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.

  • Review
  • Published:

The diabetic, hypertensive heart: epidemiology and mechanisms of a very high-risk situation

Journal of Human Hypertension volume 23, pages 709–717 (2009)Cite this article

Abstract

The prevalence of diabetes is escalating, and is leading to increased rates of heart failure, myocardial infarction and cardiovascular death. Due to several inter-related biological processes, hypertension is often associated with diabetes, and accelerates these morbid conditions. These points are outlined below.

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

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

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Wild S, Roglic G, Green A, Sicree R, King H . Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047–1053.

    Article  PubMed  Google Scholar 

  2. Rosengren A, Welin L, Tsipogianni A, Wilhelmsen L . Impact of cardiovascular risk factors on coronary heart disease and mortality among middle aged diabetic men: a general population study. Br Med J 1989; 299: 1127–1131.

    Article  CAS  Google Scholar 

  3. Tenenbaum A, Fisman EZ, Boyko V, Goldbourt U, Auerbach I, Shemesh J et al. Prevalence and prognostic significance of unrecognised systemic hypertension in patients with diabetes mellitus and healed myocardial infarction and/or stable angina pectoris. Am J Cardiol 1999; 84: 294–298.

    Article  CAS  PubMed  Google Scholar 

  4. Janghorbani M, Hu FB, Willett WC, Li TY, Manson JE, Logroscino G et al. Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes; The Nurses' Health Study. Diabetes Care 2007; 30: 1730–1735.

    Article  PubMed  Google Scholar 

  5. Goff DC, Zaccaro DJ, Haffner SM, Saad MF . Insulin sensitivity and the risk of incident hypertension: insights from the Insulin Resistance Atherosclerosis Study. Diabetes Care 2003; 26: 805–809.

    Article  PubMed  Google Scholar 

  6. Salonen JT, Lakka TA, Lakka H, Valkonen V, Everson SA, Kaplan GA . Hyperinsulinaemia is associated with the incidence of hypertension and dyslipidaemia in middle-aged men. Diabetes 1998; 47: 270–276.

    Article  CAS  PubMed  Google Scholar 

  7. Barr ELM, Magliano DJ, Zimmet PZ, Polkinghorne KR, Atkins RC, Dunstan DW et al. AusDiab 2005: The Australian Diabetes, Obesity and Lifestyle Study—tracking the accelerating epidemic: its causes and outcomes. International Diabetes Institute: Melbourne, Australia. http://www.diabetes.com.au/pdf/AUSDIAB_Report_Final.pdf. (accessed 28/02/09) P11.

  8. Qiao Q, Jousilahti P, Eriksson J, Tuomilehto J . Predictive properties of impaired glucose tolerance for cardiovascular risk are not explained by the development of overt diabetes during follow-up. Diabetes Care 2003; 26: 2910–2914.

    Article  PubMed  Google Scholar 

  9. Lotufo PA, Gaziano JM, Chae CU, Ajani UA, Moreno-John G, Buring JE et al. Diabetes and all-cause and coronary heart disease mortality among US male physicians. Arch Intern Med 2001; 161: 242–247.

    Article  CAS  PubMed  Google Scholar 

  10. Booth GL, Kapral MK, Fung K, Tu JV . Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet 2006; 368: 29–36.

    Article  PubMed  Google Scholar 

  11. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective trials. Lancet 2002; 360: 1903–1913.

    Article  PubMed  Google Scholar 

  12. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK . The progression from hypertension to congestive heart failure. JAMA 1996; 275: 1557–1562.

    Article  CAS  PubMed  Google Scholar 

  13. Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H . Coronary-heart-disease risk and impaired glucose tolerance, The Whitehall Study. Lancet 1980; 315: 1373–1376.

    Article  Google Scholar 

  14. Tenenbaum A, Fisman EZ, Boyko V, Goldbourt U, Graff E, Shemesh J et al. Hypertension in diet versus pharmacologically treated diabetics: mortality over a 5-year follow-up. Hypertension 1999; 33: 1002–1007.

