Información del artículo
La hipertensión arterial y la diabetes mellitus tipo 2 son dos de las enfermedades que con mayor frecuencia inciden en el mundo occidental. La hipertensión en los individuos diabéticos incrementa el riesgo y acelera el curso de las enfermedades cardíacas, la enfermedad vascular periférica, el accidente vascular cerebral, la retinopatía y la nefropatía.
El presente artículo pretende revisar de forma sumarizada las relaciones existentes entre ambos procesos patológicos, con especial énfasis en los mecanismos patogenéticos comunes, entre los que destacan el papel de la resistencia a la insulina, de las alteraciones en el metabolismo iónico y del eje renina-angiotensina. Además se revisan las opciones terapéuticas que pueden incidir en el manejo de ambas enfermedades, tanto desde la perspectiva del manejo farmacológico, como de los distintos fármacos utilizados en el tratamiento de la hipertensión arterial en el enfermo diabético tipo 2.
El Texto completo está disponible en PDF
Bibliografía
[1.]
J.R. Sowers, M. Epstein.
Diabetes mellitus and associated hypertension, vascular disease and nephropathy.
Hypertension, 26 (1995), pp. 869-879
[2.]
J.H. Fuller.
Epidemiology of hypertension associated with diabetes mellitus.
Hypertension, 2 (1985), pp. 113-117
[3.]
W.B. Kannel, D.L. McGee.
Diabetes and cardiovascular risk factors: The Framingham study.
Circulation, 59 (1979), pp. 8-13
[4.]
J.H. Fuller, M.J. Shiley, G. Rose, R.J. Jarret, H. Keen.
Coronary heart disease risk and impaired glucose tolerance: the Whitehall Study.
Lancet, 1 (1980), pp. 1.373-1.376
[5.]
W.H. Pan, L.B. Cedres, K. Liu, A. Dyer, J.A. Schoenberger, R.B. Shekelle, et al.
Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and woman.
Am J Epidemiol, 123 (1986), pp. 504-516
[6.]
W.J. Butler, L.D. Ostrander, W.J. Carman, D.E. Lamphier.
Mortality from coronary heart disease in the Tecumseh study, long-term effect of diabetes mellitus, glucose tolerance and other risk factors.
Am J Epidemiol, 121 (1985), pp. 541-547
[7.]
R.D. Abbott, R.P. Donahue, S.W. MacMahon, D.M. Reed, K. Yano.
Diabetes and the risk of stroke, the Honolulu heart program.
JAMA, 257 (1987), pp. 949-952
[8.]
D. Bild, S.M. Teutsch.
The control of hypertension in persons diabetes.
A public health approach Public Health Rep, 102 (1987), pp. 522-529
[9.]
K. Borch-Johnson, R.N. Nissen, J. Nerup.
Blood pressure after 40 years of insulin-dependent diabetes.
Nephron, 4 (1985), pp. 11-12
[10.]
A. Teuscher, M. Egger, J.B. Herman.
Diabetes and hypertension: blood pressure in clinical diabetic patients and a control population.
Arch Intern Med, 149 (1989), pp. 1.942-1.945
[11.]
Consensus Statement. Proceedings from the International Workshop on Preventing the Kidney Disease of Diabetes Mellitus: Public Health Perspectives.
Am J Kidney Dis, 13 (1989), pp. 2-6
[12.]
C.K. Christensen, C.E. Mogensen.
The course of incipient diabetic nephropathy: studies of albumin excretion and blood pressure.
Diabetic Med, 2 (1985), pp. 97-102
[14.]
G. Viberti, J.J. Bending.
Early diabetic nephropathy: detection and prevention.
Adv Nephrol, 17 (1988), pp. 101-112
[15.]
W.C. Knowler, P.J. Bennett, E.J. Ballentine.
Increased incidence of retinopathy in diabetics with elevated blood pressure.
N Engl J Med, 302 (1980), pp. 645-650
[16.]
J.R. Sowers, J. Levy, M.B. Zemel.
Hypertension and diabetes.
Med Clin North Am, 72 (1988), pp. 1.399-1.414
[17.]
H.U. Janka, E. Standle, H. Mehnett.
Peripheral vascular disease in diabetes mellitus and its relationship to cardiovascular risk factors: screening with doppler ultrasonic techniques.
