Speaker Abstract

The Effect of Hypertension on Diabetes Outcomes

Ellen Burgess, University of Calgary, Calgary T2N 2T9.

Hypertension develops more commonly in persons with diabetes than in those without it, and is an independent risk factor for the development of nephropathy. Treatment of hypertension with non-specific medications such as diuretics has been shown to reduce the risk of cardiovascular events, and slow the rate of deterioration of renal function. More specific treatment with an ACE inhibitor (ACEI) has been shown to also slow the rate of deterioration of renal function even moreso in patients with type I diabetes; preliminary evidence supports this in type 2 diabetes.

As well, ACEI therapy appears to slow the development of proliferative retinopathy. The effect of an ACEI may be beyond just the lowering of the hypertension; angiotensin 11, which appears to be important in diabetic hypertension, stimulates growth factors like TGF-beta (transforming growth factor-beta) which in turn causes fibrosis and destruction in many tissues including the heart, kidney and vascular smooth muscle layers. The benefits of ACEI and potentially also angiotensin type 1 receptor blockers includes the interruption of the effects of these growth factors and cytokines.