In type 2 diabetes mellitus, an 80% increase in blood pressure has a longer history that is not directly associated with diabetes, and is often caused by essential hypertension. Arterial hypertension in type 2 DM precedes diabetes, combined with hyperinsulinemia and insulin resistance, which are essential components of the metabolic syndrome. Already at the stage of impaired glucose tolerance, a clear correlation is revealed between the magnitude of blood pressure and carbohydrate metabolism. The prevalence of hypertension among individuals with impaired glucose tolerance is 20-40%. A prospective observation made it possible to establish a direct correlation between the degree of severity of carbohydrate metabolism disorders and the frequency of increased blood pressure in people of the middle age group. At the same time, according to Nilsson et al. (1990),in 20–30% of patients with essential hypertension, disorders of carbohydrate metabolism are detected — impaired glucose tolerance or type 2 diabetes. The frequency of nephropathy in type 2 diabetes is somewhat lower than in type 1 diabetes. However, in its presence, the incidence of hypertension increases – According to the clinic Steno, the third place among the etiological signs of hypertension. In patients with type 2 diabetes in the presence of severe chronic renal failure, the incidence of hypertension is almost 90%.In patients with type 2 diabetes in the presence of severe chronic renal failure, the incidence of hypertension is almost 90%.In patients with type 2 diabetes in the presence of severe chronic renal failure, the incidence of hypertension is almost 90%.
Other etiological factors of hypertension in diabetes include renal stone disease, chronic pyelonephritis, gout, and more rare causes: kidney tumors, paraneoplastic syndrome. Hypertension can also be caused by the combination of diabetes with other endocrine disorders (thyrotoxicosis, acromegalia, illness or Itsenko-Cushing syndrome, Conn syndrome, pheochromocytoma, etc.). Occlusive vascular lesions (coarctation of the aorta, renal artery stenosis) are also taken into account when conducting a differential diagnostic search. More details on the causes of hypertension are presented in tab. four.
The basis of the development of hypertension in diabetes is several mechanisms. The level of blood pressure is determined by the ratio of cardiac (minute) release of blood and vascular peripheral resistance. One of the pathogenetic mechanisms of increasing blood pressure may be the effect of insulin on sodium reabsorption due to a direct effect on the loop of Henle. The indirect effect of insulin is associated with the activity of the sympatho-adrenal system and the renin-angiotensin-aldosterone system, an increase in the sensitivity of vascular smooth muscle to pressor agents, and the stimulation of extracellular growth factors.
It is known that hyperglycemia increases hyperosmolarity and the volume of extracellular fluid, and compensation of carbohydrate metabolism is accompanied by a decrease in blood pressure or normalization. For diabetes, starting from the period of its manifestation, the retention of sodium and water in the body is characteristic, which is