Diabetes care, 3 (1980), pp. 207-213
[18.]
J.A. O’Hare, J.B. Feriss, B. Twomey.
Poor metabolic control, hypertension and microangiopathy independently increase the transcapillary escape rate of albumin in diabetes.
Diabetologia, 25 (1983), pp. 260-266
[19.]
K.G. Lamping, W.P. Dole.
Acute hypertension selectively potentiates constrictor responses of large coronary arteries to serotonin by altering endothelial function in vivo.
Circ Res, 61 (1987), pp. 904-913
[20.]
A.V. Chobanian.
1989 Corcoran lecture: Adaptive and maldaptive responses of the arterial wall to hypertension.
Hypertension, 15 (1990), pp. 666-674
[21.]
M.J. García, P.M. McNamara, T. Gordon, W.B. Kannel.
Morbidity and mortality in diabetics in the Framingham population: sixteen year follow-up study.
Diabetes, 23 (1974), pp. 105-111
[22.]
National Stroke Association. Stroke prevention: the importance of risk factors.
Stroke Clinical Updates, 1 (1991), pp. 17-20
[23.]
P. Ducimetiere, E. Eschwege, L. Papoz, J.L. Richard, J.R. Claude, G. Rosselin.
Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population.
Diabetologia, 19 (1980), pp. 205-210
[24.]
F. Cambien, J.M. Warnet, E. Eschwege, A. Jacqueson, J.L. Richard, G. Rossilin.
Body mass, blood pressure, glucose and lipids: does plasma insulin explain their relationship?.
Arteriosclerosis, 7 (1987), pp. 197-202
[25.]
M. Modan, H. Halkin, A. Lusky, P. Segal, Z. Fuchs, A. Chetrit.
Hyperinsulinemia is characterized by jointly disturbed plasma VLDL, LDL, and HDL levels.
Arterioesclerosis, 8 (1988), pp. 227-236
[26.]
K. Landin, L. Stigendal, E. Eriksson, M. Krotkiewski, B. Risberg, L. Tengborn, et al.
Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1.
Metabolism, 39 (1990), pp. 1.044-1.048
[27.]
K. Landin, L. Tengbom, U. Smith.
Elevated fibrinogen and plasminogen activator inhibitor (PAI-1) in hypertension are related to metabolisc risk factors for cardiovascular disease.
J Intern Med, 227 (1990), pp. 273-278
[28.]
R.A. DeFronzo, C.R. Cooke, R. Andres, G.R. Faloona, P.J. Davis.
The effects of insulin on renal handling of sodium, potassium, calcium, and phosphate in man.
J Clin Invest, 55 (1975), pp. 845-855
[29.]
A.P. Rocchini, V. Katch, D. Kresilis, C. Moorehead, M. Martin, R. Lampman, et al.
Insulin and renal sodium retention in obese adolescents.
Hypertension, 14 (1989), pp. 367-374
[30.]
A.P. Rocchini, J. Key, D. Bondie, R. Chico, C. Moorehead, V. Katch, et al.
The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents.
N Engl J Med, 321 (1989), pp. 580-585
[31.]
M.L. Tuck, J.R. Sowers, L. Domfeld, G. Kledzik, M. Maxwell.
The effect of weight reduction on blood pressure, plasma renin activity and plasma aldosterone levels in obese patients.
N Engl J Med, 304 (1981), pp. 930-933
[32.]
J.R. Sowers, M. Nyby, N. Stern, F. Beck, S. Baron, R.A. Catunia, et al.
Blood pressure and hormone changes associated with weight reduction in the obese.
Hypertension, 4 (1982), pp. 686-691
[33.]
J.E. Hall, T.G. Coleman, H.C. Mizelle.
Does chronic insulinemia cause hypertension?.
Am J Hypertens, 2 (1989), pp. 171-173
[34.]
A.M. Fournier, M.T. Gadia, D.B. Kubrusly, J.S. Skyler, J.M. Sosenko.
Blood pressure, insulin, and glycemia in nondiabetic subjects.
Am J Med, 80 (1986), pp. 861-864
[35.]
A.L.M. Swislocki, B.B. Hoffman, G.M. Reaven.
