Diabetes mellitus and arterial hypertension

Main Article Content

V.O. Serhiyenko
O.O. Serhiyenko


This review article summarizes the existing literature on the current state of the problem of diabetes mellitus and arterial hypertension. According to the World Health Organization, hypertension and type 2 diabetes mellitus, after obesity, are among the leading cardiovascular risk factors that are most common among the world’s population. Over the past 30 years, the prevalence of hypertension has decreased to a quarter of the world’s population, but the incidence of diabetes mellitus has increased from 4.7 to 8.5 %, and the forecast for the future indicates a further dramatic increase. Improving awareness, treatment and control of these diseases is a major goal of the global health system. The prevalence of hypertension in patients with type 2 diabetes mellitus is up to three times higher than in patients without diabetes mellitus, and the combination of hypertension and diabetes mellitus significantly increases the likelihood of developing cardiovascular disease. The unfavorable relationship between these two conditions, accelerating the processes of atherosclerosis, can cause negative pathophysiological changes in the cardiovascular system. Also, it is known that cardiovascular autonomic neuropathy, resulting from damage to the autonomic nerve fibers that innervate the heart and blood vessels, is a significant complication of type 2 diabetes mellitus, especially in the presence of systemic hypertension. In particular, the issues related to common pathophysiological mechanisms, main systemic and metabolic factors that may contribute to the development of diabetes mellitus and hypertension comorbidity are analyzed. Classification, features of diagnosis of arterial hypertension, assessment of the disorders of the organs mediated by arterial hypertension are presented. Issues related to the main approaches of arterial hypertension treatment in diabetes mellitus are analyzed, namely prescription of the inhibitors of the renin-angiotensin system, calcium channel blockers, thiazide, and thiazide-like diuretics, beta-adrenergic receptor antagonists, alpha-blockers, mineralocorticoid-receptor antagonists as well as the features of combined therapy and treatment of resistant arterial hypertension.

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How to Cite
Serhiyenko, V., and O. Serhiyenko. “Diabetes Mellitus and Arterial Hypertension”. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), vol. 17, no. 2, May 2021, pp. 175-88, doi:10.22141/2224-0721.17.2.2021.230573.
Literature Review


International Diabetes Federation (IDF). IDF Diabetes Atlas, 8th ed. Brussels, Belgium: International Diabetes Federation; 2017. 150 p.

Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015 Oct 27;132(17):1667-78. doi:10.1161/CIRCULATIONAHA.114.008720.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017 Jan 7;389(10064):37-55. doi:10.1016/S0140-6736(16)31919-5.

NICE. Hypertension in adults: diagnosis and management. 2019. Available from: www.nice.org.uk/guidance/ng136. Accessed: 28 August 2019.

Lin J, Thompson TJ, Cheng YJ, et al. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr. 2018 Jun 15;16(1):9. doi:10.1186/s12963-018-0166-4.

Muntner P, Einhorn PT, Cushman WC, et al; 2017 National Heart, Lung, and Blood Institute Working Group. Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019 Jan 29;73(3):317-335. doi:10.1016/j.jacc.2018.10.069.

Colussi G, Da Porto A, Cavarape A. Hypertension and type 2 diabetes: lights and shadows about causality. J Hum Hypertens. 2020 Feb;34(2):91-93. doi:10.1038/s41371-019-0268-x.

Lastra G, Syed S, Kurukulasuriya LR, Manrique C, Sowers JR. Type 2 diabetes mellitus and hypertension: an update. Endocrinol Metab Clin North Am. 2014 Mar;43(1):103-22. doi:10.1016/j.ecl.2013.09.005.

Savoia C, Touyz RM. Hypertension, Diabetes Mellitus, and Excess Cardiovascular Risk: Importance of Baseline Systolic Blood Pressure. Hypertension. 2017 Nov;70(5):882-883. doi:10.1161/HYPERTENSIONAHA.117.09764.

Carthy ER. Autonomic dysfunction in essential hypertension: A systematic review. Ann Med Surg (Lond). 2013 Dec 11;3(1):2-7. doi:10.1016/j.amsu.2013.11.002.

Bassi D, Cabiddu R, Mendes RG, et al. Effects of Coexistence Hypertension and Type II Diabetes on Heart Rate Variability and Cardiorespiratory Fitness. Arq Bras Cardiol. 2018 Jul;111(1):64-72. doi:10.5935/abc.20180105.

Mori H, Saito I, Eguchi E, Maruyama K, Kato T, Tanigawa T. Heart rate variability and blood pressure among Japanese men and women: a community-based cross-sectional study. Hypertens Res. 2014 Aug;37(8):779-84. doi:10.1038/hr.2014.73.

Amiya E, Watanabe M, Komuro I. The Relationship between Vascular Function and the Autonomic Nervous System. Ann Vasc Dis. 2014;7(2):109-19. doi:10.3400/avd.ra.14-00048.

Dong JG. The role of heart rate variability in sports physiology. Exp Ther Med. 2016 May;11(5):1531-1536. doi:10.3892/etm.2016.3104.