    Article  CAS  PubMed  Google Scholar 

  15. The Hypertension in Diabetes Study Group. II Increased risk of cardiovascular complications in hypertensive type diabetic patients. J Hypertens 1993; 11: 319–325.

    Article  Google Scholar 

  16. Assmann G, Schulte H . The Prospective Cardiovascular Munster (PROCAM) study: prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease. Am Heart J 1988; 116: 1713–1724.

    Article  CAS  PubMed  Google Scholar 

  17. Hu G, Jousilahti P, Tuomilehto J . Joint effects of history of hypertension at baseline and type 2 diabetes at baseline and during follow-up on the risk of coronary heart disease. Eur Heart J 2007; 28: 3059–3066.

    Article  PubMed  Google Scholar 

  18. Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. Br Med J 2000; 321: 412–419.

    Article  CAS  Google Scholar 

  19. Zhang Y, Lee ET, Devereux RB, Yeh J, Best LG, Fabitz RR et al. Prehypertension, diabetes, and cardiovascular disease risk in a population-based sample: The Strong Heart Study. Hypertension 2006; 47: 410–414.

    Article  CAS  PubMed  Google Scholar 

  20. Hu G, Sarti C, Jousilhati P, Peltonen M, Qiao Q, Antikainen R et al. The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality. Stroke 2005; 36: 2538–2543.

    Article  PubMed  Google Scholar 

  21. Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V et al. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med 2002; 347: 797–805.

    Article  CAS  PubMed  Google Scholar 

  22. Hasslacher C, Stech W, Wahl P, Ritz E . Blood pressure and metabolic control as risk factors for nephropathy in Type 1 (insulin-dependent) diabetes. Diabetologia 1985; 28: 6–11.

    Article  CAS  PubMed  Google Scholar 

  23. Oakley WG, Pyke DA, Tattersall RB, Watkins PJ . Long-term diabetes: a clinical study of 92 patients after 40 years. Q J Med 1974; 169: 145–156.

    Google Scholar 

  24. The Hypertension in Diabetes Study Group. I Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovacular and diabetic complications. J Hypertens 1993; 11: 309–317.

    Article  Google Scholar 

  25. Gallego PH, Craig ME, Hing S, Donaghue KC . Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study. Br Med J 2008; 337: a918.

    Article  Google Scholar 

  26. Levy D, Anderson KM, Savage DD, Kannel WB, Christiansen JC, Castelli WP . Echocardiographically detected left ventricular hypertrophy: prevalence and risk factors. Ann Intern Med 1988; 108: 7–13.

    Article  CAS  PubMed  Google Scholar 

  27. Antikainen R, Grodzicki T, Palmer AJ, Beevers DG, Coles EC, Webster J et al. The determinants of left ventricular hypertrophy defined by Sokolow-Lyon criteria in untreated hypertensive patients. J Hum Hypertens 2003; 17: 159–164.

    Article  CAS  PubMed  Google Scholar 

  28. Dunn FG, McLanachan J, Isles CG, Brown I, Dargie HJ, Lever AF et al. Left ventricular hypertrophy and mortality in hypertension: an analysis of data from the Glasgow blood pressure clinic. J Hypertens 1990; 8: 775–782.

    Article  CAS  PubMed  Google Scholar 

  29. Post WS, Larson MG, Levy D . Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation 1994; 90: 179–185.

    Article  CAS  PubMed  Google Scholar 

  30. Brilla CG, Pick R, Tan LB, Janicki JS, Weber KT . Remodeling of the rat right and left ventricles in experimental hypertension. Circ Res 1990; 67: 1355–1364.

    Article  CAS  PubMed  Google Scholar 

  31. Weber KT . Fibrosis and hypertensive heart disease. Curr Opin Cardiol 2000; 15: 264–272.

    Article  CAS  PubMed  Google Scholar 

  32. Boon D, Piek JJ, van Montfrans GA . Silent ischaemia and hypertension. J Hypertens 2000; 18: 1355–1364.

    Article  CAS  PubMed  Google Scholar 

  33. Lubaszewski W, Kawecka-Jaszcz K, Czarnecke D, Rajzer M, Stochmal A . Silent myocardial ischaemia in patients with essential arterial hypertension and non-insulin dependent diabetes mellitus. J Hum Hypertens 1999; 13: 309–313.

