Type 2 diabetes mellitus and hypertension

Arterial hypertension (HTN) is a major risk factor both for atherosclerotic cardiovascular disease (ASCVD) and for microvascular complications of diabetes mellitus (DM). While the evolution of type 2 DM doubles the cardiovascular risk in men and triples it in women, HTN increases the cardiovascular risk by four times in DM patients. ASCVD represent the main cause of morbidity and mortality for DM patients and it is the highest contributor of direct and indirect costs for DM. Obesity, age, onset of chronic kidney disease (CKD) favor increasing of HTN prevalence. DM and HTN represent additional risk factors for ASCVD. Type 2 DM is characterized by a long duration of insulin resistance, with compensatory hyperinsulinemia and various degrees of hyperglycemia, associated to a high cardiovascular risk and development of macrovascular complications before diagnosis. Decrease of arterial pressure with various treatment plans proved to be efficient in reducing the cardiovascular events. Although proof regarding the distinct advantages of renin-angiotensin system (RAS) inhibitors on the ASCVD results in DM still remain unclear, the high risk for ASCVD associated to DM and high prevalence of undiagnosed ASCVD may continue to favor recommendations for using RAS inhibitors as a first line antihypertensive treatment in persons with DM. The main objective in treating HTN in DM patients is to decrease blood pressure (BP) < 140/90 (ADA and JNC8), or BP < 140/85 (ESC/EASD) mm Hg. In order to reach these values, a combination of several antihypertensive drugs is required in various patients with HTN and DM.