Epidemiology and Clinical Features of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus. Literature Review

Hypertension and type 2 diabetes mellitus are often combined and mutually enhance the adverse effect on vascular and renal prognosis. Hypertension is present in about 50 % of patients with type 2 diabetes, and diabetes, in turn, is detected in about 20 % of people with hypertension. The risk of developing hypertension in patients with type 2 diabetes is 2-2.5 times higher than in people without diabetes; the presence of hypertension increases the risk of type 2 diabetes by the same number of times. Hypertension and diabetes mutually burden each other: on the one hand, the presence of hypertension significantly increases the likelihood of developing diabetic macro- and microvascular complications (including diabetic nephropathy and retinopathy); on the other hand, type 2 diabetes, as a classic independent cardiovascular risk factor, increases the risk of complications inherent in hypertension by about 2 times Careful treatment of diabetes with maintenance of target values of glycemia for a long time may be associated with a decrease in the likelihood of developing hypertension by 24 % compared with less adequate control of glycemia. Hypertension in type 2 diabetes may have a number of features that distinguish such patients from the general population of people with hypertension. Such features include a higher proportion of isolated systolic hypertension and resistant hypertension, certain types of circadian rhythm disorders of blood pressure (categories “non-dipper” and “night-peaker”), frequent combination with albuminuria, frequent high salt sensitivity and volume-dependent nature of hypertension, and others.

1. Petrie J.R., Guzik T.J., Touyz R.M. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018; 34(5): 575-584. doi: 10.1016/j.cjca.2017.12.005.

2. Pavlou D.I., Paschou S.A., Anagnostis P. et al. Hypertension in patients with type 2 diabetes mellitus: Targets and management. Maturitas. 2018; 112: 71-77. doi: 10.1016/j.maturitas.2018.03.013

3. Kobalava Zh.D., Konradi A.O., Nedogoda S.V. et al. 2022 The Russian Society of Cardiology. Arterial hypertension in adults. Clinical recommendations (draft). [Electronic resource]. https://scardio.ru/content/Guidelines/project/KR_AG.pdf [in Russian].

4. Boned Ombuena P., Rodilla Sala E., Costa Muñoz J.A. et al. Hipertensión arterial y prediabetes [Arterial hypertension and prediabetes]. Med Clin (Barc). 2016; 147(9): 387-392. Spanish. doi: 10.1016/j.medcli.2016.06.032

5. Vallée A., Safar M.E., Blacher J. Hypertension artérielle permanente essentielle: définitions et revue hémodynamique, clinique et thérapeutique [Essential hypertension: Definitions, hemodynamic, clinical and therapeutic review]. Presse Med. 2019; 48(1 Pt 1): 19-28. French. doi: 10.1016/j.lpm.2018.11.017. Epub 2019 Jan 18. PMID: 30665781.

6. Cordero A., Lekuona I., Galve E. et al. Sección de Hipertensión Arterial, Grupo de Trabajo Corazón y Diabetes, Grupo de Trabajo Cardio-Renal, Sociedad Española de Cardiología, España. Novedades en hipertensión arterial y diabetes mellitus [Advances in arterial hypertension and diabetes mellitus]. Rev Esp Cardiol (Engl Ed). 2012; 65 Suppl 1: 12-23. Spanish. doi: 10.1016/j.recesp.2011.10.030. PMID: 22269836.

7. Cockcroft J.R., Webb D.J., Wilkinson I.B. Arterial stiffness, hypertension and diabetes mellitus. J Hum Hypertens. 2000; 14(6): 377-80. doi: 10.1038/sj.jhh.1001023. PMID: 10878698.

8. Hadjkacem F., Triki F., Frikha H. et al. L’hypertension artérielle masquée chez les diabétiques de type 2: Prévalence, facteurs associés et retentissement cardiovasculaire [Masked arterial hypertension in patients with type2 diabetes mellitus: Prevalence, associated factors and cardiovascular impact]. Ann Cardiol Angeiol (Paris). 2022; 71(3): 136-140. French. doi: 10.1016/j.ancard.2021.10.018.

9. Rolim L.P., Samelli A.G., Moreira R.R. et al. Effects of diabetes mellitus and systemic arterial hypertension on elderly patients’ hearing. Braz J Otorhinolaryngol. 2018; 84(6): 754-763. doi: 10.1016/j.bjorl.2017.08.014.

10. Abrignani M.G. Physical exercise and risk of arterial hypertension and diabetes mellitus. Let’s move, it is never too late. Eur J Prev Cardiol. 2018; 25(10): 1063-1064. doi: 10.1177/2047487318781116.