Insulin resistence, glucose intolerance and hyperinsulinemia in patients with hypertension.
Am J Hypertens, 2 (1989), pp. 419-423
[36.]
E. Ferrannini, G. Buzzigoli, R. Bonadonna, M.A. Giorico, M. Oleggini, I. Graziadei, et al.
Insulin resistence in essential hypertension.
N Engl J Med, 317 (1987), pp. 350-357
[37.]
H. Kanai, Y. Matsuzawa, K. Kotani, Y. Keno, T. Kobatake, Y. Nagai, et al.
Close correlation of intraabdominal fat accumulation to hypertension in obese women.
Hypertension, 16 (1990), pp. 484-490
[38.]
E.A. Anderson, R.P. Hoffman, T.W. Balon, C.A. Sinkey, A.L. Mark.
Hyperinsulinemia produces both simpathetic neural activation and vasodilation in normal humans.
J Clin Inves, 87 (1991), pp. 2.246-2.252
[39.]
C.J. Mathias, D.F. daCosta, P. Fosbraey, N.J. Christesen, R. Bunmister.
Hypotensive and sedative effects of insulin in autonomic failure.
Br Med J, 295 (1987), pp. 161-163
[40.]
R.W.M.M. Jansen, B.J.M. Pentermen, H.T.J. van Lier, W.H. Hoefnagels.
Blood pressure reduction after oral glucose loading and its relation to age, blood pressure and insulin.
Am J Cardiol, 60 (1987), pp. 1.087-1.091
[41.]
S. Lillioja, A.A. Young, C.L. Culter.
Skeletal muscle capillary density and fiber type are possible determinants of in vivo insulin resistance in man.
J Clin Invest, 80 (1987), pp. 415-424
[42.]
S. Julius, T. Gutbrandsson, K. Jamerson, S.T. Shahab, O. Andersson.
The hemodynamic link between insulin resistance and hypertension.
J Hypertens, 9 (1991), pp. 983-986
[43.]
J.R. Sowers, P.R. Standley, J.L. Ram, S. Jacober, L. Simpson, K. Rose.
Hyperinsulinemia, insulin resistance, and hyperglycemia: contributing factors in the pathogenesis of hypertension and atherosclerosis.
Am J Hypertens, 6 (1993), pp. 260S-270S
[44.]
C.E. Mogensen.
Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes.
N Engl J Med, 310 (1984), pp. 356-360
[45.]
E.M. Damsgaard, A. Froland, O.D. Jorgensen, C.E. Mogensen.
Microalbuminuria as a predictor of increase of mortality in elderly people.
Br Med J, 300 (1990), pp. 297-301
[46.]
E. Ritz, M. Nowicki, D. Fliser, D. Horner, H.P. Klimm.
Proteinuria and hypertension.
Kidney International, 46 (1994), pp. S76-80
[47.]
B. Agrawal, A. Berger, K. Wolf, F.C. Luft.
Microalbuminuria screening by reagent strip predicts cardiovascular risk in hypertension.
J Hypertension, 14 (1996), pp. 223-228
[48.]
L. Mykkänen, S.M. Haffner, J. Kuusisto, K. Pyorälä, M. Laasko.
Microalbuminuria precedes the development of NIDDM.
Diabetes, 43 (1994), pp. 552-557
[49.]
R.C. Harris, B.M. Brenner, J.L. Seifert.
Sodium-hydrogen exchange and glucose transport in renal microvillus membrane vessels from rats with diabetes mellitus.
J Clin Invest, 77 (1987), pp. 724-733
[50.]
S. Reddy, S. Shehin, J.R. Sowers, G. Dardas, M. Zemel.
Aortic 45 Ca flux and blood pressure regulation in streptozotocininduced diabetic rats.
J Vasc Med Biol, 22 (1990), pp. 81-85
[51.]
M.B. Zemel, S. Reddy, S.E. Shehin, W. Lockette, J.R. Sowers.
Vascular reactivity in Zucker obese rats: Role of insulin resistance.
J Vasc Med Biol, 2 (1990), pp. 81-85
[52.]
J. Levy, M.B. Zemel, J.R. Sowers.
Role of cellular calcium metabolism in abnormalities in glucose metabolism and diabetic hypertension.
Am J Med, 87 (1989), pp. 7-16
[53.]
