Management of hypertension in cardiometabolic syndrome and diabetes with associated nephropathy

Hypertension is twice as common in people with diabetes compared with nondiabetics and accounts for up to 85% excess cardiovascular disease risk; patients with hypertension also are more prone to diabetes compared with normotensive individuals. In type 2 diabetes, hypertension tends to cluster with other components of the metabolic syndrome such as microalbuminuria, central obesity, dyslipidemia increased inflammatory, and procoagulant state. Hypertension in people with diabetes is usually associated with increased salt sensitivity, volume expansion, isolated systolic hypertension, loss of nocturnal dipping of the blood pressure and pulse, orthostatic hypotension, and microalbuminuria. Management of hypertension in this high cardiovascular disease risk population mandates the weight reduction and exercise together with the use of aspirin, lowering of low-density lipoprotein (LDL) cholesterol to 100 mg/dL (2.6 mmol/L), and blood pressure lowering to 130/80 mmHg with agents that afford cardiovascular disease and renal protection such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers. The use of thiazide-type diuretics also has been shown to reduce cardiovascular disease risk in the diabetic patients and is usually required as a part of the multidrug therapy necessary to control blood pressure in this patient population.