    Article  CAS  PubMed  Google Scholar 

  34. Indermuhle A, Vogel R, Meier P, Wirth S, Stoop R, Mohaupt MG et al. The relative blood volume differentiates between hypertensive heart disease and athlete's heart in humans. Eur Heart J 2006; 27: 1571–1578.

    Article  PubMed  Google Scholar 

  35. Treasure CB, Klein JL, Vita JA, Manoukian SV, Renwick GH, Selwyn AP et al. Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels. Circulation 1993; 87: 86–93.

    Article  CAS  PubMed  Google Scholar 

  36. Brush JE, Cannon RO, Schenke WH, Bonow RO, Leon MB, Maron BJ et al. Angina due to coronary microvascular disease in hypertensive patients without left ventricular hypertrophy. N Engl J Med 1988; 319: 1302–1307.

    Article  PubMed  Google Scholar 

  37. Opherk D, Mall G, Zebe H, Schwarz F, Weihe E, Manthey J et al. Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 1984; 69: 1–7.

    Article  CAS  PubMed  Google Scholar 

  38. van Hoeven KH, Factor SM . Endomyocardial biopsy diagnosis of small vessel disease: a clinicopathologic study. Int J Cardiol 1990; 26: 103–110.

    Article  CAS  PubMed  Google Scholar 

  39. Mayet J, Hughes A . Cardiac and vascular pathophysiology in hypertension. Heart 2003; 89: 1104–1109.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Palmieri V, Belle JN, Roman MJ, Gerdts E, Papademetriou V, Watchell K et al. Pulse pressure/stroke index and left ventricular geometry and function: the LIFE Study. J Hypertens 2003; 21: 781–787.

    Article  CAS  PubMed  Google Scholar 

  41. Mottram PM, Haluska BA, Leano R, Carlier S, Case C, Marwick TH . Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart 2005; 91: 1551–1556.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kesavan S, Edmond J, Finch D, Baumbach A . Severity of coronary artery disease at presentation in patients with diabetes mellitus—an observational study of 14770 patients. Eur Heart J 2008; 29: 468.

    Google Scholar 

  43. Jokl R, Laimins M, Klein RL, Lyons TJ, Lopes-Virella MF, Colwell JA . Platelet plasminogen activator inhibitor 1 in patients with type II diabetes. Diabetes Care 1994; 17: 818–823.

    Article  CAS  PubMed  Google Scholar 

  44. Geisler T, Anders N, Bischofs C, Rapin M, Schoelzel B, Bigalke B et al. Type II diabetes is associated with increased residual platelet aggregation in patients receiving dual antiplatelet therapy after coronary stent implantation. ePoster ESC Congress 2008. http://spo.escardio.org/eslides/view.aspx?eevtid=24&id=2876(accessed 28/02/09).

  45. Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A . New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972; 30: 595–602.

    Article  CAS  PubMed  Google Scholar 

  46. Fang ZY, Yuda S, Anderson V, Short L, Case C, Marwick TH . Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 2003; 41: 611–617.

    Article  CAS  PubMed  Google Scholar 

  47. Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, Welty TK et al. Impact of diabetes on cardiac structure and function: The Strong Heart Study. Circulation 2000; 101: 2271–2276.

    Article  CAS  PubMed  Google Scholar 

  48. Boyer JK, Thanigaraj S, Schechtman KB, Perez JE . Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004; 93: 870–875.

    Article  PubMed  Google Scholar 

  49. Galderisi M, Capaldo B, Sidiropoulos M, D'Errico A, Ferrara L, Turco A et al. Determinants of reduction of coronary flow reserve in patients with type 2 diabetes mellitus or arterial hypertension without angiographically determined epicardial coronary stenosis. Am J Hypertens 2007; 20: 1283–1290.