11. Dedov I.I., SHestakova M.V., Majorov A.YU. et al. Clinical guidelines 2022 Type 2 diabetes mellitus in adults. 2022: 1-228. https://diseases.medelement.com/disease/сахарный-диабет-2-типа-у-взрослых-кр-рф-2022/17220 [in Russian].

12. Draznin B., Aroda V.R., Bakris G. et al. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022 American Diabetes Association Professional Practice Committee. 2022; 45(Suppl 1): 144-174. doi: 10.2337/dc22-S010.

13. Smulyan H., Lieber A., Safar M.E. Hypertension, Diabetes Type II, and Their Association: Role of Arterial Stiffness. Am J Hypertens. 2016; 29(1): 5-13. doi: 10.1093/ajh/hpv107.

14. Tirapani L.D.S., Fernandes N.M.D.S. A narrative review of the impacts of income, education, and ethnicity on arterial hypertension, diabetes mellitus, and chronic kidney disease in the world. Saudi J Kidney Dis Transpl. 2019; 30(5): 1084-1096. doi: 10.4103/1319-2442.270264.

15. de Lira C.A.B., Viana R.B., Luz N.F., et al. Analysis of type 2 diabetes mellitus and arterial hypertension content in exercise physiology textbooks. Adv Physiol Educ. 2019; 43(3): 253-258. doi: 10.1152/advan.00043.2019.

16. Scheen A.J. Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 2. Overview of physiological and biochemical mechanisms. Diabetes Metab. 2004; 30: 498–505. https://www.sciencedirect.com/science/article/abs/pii/S1262363607701477

17. Filimonova A.S., Rasova S.A., Sopenko I.V. et al. Arterial hypertension and related factors in patients with type 2 diabetes mellitus. Current scientific research in the modern world. 2021; № 12-1(80): 143-148 [in Russian].

18. Rishko O.A., Derbak M.A., Ihnatko Y.Y. et al. The clinical experience of the effective use of dapagliflozin in comorbid cardiac patients with concomitant type 2 diabetes mellitus and arterial hypertension on the background of overweight in outpatient setting. Wiad Lek. 2022; 75(10): 2397-2401. doi: 10.36740/WLek202210114.

19. Berra C., Manfrini R., Regazzoli D. et al. Blood pressure control in type 2 diabetes mellitus with arterial hypertension. The important ancillary role of SGLT2-inhibitors and GLP1-receptor agonists. Pharmacol Res. 2020; 160: 105052. doi: 10.1016/j.phrs.2020.105052.

20. Chahoud J., Mrad J., Semaan A. Prevalence of diabetes mellitus among patients with essential arterial hypertension. J Med Liban. 2015;63(2):74-80. doi: 10.12816/0012554.

21. Chernatska O., Demikhova N. Improvement of treatment in persons with arterial hypertension and type 2 diabetes mellitus. Georgian Med News. 2018; (284): 47-51.

22. Babkin, A.P. Optimization of the treatment of hypertension in patients with diabetes mellitus. System analysis and management in biomedical systems. 2020; T. 19, № 4:37-41 [in Russian].

23. Steffen P.L.S., Mendonça C.S., Meyer E. et al. Motivational Interviewing in the Management of Type 2 Diabetes Mellitus and Arterial Hypertension in Primary Health Care: An RCT. Am J Prev Med. 2021 May; 60(5): e203-e212. doi: 10.1016/j.amepre.2020.12.015.

24. ElSayed N.A., Aleppo G., Aroda V.R. et al. Standards of Care in Diabetes—2023. Diabets Care. 2023; 46(S1): 1-291. doi: https://diabetesjournals.org/care/issue/46/Supplement_1

25. Comini L.O., de Oliveira L.C., Borges L.D. et al. Prevalence of chronic kidney disease in Brazilians with arterial hypertension and/or diabetes mellitus. J Clin Hypertens (Greenwich). 2020 Sep; 22(9): 1666-1673. doi: 10.1111/jch.13980.

