Mechanisms and pharmacotherapy of hypertension associated with type 2 diabetes

Type 2 diabetes is often complicated with hypertension, such that 73.6 % of patients >= 18 years with type diabetes also have hypertension. With increasing age, the risk of developing these conditions rises significantly. Co-existence of type 2 diabetes and hypertension suggests that there are overlapping genetic, physiologic, and environmental factors at play. Research has shown several overlying metabolic abnormalities including sym-pathetic nervous system overactivation, insulin resistance, inflammatory and endothelial dysfunction, delete-rious expression of microRNAs, and obstructive sleep apnea. Though diet and physical activity are the mainstays of treatment early in the disease course, they are generally not a viable long-term strategy. Treatment with novel hypoglycemic and anti-hypertensive medications can greatly assist in preventing long-term complications of these chronic conditions. Recognition of the common causes and consequences of type 2 diabetes and comorbid hypertension allows for a robust response towards being proactive regarding prevention and treatment of this unique patient population. Thus, the purpose of this current review is four-part: to (1) review the latest dis-coveries into the mechanisms of hypertension in the setting of type 2 diabetes, (2) discuss the latest treatments of hypertension with a brief discussion about novel hypoglycemic agents in patients with type 2 diabetes, (3) summarize blood pressure targets and (4) to address evidence gaps in treating patients with diabetes and resistant hypertension, and elderly individuals with both hypertension and diabetes.

Automated summary

Type 2 diabetes often overlaps with hypertension due to genetic, physiological, and environmental factors. There are several metabolic abnormalities that contribute to the coexistence. While diet and exercise are early treatment options, long-term strategies are needed. Novel medications can prevent long-term complications. Understanding the common causes and consequences allows for proactive prevention and treatment.