    Article  PubMed  Google Scholar 

  50. Pitkanen OP, Nuutila P, Raitakari OT, Ronnemaa T, Koskinen PJ, Iida H et al. Coronary flow reserve is reduced in young men with IDDM (insulin-dependent diabetes mellitus). Diabetes 1998; 47: 248–255.

    Article  CAS  PubMed  Google Scholar 

  51. Moir S, Hanekom L, Fang ZY, Haluska B, Wong C, Burgess M et al. Relationship between myocardial perfusion and dysfunction in diabetic cardiomyopathy: a study of quantitative contrast echocardiography and strain rate imaging. Heart 2006; 92: 1414–1419.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Fang ZY, Najos-Valencia O, Leano R, Marwick TH . Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine. J Am Coll Cardiol 2003; 42: 446–453.

    Article  CAS  PubMed  Google Scholar 

  53. Galderisi M, de Simone G, Innelli P, Turco A, Turco S, Capaldo B et al. Impaired inotropic response in type 2 diabetes mellitus: a Strain Rate Imaging Study. Am J Hypertens 2007; 20: 548–555.

    Article  PubMed  Google Scholar 

  54. Semeniuk LM, Kryki AJ, Severson DL . Echocardiographic assessment of cardiac function in diabetic db/db and transgenic db/db-hGLUT4 mice. Am J Physiol Heart Circ Physiol 2002; 283: H976–H982.

    Article  CAS  PubMed  Google Scholar 

  55. Golfman LS, Wilson CR, Sharma S, Burgmaier M, Young ME, Guthrie PH et al. Activation of PPAR-gamma enhances myocardial glucose utilisation and improves contractile function in isolated working hearts of ZDF rats. Am J Physiol Endocrinol Metab 2005; 289: E328–E336.

    Article  CAS  PubMed  Google Scholar 

  56. Herrero P, Peterson LR, McGill JB, Matthew S, Lesniak D, Dence C et al. Increased myocardial fatty acid metabolism in patients with type 1 diabetes mellitus. J Am Coll Cardiol 2006; 47: 598–604.

    Article  CAS  PubMed  Google Scholar 

  57. Peterson LR, Herrero P, Schechtman KB, Racette SB, Waggoner AD, Kisrieva-Ware Z et al. Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Circulation 2004; 109: 2191–2196.

    Article  PubMed  Google Scholar 

  58. Trost SU, Belke DB, Bluhm WF, Meyer M, Swanson E, Dillman WH . Overexpression of the sarcoplasmic reticulum Ca2+-ATPase improves myocardial contractility in diabetic cardiomyopathy. Diabetes 2002; 51: 1166–1171.

    Article  CAS  PubMed  Google Scholar 

  59. Scognamiglio R, Casara D, Avogaro A . Myocardial dysfunction and adrenergic innervation in patients with Type 1 diabetes mellitus. Diabetes Nutr Metab Clin Exp 2000; 13: 346–349.

    CAS  Google Scholar 

  60. Kahn JK, Zola B, Juni JE, Vinik AI . Decreased exercise heart rate and blood pressure response in diabetic subjects with cardiac autonomic neuropathy. Diabetes Care 1986; 9: 389–394.

    Article  CAS  PubMed  Google Scholar 

  61. Tedesco MA, Natale F, Di Salvo G, Caputo S, Capasso M, Calabro R . Effects of coexisting hypertension and type II diabetes mellitus on arterial stiffness. J Hum Hypertens 2004; 18: 469–473.

    Article  CAS  PubMed  Google Scholar 

  62. Jain A, Avendano G, Dharamsey S, Dasmahaptra A, Agarwal R, Reddi A et al. Left ventricular diastolic function in hypertension and role of plasma glucose and insulin: comparison with diabetic heart. Circulation 1996; 93: 1396–1402.

