Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection.
Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection.
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DOI：
10.1111/j.1751-7176.2011.00434.x
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发表时间：
2011-04
期刊：
影响因子：
--
通讯作者：
Dagogo-Jack S
中科院分区：
文献类型：
--
作者：
Long AN;Dagogo-Jack S
高达75%的成年糖尿病患者同时患有高血压，而仅患有高血压的患者往往表现出胰岛素抵抗的迹象。因此，高血压和糖尿病是常见的相互交织的疾病，在潜在的风险因素（包括种族，家族，血脂异常和生活方式决定因素）和并发症方面有显著的重叠。这些并发症包括微血管和大血管疾病。在长期糖尿病或高血压患者中公认的大血管并发症包括冠状动脉疾病、心肌梗死、中风、充血性心力衰竭和外周血管疾病。尽管微血管并发症（视网膜病变、肾病和神经病变）通常与高血糖症相关，但研究表明高血压构成了重要的风险因素，尤其是肾病。糖尿病和高血压的家族易感性似乎是多基因起源的，这阻碍了控制或预防这些疾病的“基因治疗”方法的可行性。另一方面，高血压和糖尿病病因学中共同的生活方式因素为非药物干预提供了充足的机会。因此，糖尿病和高血压管理的最初方法必须强调体重控制、体育活动和饮食调整。有趣的是，生活方式干预在糖尿病和高血压的一级预防中非常有效。这些原则也适用于预防这两种疾病的下游大血管并发症。除了改变生活方式外，大多数患者还需要特定的药物来实现高血压和糖尿病的国家治疗目标。高血糖、高血压、血脂异常和潜在的高凝状态和促炎状态的管理需要联合使用多种药物。
Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance. Thus, hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications. These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease. Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy. The familial predisposition to diabetes and hypertension appears to be polygenic in origin, which militates against the feasibility of a “gene therapy” approach to the control or prevention of these conditions. On the other hand, the shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for nonpharmacological intervention. Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification. Interestingly, lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders. In addition to lifestyle modification, most patients will require specific medications to achieve national treatment goals for hypertension and diabetes. Management of hyperglycemia, hypertension, dyslipidemia and the underlying hypercoagulable and proinflammatory states requires the use of multiple medications in combination.
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影响因子：
13.2
作者：
Bakris, GL;Williams, M;Sowers, J
通讯作者：
Sowers, J
影响因子：
5.4
作者：
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120.7
作者：
Congdon, NG;Friedman, DS;Lietman, T
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Lietman, T
影响因子：
120.7
作者：
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影响因子：
158.5
作者：
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通讯作者：
Huang, Grant D.