Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Hypertension in patients with type-II diabetes: relation to urinary albumin excretion, endothelial function and inflammation

Journal of Human Hypertension volume 19, pages 421–424 (2005)Cite this article

Isolated diabetes mellitus is a frequent and increasing public health problem.1 Importantly, diabetes has a prevalence of 2–5% in most Western countries, and is rapidly increasing in Asiatic countries due to changes in dietary habits during the last years.2 The association between diabetes mellitus and hypertension has been described in 60–65% of diabetic patients, with implications for cardiovascular risk.2, 3 For example, a type-II diabetic patient with no previous myocardial infarction has a cardiovascular risk similar to a nondiabetic patient with a myocardial infarction, and the existence of diabetes mellitus itself worsens the 1-year mortality after a myocardial infarction by about 60% — but controlled hypertension does not worsen the outcome.3 Additionally, the importance of an elevated systolic pressure in subjects with diabetes is often underestimated and the number of antihypertensive drugs prescribed is insufficient.4

The pathophysiology of cardiovascular disease in subjects with diabetes is multifactorial, and in addition to the classic risk factors (such as hypertension, dyslipidaemia and obesity) in type-II diabetes, increased urinary albumin excretion, endothelial dysfunction, and chronic inflammation are inter-related processes that develop in parallel, progress with time, and are strongly and independently associated with risk of death.5 Thus, a management strategy of hypertension in diabetes that beneficially influences multiple pathophysiological processes would be important. However, the cynic would argue that some antihypertensive drugs are better than others, but gone are the days that antihypertensive drug monotherapy would be adequate to achieve blood pressure treatment targets.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. King H, Aubert RE, Herman WH . Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998; 21: 1414–1431.

    Article  CAS  PubMed  Google Scholar 

  2. Contreras F et al. Diabetes and hypertension physiopathology and therapeutics. J Hum Hypertens 2000; 14: S26–S31.

    Article  PubMed  Google Scholar 

  3. Jonas M et al. Hospital and 1-year outcome after acute myocardial infarction in patients with diabetes mellitus and hypertension. J Hum Hypertens 2003; 17: 665–670.

    Article  CAS  PubMed  Google Scholar 

  4. Boero R et al. How well are hypertension and albuminuria treated in type II diabetic patients? J Hum Hypertens 2003; 17: 413–418.

    Article  CAS  PubMed  Google Scholar 

  5. Stehouwer CD et al. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes 2002; 51: 1157–1165.

    Article  CAS  PubMed  Google Scholar 

  6. Schram MT et al. Aggressive antihypertensive therapy based on hydrochlorothiazide, candesartan or lisinopril as initial choice in hypertensive type 2 diabetic individuals: effects on albumin excretion, endothelial function and inflammation in a double blind, randomised clinical trial. J Hum Hypertens [E-pub ahead of print: 13 January 2005. doi:10.1038/sj.jhh.1001812].

    Article  CAS  PubMed  Google Scholar 

  7. Savage S, Estacio RO, Jeffers B, Schrier RW . Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, and cardiovascular disease in NIDDM. Diabetes Care 1996; 19: 1243–1248.

    Article  CAS  PubMed  Google Scholar 

  8. Leoncini G et al. Microalbuminuria is an integrated marker of subclinical organ damage in primary hypertension. J Hum Hypertens 2002; 16: 399–404.

    Article  CAS  PubMed  Google Scholar 

  9. Bakris GL et al. Impact of an ACE inhibitor and calcium antagonist on microalbuminuria and lipid subfractions in type 2 diabetes: a randomised, multi-centre pilot study. J Hum Hypertens 2002; 16: 185–191.

    Article  CAS  PubMed  Google Scholar 

  10. Bakris G, White D . Effects of an ACE inhibitor combined with a calcium channel blocker on progression of diabetic nephropathy. J Hum Hypertens 1997; 11: 35–38.

    Article  CAS  PubMed  Google Scholar 

  11. Sachse A, Verboom CN, Jäger B . Efficacy of eprosartan in combination with HCTZ in patients with essential hypertension. J Hum Hypertens 2002; 16: 169–176.

    Article  CAS  PubMed  Google Scholar 

  12. Fernández R, et al, on behalf of The TRAVEND Study Group. Effect of two antihypertensive combinations on metabolic control in type-2 diabetic hypertensive patients with albuminuria: a randomised, double-blind study. J Hum Hypertens 2001; 15: 849–856.

    Article  PubMed  Google Scholar 

  13. Fogari R et al. Long-term effects of ramipril and nitrendipine on albuminuria in hypertensive patients with type II diabetes and impaired renal function. J Hum Hypertens 1999; 13: 47–53.