    Article  CAS  PubMed  Google Scholar 

  63. Govind S, Brodin LA, Nowak J, Quintana M, Raumina S Ramesh SS et al. Isolated type 2 diabetes mellitus causes myocardial dysfunction that becomes worse in the presence of cardiovascular diseases: (MYDID) Study 1. Cardiology 2005; 103: 189–195.

    Article  PubMed  Google Scholar 

  64. van Hoeven KH, Factor SM . A comparison of the pathological spectrum of hypertensive, diabetic, and hypertensive-diabetic heart disease. Circulation 1990; 82: 848–855.

    Article  CAS  PubMed  Google Scholar 

  65. Rizzoni D, Palombo C, Porteri E, Muiesan ML, Kozakova M, La Canna G et al. Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients. J Hypertens 2003; 21: 625–631.

    Article  CAS  PubMed  Google Scholar 

  66. Rizzoni D, Porteri E, Boari GEM, De Ciuceis C, Sleiman I, Muiesan ML et al. Prognostic significance of small-artery structure in hypertension. Circulation 2003; 108: 2230–2235.

    Article  PubMed  Google Scholar 

  67. Rizzoni D, Porteri E, Guelfi D, Muiesan ML, Valentini U, Cimino A et al. Structural alterations in subcutaneous small arteries of normotensive and hypertensive patients with non-insulin-dependent diabetes mellitus. Circulation 2001; 103: 1238–1244.

    Article  CAS  PubMed  Google Scholar 

  68. Rizzoni D, Porteri E, Castellano M, Bettoni G, Muiesan ML, Muiesan P et al. Vascular hypertrophy and remodeling in secondary hypertension. Hypertension 1996; 28: 785–790.

    Article  CAS  PubMed  Google Scholar 

  69. Rizzoni D, Porteri E, Guelfi D, Piccoli A, Castellano M, Pasini G et al. Cellular hypertrophy in subcutaneous small arteries of patients with renovascular hypertension. Hypertension 2000; 35: 931–935.

    Article  CAS  PubMed  Google Scholar 

  70. King GL, Goodman D, Buzney S, Moses A, Kahn CR . Receptors and growth-promoting effects of insulin and insulin like growth factors on cells from bovine retinal capillaries and aorta. J Clin Invest 1985; 75: 1028–1036.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Kamide K, Hori MT, Zhu JH, Takagawa Y, Barrett JD, Eggena P et al. Insulin and insulin-like growth factor-1 promotes angiotensinogen production and growth in vascular smooth muscle cells. J Hypertens 2000; 18: 1051–1056.

    Article  CAS  PubMed  Google Scholar 

  72. Kato H, Suzuki H, Tajima S, Ogata Y, Tominaga T, Sato A et al. Angiotensin II stimulates collagen synthesis in cultured vascular smooth muscle cells. J Hypertens 1991; 9: 17–22.

    Article  CAS  PubMed  Google Scholar 

  73. Prior JO, Quinones MJ, Hernandez-Pampaloni M, Facta AD, Schindler TH, Sayre JW et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005; 111: 2291–2298.

    Article  CAS  PubMed  Google Scholar 

  74. Taddei S, Virdis A, Mattei P, Arzilli F, Salvetti A . Endothelium-dependent forearm vasodilation is reduced in normotensive subjects with familial history of hypertension. J Cardiovasc Pharmacol 1992; 20 (Suppl 12): 193–195.

    Article  Google Scholar 

  75. Grunfeld B, Balzareti M, Romo M, Giminez M, Gutman R . Hyperinsulinemia in normotensive offspring of hypertensive parents. Hypertension 1994; 23 (Suppl I): I12–I15.

    Article  CAS  PubMed  Google Scholar 

  76. Balletshofer BM, Rittig K, Enderle MD, Volk A, Maerker E, Jacob S et al. Endothelial dysfunction is detectable in young normotensive first-degree relatives of subjects with type 2 diabetes in association with insulin resistance. Circulation 2000; 101: 1780–1784.

