Hypertension with diabetes mellitus: physiology and pathology

Hypertension with diabetes mellitus: physiology and pathology Elevated blood pressure is closely related to increased circulatory fluid volume and peripheral vascular resistance. Patients with diabetes mellitus experience increased peripheral artery resistance caused by vascular remodeling and increased body fluid volume associated with insulin resistance-induced hyperinsulinemia and hyperglycemia. Both of these mechanisms elevate systemic blood pressure. Thus, fully understanding the pathophysiology of hypertension in diabetes mellitus requires knowing the natural history of type 2 diabetes. Patients exhibit hyperinsulinemia with insulin resistance due to impaired glucose tolerance and early-stage diabetes. Hypertension occurs because of increased body fluid volume. After reaching mid-stage diabetes the vascular remodeling has progressed and peripheral vascular resistance also contributes to hypertension. Moreover, vascular remodeling strongly influences diabetic complications. Specifically, afferent arteriolar remodeling during diabetic nephropathy leads to increased glomerular pressure. Thus, treatment with a renin-angiotensin system inhibitor that promotes renal damage regression is critical to lowering the systemic blood pressure and dilating efferent arterioles to reduce glomerular pressure. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Hypertension Research Springer Journals

Hypertension with diabetes mellitus: physiology and pathology

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Publisher
Springer Journals
Copyright
Copyright © 2018 by The Japanese Society of Hypertension
Subject
Medicine & Public Health; Medicine/Public Health, general; Internal Medicine; Public Health; Geriatrics/Gerontology; Obstetrics/Perinatology/Midwifery; Health Promotion and Disease Prevention
ISSN
0916-9636
eISSN
1348-4214
D.O.I.
10.1038/s41440-018-0034-4
Publisher site
See Article on Publisher Site

Abstract

Elevated blood pressure is closely related to increased circulatory fluid volume and peripheral vascular resistance. Patients with diabetes mellitus experience increased peripheral artery resistance caused by vascular remodeling and increased body fluid volume associated with insulin resistance-induced hyperinsulinemia and hyperglycemia. Both of these mechanisms elevate systemic blood pressure. Thus, fully understanding the pathophysiology of hypertension in diabetes mellitus requires knowing the natural history of type 2 diabetes. Patients exhibit hyperinsulinemia with insulin resistance due to impaired glucose tolerance and early-stage diabetes. Hypertension occurs because of increased body fluid volume. After reaching mid-stage diabetes the vascular remodeling has progressed and peripheral vascular resistance also contributes to hypertension. Moreover, vascular remodeling strongly influences diabetic complications. Specifically, afferent arteriolar remodeling during diabetic nephropathy leads to increased glomerular pressure. Thus, treatment with a renin-angiotensin system inhibitor that promotes renal damage regression is critical to lowering the systemic blood pressure and dilating efferent arterioles to reduce glomerular pressure.

Journal

Hypertension ResearchSpringer Journals

Published: Mar 19, 2018

References

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