kidney through a variety of mechanisms, may also provide renal and cardiovascular benefits that extend beyond those attributable to BP control. Thus, the effective co-management of diabetes and hypertension through combined glucose and BP control remains an unmet medical need for which strategies still need to be developed.