26. Gerstein H.C., Yusuf S., Mann J.F.E. et al. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 2000; 355: 253–259. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)12323-7/fulltext

27. Arnold, S.V., Bhatt D.L., Barsness G.W. et al. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation. 2020; 141: 779–806. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000766

28. Yusuf S., Teo K., Anderson C. et al. Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators; Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: A randomised controlled trial. Lancet. 2008; 372: 1174–1183. https://www.sciencedirect.com/science/article/abs/pii/S0140673608612428

29. Williams B., Mancia G., Spiering W. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal. 2018; 39(33): 3021–3104. https://doi.org/10.1093/eurheartj/ehy339

30. De Boer I.H., Bangalore S., Benetos А.et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes care. 2017; 40 (9): 1273-1284. http://medi-guide.meditool.cn/ymtpdf/F042CABB-0E65-6FBB-5BED-D29701E8024A.pdf

31. Arnold S.V., Bhatt D.L., Barsness G.W. et al. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation. 2020; 141: 779–806. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000766

32. Strawn W.B. Ferrario C.M. Mechanisms linking angiotensin II and atherogenesis. Curr. Opin. Lipidol. 2002; 13: 505–512. https://journals.lww.com/co-lipidology/abstract/2002/10000/mechanisms_linking_angiotensin_ii_and.6.aspx

33. de Boer I.H., Bangalore S., Benetos A. et all. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017; 40: 1273–1284. http://medi-guide.meditool.cn/ymtpdf/F042CABB-0E65-6FBB-5BED-D29701E8024A.pdf

34. Gerstein H.C., Mann J.F., Pogue J. et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care. 2000; 23 (Suppl. 2): 35–39. https://www.proquest.com/openview/766619903e52ede1e8b15966e32931c2/1?pq-origsite=gscholar&cbl=47715

35. Patel A. MacMahon S., Chalmers J. et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): A randomised controlled trial. Lancet. 2007; 370: 829–840. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61303-8/fulltext?code=lancet-site&isEOP=true

36. Jamerson K., Weber M.A., Bakris G.L. et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N. Engl. J. Med. 2008; 359: 2417–2428. https://www.nejm.org/doi/full/10.1056/nejmoa0806182

37. Weber M.A., Bakris G.L., Jamerson K. et al. Cardiovascular events during differing hypertension therapies in patients with diabetes. J. Am. Coll. Cardiol. 2010; 56: 77–85. https://www.jacc.org/doi/abs/10.1016/j.jacc.2010.02.046

38. Epstein M. Adding spironolactone to conventional antihypertensives reduces albuminuria in patients with diabetic nephropathy. Nat. Clin. Pract. Nephrol. 2006; 2: 310–311. https://www.nature.com/articles/ncpneph0192

39. Mehdi U.F., Adams-Huet B., Raskin P. et al. Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximal angiotensin-converting enzyme inhibition in diabetic nephropathy. J. Am. Soc. Nephrol. 2009; 20: 2641–2650. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794224/

40. Tuomilehto J., Rastenyte D., Birkenhäger W.H. et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N. Engl. J. Med. 1999; 340: 677–684. https://www.nejm. org/doi/full/10.1056/nejm199903043400902

41. Xu G., Chen J., Jing G. et al. Preventing β-cell loss and diabetes with calcium channel blockers. Diabetes. 2012; 61: 848–856. https://diabetesjournals.org/diabetes/article/61/4/848/15920/Preventing-Cell-Loss-and-Diabetes-With-Calcium

42. Zhang X., Zhao Q. Association of Thiazide-Type Diuretics With Glycemic Changes in Hypertensive Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials. J. Clin. Hypertens. 2016; 18: 342–351. https://onlinelibrary.wiley.com/doi/full/10.1111/jch.12679

43. Gupta A.K., Dahlof B., Dobson J. et al. Anglo-Scandinavian Cardiac Outcomes Trial Investigators. Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. Diabetes Care. 2008; 31: 982–988. https://diabetesjournals.org/care/article/31/5/982/29987/Determinants-of-New-Onset-Diabetes-Among-19-257

44. Bangalore S., Parkar S., Grossman E. et al. A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus. Am. J. Cardiol. 2007; 100: 1254–1262. https://www.sciencedirect.com/science/article/abs/pii/S000291490701332X

45. Fisker F.Y., Grimm D., Wehland M. Third-generation betaadrenoceptor antagonists in the treatment of hypertension and heart failure. Basic Clin. Pharmacol. Toxicol. 2015; 117: 5–14. https://onlinelibrary.wiley.com/doi/full/10.1111/bcpt.12396

46. Borges L.D., Comini L.O., de Oliveira L.C. et al. Hypertriglyceridemic waist phenotype and associated factors in individuals with arterial hypertension and/or diabetes mellitus. J Nutr Sci. 2021 Sep 14; 10: e74. doi: 10.1017/jns.2021.71.

47. Nascimento-Souza M.A., Lima-Costa M.F., Peixoto S.V. “A body shape index” and its association with arterial hypertension and diabetes mellitus among Brazilian older adults: National Health Survey (2013). Cad Saude Publica. 2019; 35(8): e00175318. doi: 10.1590/0102-311X00175318.