Abstract
Alberto F. Rubio-Guerra
Abstract
Hypertension and type-2 diabetes mellitus (DM2) are mayor preventable risk factors for cardiovascular disease, besides those chronic diseases tends to coexist in the same patient. In Mexico, most of hypertensive subjects have DM2, interestingly, a third of type 2 diabetic patients are hypertensive at the time of diagnosis of DM2. Indeed, each 10 mmHg of increase in the systolic pressure figures, raises the risk of microvascular complications, acute myocardial infarction and death in patients with DM2. The association also increases 6 times the risk of developing chronic kidney disease. Both diseases present interrelated and common pathophysiological mechanisms, as activation of the renin-angiotensin-aldosterone system, dysregulation in the secretion of adipokines, insulin resistance, endothelial dysfunction and increase in sympathetic tone. Interestingly, hyperglycemia is associated with an increased risk of hypertension, and poor control of arterial hypertension doubles the risk of developing DM2 The benefit of the management of arterial hypertension in the patient with DM2 is well demonstrated, unfortunately, and although nowadays we have several families of effective and safe antihypertensive agents, most diabetic hypertensive subjects remain with a suboptimal blood pressure control with immunotherapy. Indeed, combination therapy looks like a better option than increasing the dose of a single agent, then, most patients will need a combination of antihypertensive agents to achieve those therapeutic goals. However, there are few studies that show us the safety and efficacy of the different combinations in the management of arterial hypertension, and even less studies has been conducted specifically in hypertensive patients with type-2 diabetes mellitus. In this review, we analyse the latest information available about the treatment of hypertension with combination therapy in hypertensive patients with type-2 diabetes mellitus, looking for the best combination for the treatment of those patients.