Hypertension

Hypertension is a major risk factor for cardiovascular disease (CVD). It substantially increases the risk for coronary heart disease (CHD), stroke, and nephropathy. There is a positive association between hypertension and insulin resistance and the evidence of a causal link is growing. When hypertension coexists with diabetes, as it commonly does, the risk of stroke or CVD is doubled and the risk for developing end-stage renal disease increases to 5-6 times, compared to hypertensive patients without diabetes. In this chapter we discuss the interaction of hypertension, insulin resistance, and other CVD risk factors in the context of the metabolic syndrome, emphasizing the unique aspects of hypertension in patients with diabetes. Therapy for hypertension is discussed in the light of the major prospective trials available to date, such as the HOPE, RENAAL, IDNT, and IRMA.