    Article  CAS  PubMed  Google Scholar 

  77. Vollenweider P, Randin D, Tappy L, Jequier E, Nicod P, Scherrer U . Impaired insulin-induced sympathetic neural activation and vasodilation in skeletal muscle in obese humans. J Clin Invest 1994; 93: 2365–2371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Baron AD, Bretchel-Hook G, Johnson A, Hardin D . Skeletal muscle blood flow. A possible link between insulin resistance and blood pressure. Hypertension 1993; 21: 129–135.

    Article  CAS  PubMed  Google Scholar 

  79. Grassi G, Cattaneo BM, Seravalle G, Lanfranchi A, Mancia G . Baroreflex control of sympathetic nerve activity in essential and secondary hypertension. Hypertension 1998; 31: 68–72.

    Article  CAS  PubMed  Google Scholar 

  80. Huggett RJ, Scott EM, Gilbey SG, Stoker JB, Mackintosh AF, Mary DASG . Impact of type 2 diabetes mellitus on sympathetic neural mechanisms in hypertension. Circulation 2003; 108: 3097–3101.

    Article  CAS  PubMed  Google Scholar 

  81. Bevan RD . Trophic effects of peripheral adrenergic nerves on vascular structure. Hypertension 1984; 6 (Suppl 3): 19–26.

    Google Scholar 

  82. Patel MB, Stewart JM, Loud AV, Anversa P, Wang J, Fiegel L et al. Altered function and structure of the heart in dogs with chronic elevation in plasma norepinephrine. Circulation 1991; 84: 2091–2100.

    Article  CAS  PubMed  Google Scholar 

  83. Sen S, Tarazi RC, Khairallah PA, Bumpus FM . Cardiac hypertrophy in spontaneously hypertensive rats. Circ Res 1974; 35: 775–781.

    Article  CAS  PubMed  Google Scholar 

  84. Crespo MJ, Moreta S, Gonzalez J . Cardiovascular deterioration in STZ-diabetic rats: possible role of vascular RAS. Pharmacology 2003; 68 (1): 1–8.

    Article  CAS  PubMed  Google Scholar 

  85. Zhuo JL . Monocyte chemoattractant protein-1: a key mediator of angiotensin II-induced target organ damage in hypertensive heart disease. J Hypertens 2004; 22: 451–454.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Hu FB, Stampfer MJ . Is type 2 diabetes mellitus a vascular condition? Arterioscler Thromb Vasc Biol 2003; 23: 1715–1716.

    Article  CAS  PubMed  Google Scholar 

  87. Klahr S, Morrissey JJ . The role of vasoactive compounds, growth factors and cytokines in the progression of renal disease. Kidney Int 2000; 75 (Suppl): 7–14.

    Article  Google Scholar 

  88. Turner R, Holman R, Stratton I, Cull C, Frighi V, Manley S et al. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1988; 317: 703–713.

    Google Scholar 

  89. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW . 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–1589.

    Article  CAS  PubMed  Google Scholar 

  90. National Collaborating Centre for Chronic Conditions. Type 2 diabetes: national clinical guideline for management in primary and secondary care (update). Royal College of Physicians: London 2008. http://www.nice.org.uk/nicemedia/pdf/CG66diabetesfullguideline.pdf (accessed 28/02/09) p152.

  91. Engeli S, Bohnke J, Gorzelniak K, Janke J, Schling P, Bader M et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005; 45: 356–362.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Supported in part by a Centres for Clinical Research Excellence Award (455832), National Health and Medical Research Council, Canberra, Australia.

Author information

Authors and Affiliations

  1. University of Queensland, School of Medicine, Brisbane, Queensland, Australia

    B Franjic & T H Marwick

Authors
  1. B Franjic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T H Marwick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T H Marwick.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Franjic, B., Marwick, T. The diabetic, hypertensive heart: epidemiology and mechanisms of a very high-risk situation. J Hum Hypertens 23, 709–717 (2009). https://doi.org/10.1038/jhh.2009.43

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2009.43

Keywords

This article is cited by

Search

Advanced search

Quick links