HYPERTENSION AND DIABETES
Despite the progress that has been made trying to reduce the occurrence of cardiovascular disease, this pathology continues to be the leading cause of mortality and morbidity worldwide. There are of course many risk factors for cardiovascular disease, including, but not limited to, hypertension, smoking, high cholesterol, diabetes, lack of exercise, being overweight or obese, and a family history of heart disease. (…)
The association between diabetes and hypertension: an overview of its clinical impact
Hypertension and diabetes have major adverse impacts on cardiovascular and renal disease, and often, these diseases can be found in the same individual. This paper reviews the available data on the high prevalence of the association between hypertension and diabetes. It then shows that this association leads to a marked increase in the risk of many events due to the damage to the microvasculature and macrovasculature that is caused by either high blood pressure or impaired glucose metabolism. Finally, the article focuses on how to treat patients with both diabetes and hypertension. Of note, neither risk factor is irreversible; ie, a reduction in blood pressure or blood glucose has a protective effect on the above-mentioned complications, and, although some differences between different drugs or treatment strategies exist, the benefits appear to be largely related to lowering blood pressure or blood glucose per se regardless of how it is obtained. In both cases, therapeutic success is not easy, as the target systolic blood pressure values recommended by most guidelines are usually reached with a combination of antihypertensive drugs, which should include a renin-angiotensin system blocker to enhance the protective effect of treatment on the kidney. (…)
Diabetes and hypertension: are they two diseases of the endothelium?
Diabetes and hypertension are key risk factors implicated in the development of endothelial dysfunction and atherosclerotic vascular phenotypes. This condition is associated with reduced nitric oxide bioavailability, accumulation of reactive oxygen species, lipid peroxidation, and inflammatory transcriptional programs fostering upregulation of adhesion molecules. The interplay between diabetes and hypertension is characterized by detrimental cross talk between the renin-angiotensin-aldosterone system, redox signaling, and enzymes implicated in the mitochondrial machinery. Understanding these complex networks may reveal novel mechanism-based approaches to counteract the development of atherosclerotic complications in people with diabetes and hypertension. The present article provides a mechanistic overview linking diabetic and hypertensive endothelial dysfunction. (…)
Diabetes and hypertension: is double therapy useful?
Diabetes and hypertension are the âbad companionsâ and each is more common together in the same patient than separately in the general population. Both are risk factors for cardiovascular disease and mortality, and, when both are present, these risks are additive. Fortunately, each is amenable to treatment and double therapy is particularly useful because a more intensive glucose- lowering therapy is especially successful in protecting against microvascular disease, while blood pressureâlowering therapy is highly effective in protecting against major cardiovascular events, such as heart attack and stroke, and in lowering mortality. Furthermore, there is convincing evidence that the two therapies are either additive or at least complementary. Therefore, in answer to the question âis double therapy useful?â we can confidently replyââYes, not only useful, but mandatory!â (…)
Diabetes and hypertension: is treating hyperglycemia useful?
The majority of people with diabetes have hypertension. Hypertension is an independent risk factor for most diabetes complications, including cardiovascular disease. This paper examines the evidence for treating hyperglycemia as a means of improving cardiovascular risk in people with hypertension and diabetes or prediabetes. Major trials demonstrate modest benefits of lowering glucose that become apparent only after prolonged follow- up. People who are early in the course of diabetes and have a longer life expectancy are likely to benefit from intensified glycemic control. Older people with a high burden of other risk factors and established macrovascular complications are less likely to benefit. Newer hypoglycemic agents have small beneficial effects on blood pressure, although data on the cardiovascular impact of this effect is preliminary. (…)
Role of natural products as effective medicines
Many effective therapeutic agents were initially discovered by physicians who also had strong scientific skills. The classic European example is William Withering who practiced medicine in the country town of Stafford (Staffordshire), UK. Withering created a large herbarium at his home, collecting plants from all over England, which he subsequently described in his book A Botanical Arrangement of All the Vegetables Naturally Growing in Great Britain.1 This was first published in 1776 and it ran until 1796 with a total of four editions. (…)