    Article  CAS  PubMed  Google Scholar 

  14. Agardh CD et al. Greater reduction of urinary albumin excretion in hypertensive type II diabetic patients with incipient nephropathy by lisinopril than by nifedipine. J Hum Hypertens 1996; 10: 185–192.

    CAS  PubMed  Google Scholar 

  15. Parving HH, et al, Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–878.

    Article  CAS  PubMed  Google Scholar 

  16. Mogensen CE et al. Randomised controlled trial of dual blockade of renin–angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000; 321: 1440–1444.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chin BS, Lip GYH . Blockade of the renin–angiotensin–aldosterone system with combination angiotensin receptor antagonist and ACE inhibitor therapy: observations from Val-HeFT and CALM. J Hum Hypertens 2001; 15: 89–92.

    Article  CAS  PubMed  Google Scholar 

  18. Nakao N et al. Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease. (CO-OPERATE): a randomised control trial. Lancet 2003; 361: 117–124.

    Article  CAS  PubMed  Google Scholar 

  19. Stehouwer CD et al. Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet 1992; 340: 319–323.

    Article  CAS  PubMed  Google Scholar 

  20. Nadar S, Blann AD, Lip GY . Antihypertensive therapy and endothelial function. Curr Pharm Des 2004; 10: 3607–3614.

    Article  CAS  PubMed  Google Scholar 

  21. Tan KC, Chow WS, Ai VH, Lam KS . Effects of angiotensin II receptor antagonist on endothelial vasomotor function and urinary albumin excretion in type 2 diabetic patients with microalbuminuria. Diabetes Metab Res Rev 2002; 18: 71–76.

    Article  CAS  PubMed  Google Scholar 

  22. Ito A et al. Angiotensin-converting enzyme activity is involved in the mechanism of increased endogenous nitric oxide synthase inhibitor in patients with type 2 diabetes mellitus. Circ J 2002; 66: 811–815.

    Article  CAS  PubMed  Google Scholar 

  23. O'Driscoll G et al. Improvement in endothelial function by angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus. J Am Coll Cardiol 1999; 33: 1506–1511.

    Article  CAS  PubMed  Google Scholar 

  24. Vehkavaara S, Yki-Jarvinen H . 3.5 years of insulin therapy with insulin glargine improves in vivo endothelial function in type 2 diabetes. Arterioscler Thromb Vasc Biol 2004; 24: 325–330.

    Article  CAS  PubMed  Google Scholar 

  25. Yudkin JS, Stehouwer CDA, Emeis JJ, Coppack SW . C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999; 19: 972–978.

    Article  CAS  PubMed  Google Scholar 

  26. Jager A et al. Increased levels of soluble vascular cell adhesion molecule 1 are associated with risk of cardiovascular mortality in type 2 diabetes: the Hoorn study. Diabetes 2000; 49: 485–491.

    Article  CAS  PubMed  Google Scholar 

  27. Nomura S, Kanazawa S, Fukuhara S . Effects of efonidipine on platelet and monocyte activation markers in hypertensive patients with and without type 2 diabetes mellitus. J Hum Hypertens 2002; 16: 539–547.

    Article  CAS  PubMed  Google Scholar 

  28. Schonbeck U, Libby P . CD40 signaling and plaque instability. Circ Res 2001; 89: 1092–1103.

    Article  CAS  PubMed  Google Scholar 

  29. Lim HS, Blann AD, Lip GY . Soluble CD40 ligand, soluble P-selectin, interleukin-6, and tissue factor in diabetes mellitus: relationships to cardiovascular disease and risk factor intervention. Circulation 2004; 109: 2524–2528.

    Article  CAS  PubMed  Google Scholar 

  30. Lip GYH, Blann AD . Thrombogenesis, atherogenesis and angiogenesis in vascular disease: a new ‘vascular triad’. Ann Med 2004; 36: 119–125.

    Article  CAS  PubMed  Google Scholar 

  31. He FJ, MacGregor GA . Cost of poor pressure control in the UK: 62 000 unnecessary deaths per year. J Human Hypertens 2003; 17: 455–457.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the support of the Sandwell and West Birmingham Hospitals NHS Trust Research and Development programme for the Haemostasis, Thrombosis and Vascular Biology Unit.

Author information

Authors and Affiliations

  1. Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

    G I Varughese & G Y H Lip

Authors
  1. G I Varughese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Y H Lip
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Y H Lip.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varughese, G., Lip, G. Hypertension in patients with type-II diabetes: relation to urinary albumin excretion, endothelial function and inflammation. J Hum Hypertens 19, 421–424 (2005). https://doi.org/10.1038/sj.jhh.1001833

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001833

This article is cited by

Search

Advanced search

Quick links