Arroyo-Carmona RE, López-Serrano AL, Albarado-Ibañez A, et al. Heart Rate Variability as Early Biomarker for the Evaluation of Diabetes Mellitus Progress. J Diabetes Res. 2016;2016:8483537. doi:10.1155/2016/8483537.

Jin L, Min G, Wei C, Min H, Jie Z. Exercise training on chronotropic response and exercise capacity in patients with type 2 diabetes mellitus. Exp Ther Med. 2017 Mar;13(3):899-904. doi:10.3892/etm.2017.4084.

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

Sun D, Zhou T, Heianza Y, et al. Type 2 Diabetes and Hypertension. Circ Res. 2019 Mar 15;124(6):930-937. doi:10.1161/CIRCRESAHA.118.314487.

Tsimihodimos V, Gonzalez-Villalpando C, Meigs JB, Ferrannini E. Hypertension and Diabetes Mellitus: Coprediction and Time Trajectories. Hypertension. 2018 Mar;71(3):422-428. doi:10.1161/HYPERTENSIONAHA.117.10546.

Sowers JR. Diabetes mellitus and vascular disease. Hypertension. 2013 May;61(5):943-7. doi:10.1161/HYPERTENSIONAHA.111.00612.

Khangura D, Hong J, Kurukulasuriya R, Sowers JR. Diabetes and hypertension. In: Rodriguez-Saldana J, editor. The Diabetes Textbook. Cham: Springer Nature Switzerland AG; 2019. 573-585pp. doi:10.1007/978-3-030-11815-0_37.

Poulter NR, Castillo R, Charchar FJ, et al. Are the American Heart Association/American College of Cardiology High Blood Pressure Guidelines Fit for Global Purpose?: Thoughts From the International Society of Hypertension. Hypertension. 2018 Aug;72(2):260-262. doi:10.1161/HYPERTENSIONAHA.118.11452.

Williams B, Mancia G, Spiering W, et al; Authors/Task Force Members. 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 and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018 Oct;36(10):1953-2041. doi:10.1097/HJH.0000000000001940.

Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-1357. doi:10.1161/HYPERTENSIONAHA.120.15026.

Valenza G, Citi L, Garcia RG, Taylor JN, Toschi N, Barbieri R. Complexity Variability Assessment of Nonlinear Time-Varying Cardiovascular Control. Sci Rep. 2017 Feb 20;7:42779. doi:10.1038/srep42779.

Stergiou GS, O'Brien E, Myers M, et al; STRIDE BP Scientific Advisory Board. STRIDE BP international initiative for accurate blood pressure measurement: Systematic review of published validation studies of blood pressure measuring devices. J Clin Hypertens (Greenwich). 2019 Nov;21(11):1616-1622. doi:10.1111/jch.13710.

Stergiou GS, Palatini P, Modesti PA, et al. Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens. 2020 Jul;38(7):1235-1243. doi:10.1097/HJH.0000000000002341.

Serhiyenko VA, Serhiyenko LM, Serhiyenko AA, authors. Recent advances in the treatment of neuropathies in type 2 diabetes mellitus patients: focus on benfotiamine (review and own data), Charter 1. In: Berhardt LV, ed. Advances in Medicine and Biology (Numbered series). New York: Nova Science Publishers; 2020. 1-80 pp.

Vinik AI, Casellini C, Parson HK, Colberg SR, Nevoret ML. Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events. Front Neurosci. 2018 Aug 27;12:591. doi:10.3389/fnins.2018.00591.

Rabi DM, McBrien KA, Sapir-Pichhadze R, et al. Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020 May;36(5):596-624. doi:10.1016/j.cjca.2020.02.086.

Dedov II, Shestakova MV, Mayorov AYu, et al. Standards of specialized diabetes care. 9th ed. Diabetes mellitus. 2019;22(1S1):1-144. doi:10.14341/DM221S1. (in Russian).

He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013 Apr 3;346:f1325. doi:10.1136/bmj.f1325.

Gay HC, Rao SG, Vaccarino V, Ali MK. Effects of Different Dietary Interventions on Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Hypertension. 2016 Apr;67(4):733-9. doi:10.1161/HYPERTENSIONAHA.115.06853.

Cicero AFG, Grassi D, Tocci G, Galletti F, Borghi C, Ferri C. Nutrients and Nutraceuticals for the Management of High Normal Blood Pressure: An Evidence-Based Consensus Document. High Blood Press Cardiovasc Prev. 2019 Feb;26(1):9-25. doi:10.1007/s40292-018-0296-6.

Xie C, Cui L, Zhu J, Wang K, Sun N, Sun C. Coffee consumption and risk of hypertension: a systematic review and dose-response meta-analysis of cohort studies. J Hum Hypertens. 2018 Feb;32(2):83-93. doi:10.1038/s41371-017-0007-0.

Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health. 2017 Feb;2(2):e108-e120. doi:10.1016/S2468-2667(17)30003-8.

GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1345-1422. doi:10.1016/S0140-6736(17)32366-8.

Costa EC, Hay JL, Kehler DS, et al. Effects of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training On Blood Pressure in Adults with Pre- to Established Hypertension: A Systematic Review and Meta-Analysis of Randomized Trials. Sports Med. 2018 Sep;48(9):2127-2142. doi:10.1007/s40279-018-0944-y.

Solano López AL. Effectiveness of the Mindfulness-Based Stress Reduction Program on Blood Pressure: A Systematic Review of Literature. Worldviews Evid Based Nurs. 2018 Oct;15(5):344-352. doi:10.1111/wvn.12319.

Wang J, Xiong X. Evidence-based chinese medicine for hypertension. Evid Based Complement Alternat Med. 2013;2013:978398. doi:10.1155/2013/978398.

Liwa AC, Smart LR, Frumkin A, Epstein HA, Fitzgerald DW, Peck RN. Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review. Curr Hypertens Rep. 2014 Jun;16(6):437. doi:10.1007/s11906-014-0437-9.

Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2015 Feb 10;313(6):603-15. doi:10.1001/jama.2014.18574.

de Boer IH, Bangalore S, Benetos A, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Sep;40(9):1273-1284. doi:10.2337/dci17-0026.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71(6):e13-e115. doi:10.1161/HYP.0000000000000065.

Mooradian AD. Diabetes and Atherogenic Dyslipidemia In: Rodriguez-Saldana J, editor. The Diabetes Textbook. Cham: Springer Nature Switzerland AG; 2019. 587-596pp. doi:10.1007/978-3-030-11815-0_38.

American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1):S111-S134. doi:10.2337/dc20-S010.

Bando H. Recommended management of hypertensive patients with diabetes for renin-angiotensin system (RAS) inhibitors. Diab Res Open Access. 2020 Apr 16;2(1):4-8. doi:10.36502/2020/droa.6161.

Haneda M, Noda M, Origasa H, et al. Japanese Clinical Practice Guideline for Diabetes 2016. J Diabetes Investig. 2018 Mar 26;9(3):657–97. doi:10.1111/jdi.12810.

Bangalore S, Fakheri R, Toklu B, Messerli FH. Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials. BMJ. 2016 Feb 11;352:i438. doi:10.1136/bmj.i438.

Wright JT Jr, Williamson JD, Whelton PK, et al; SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16. doi:10.1056/NEJMoa1511939.

Serhiyenko AA, Serhiyenko VA. Diabetic cardiomyopathy: treatment. Mìžnarodnij endokrinologìčnij žurnal. 2020;16(8):669-680. doi:10.22141/2224-0721.16.8.2020.222888. (in Ukrainian).

Palmer SC, Mavridis D, Navarese E, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. Lancet. 2015 May 23;385(9982):2047-56. doi:10.1016/S0140-6736(14)62459-4.

Catalá-López F, Macías Saint-Gerons D, González-Bermejo D, et al. Cardiovascular and Renal Outcomes of Renin-Angiotensin System Blockade in Adult Patients with Diabetes Mellitus: A Systematic Review with Network Meta-Analyses. PLoS Med. 2016 Mar 8;13(3):e1001971. doi:10.1371/journal.pmed.1001971.

Parving HH, Brenner BM, McMurray JJ, et al; ALTITUDE Investigators. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 2012 Dec 6;367(23):2204-13. doi:10.1056/NEJMoa1208799.

Mancia G, Schumacher H, Redon J, et al. Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET). Circulation. 2011 Oct 18;124(16):1727-36. doi:10.1161/CIRCULATIONAHA.110.008870.

Koval SM, Yushko KO, Snihurska IO, et al. Relations of angiotensin-(1-7) with hemodynamic and cardiac structural and functional parameters in patients with hypertension and type 2 diabetes. Arterial Hypertension. 2019;23(3):183-189. doi:10.5603/AH.a2019.0012.

Iliescu R, Lohmeier TE, Tudorancea I, Laffin L, Bakris GL. Renal denervation for the treatment of resistant hypertension: review and clinical perspective. Am J Physiol Renal Physiol. 2015 Oct 1;309(7):F583-94. doi:10.1152/ajprenal.00246.2015.

Bakris GL, Pitt B, Weir MR, et al; AMETHYST-DN Investigators. Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease: The AMETHYST-DN Randomized Clinical Trial. JAMA. 2015 Jul 14;314(2):151-61. doi:10.1001/jama.2015.7446.

Filippatos G, Anker SD, Böhm M, et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J. 2016 Jul 14;37(27):2105-14. doi:10.1093/eurheartj/ehw132.

Diabetes Canada Clinical Practice Guidelines Expert Committee; Tobe SW, Gilbert RE, Jones C, Leiter LA, Prebtani APH, Woo V. Treatment of Hypertension. Can J Diabetes. 2018 Apr;42 Suppl 1:S186-S189. doi:10.1016/j.jcjd.2017.10.011.