The Patient with Hypertension and Type II Diabetes mellitus in General Practice: Modern Aspects of Therapy

Abstract

The type 2 diabetes mellitus (DM) has been shown to double the risk of cardiovascular disease in men and three times in women, and the presence of hypertension (AH) further increases the risk of diabetes by four times. Among patients with hypertension, the prevalence of diabetes is 2–2,5 times higher than in people with normal blood pressure. Elevated blood pressure is one of the risk factors for the development of macro- and microvascular complications in patients with diabetes. The UKPDS study found that an increase in systolic blood pressure (CAT) for every10 mmHg. Art. in patients with type 2 diabetes was associated with an increase in mortality by 17 %, myocardial infarction – by 12 % and microvascular complications – by 13 %. On the example of the given clinical case of a patient with hypertension in combination with type II diabetes, the peculiarity of the course of the disease, risk factors are considered. Desired therapeutic target levels were determined: blood pressure <130/80 mm Hg Art., HbAlc <7 % –7,5 %; LDL cholesterol <1.8 mmol/l; weight loss by 5–7 %; slowing the progression / regression of nephropathy (microalbuminuria). The strategy of drug therapy of hypertension in combination with diabetes is combination therapy in most patients, especially in the context of lower target blood pressure levels, using to improve adherence to treatment of fixed combinations (step-by-step therapy) in one tablet for most patients.

Among the most adequate combinations of antihypertensive drugs that have an evidence base and can be used in patients with hypertension with diabetes, the following are recommended: angioconversion enzyme inhibitor (ACE inhibitor) + calcium channel blockers (BCC) + diuretic; angiotensin receptor blockers (ARBs II) + BCC + diuretic; ACE inhibitors + diuretics; ARB II + diuretic; BPC + diuretic; BPC (amlodipine, lercanidipine) + β-blocker (with vasodilating effect).