W. Shaeter, J. Priessen, R. Mannhold, A.F. Gries.
Ca2+-Mg2+- ATPase activity of human red blood cells in healthy and diabetic volunteers.
Klin Wochenschr, 65 (1987), pp. 17-21
[54.]
B.A. Bedford-Johnson, J.R. Sowers, P.C. Zemel, F.C. Luft, M.B. Zemel.
Increased sodium-lithium countertransport in black non-insulin-dependent diabetic hypertensives.
Am J Hypertens, 3 (1990), pp. 563-565
[55.]
J. Levy, J.R. Sowers, M.B. Zemel.
Abnormal Ca2+-ATPase activity in erythrocytes of non insulin-dependent diabetic rats.
Horm Metab Res, 22 (1990), pp. 138-142
[56.]
M. Canessa, B. Falkner, S. Hulman.
Red blood cell Na/H exchanger (EXC) activity is elevated in young hypertensive blacks.
Hypertension, 18 (1991), pp. 378
[57.]
A. Aviv, A. Livne.
The Na+/H+ antiport, cytosolic free Ca2+ and essential hypertension: A hypothesis.
Am J Hypertens, 1 (1988), pp. 410-413
[58.]
B.C. Berk, J.A. Brock, R.C. Webb, M.B. Taubman, W.J. Atkinson, M.A. Gimbrone, et al.
Epidermal growth factor a vascular smooth muscle mitogen, induces rat aortic contraction.
J Clin Invest, 75 (1985), pp. 1.083-1.086
[59.]
P. Weidmann, P. Ferrari.
Cental role of sodium in hypertension in diabetic subjects.
Diabetes care, 14 (1991), pp. 220-232
[60.]
M. Lorenzi, E. Cagliero, S. Toledo.
Glucose toxicity for human endothelial cells in culture: Delayed replication, disturbed cell cycle and accelerated death.
Diabetes, 34 (1985), pp. 621-627
[61.]
S. Roy, R. Sala, E. Cagliero, M. Lorenzi.
Overexpression of fibronectin induced by diabetes or high glucose: Phenomenon with a memory.
Proc Natl Acad Sci, 87 (1990), pp. 404-408
[62.]
M. Brownlee, A. Cerami, H. Vlassara.
Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications.
N Engl J Med, 318 (1988), pp. 1.315-1.321
[63.]
H. Vlassara, M. Brownlee, A. Cerami.
Novel macrophage receptor for glucose-modified proteins is distinct from previously described scavenger receptors.
N Engl J Med, 164 (1986), pp. 1.301-1.309
[64.]
H. Vlassara, M. Brownlee, K. Manaque, A. Pasagian, A. Cerami.
Cachectin/TNF and IL-2 synthesis and secretion are induced by glucose modified protein binding to a high affinity macrophage receptor.
Science, 240 (1988), pp. 1.546-1.548
[65.]
J. Le, J. Vileck.
Tumor necrosis factor and interleukin-1. Cytokines with multiple overlapping biological activities.
Lab Invest, 56 (1987), pp. 234-248
[66.]
J.A. O’Hare, J.B. Ferriss, D. Brady, B. Twomey, D.J. O’Sullivan.
Exchangeable sodium and renin in hypertensive diabetic patients with and without nephropathy.
Hypertension, 7 (1985), pp. II-43-II-48
[67.]
The National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on hypertension in diabetes.
Hypertension, 23 (1994), pp. 145-148
[68.]
P.H. Bennet, S. Haffner, B.L. Kasiske, W.F. Keane, C.E. Mogensen, H. Parving, et al.
Diabetic renal disease recommendations. Screening and management of microalbuminuria in patients with diabetes mellitus: recomendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the Council on Diabetes Mellitus of the National Kidney Foundation.
Am J Kidney Dis, 25 (1995), pp. 107-112
[69.]
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
BMJ, 317 (1998), pp. 703-713
[70.]
L. Hansson, A. Zanchetti, S.G. Carruthers, B. Dahlöf, D. Elmfeldt, S. Julius, et al.
Effects of intensive blood-pressure loweing and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial.
Lancet, 351 (1998), pp. 1.755-1.762
[71.]
Joint National Committee. Sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure.
Arch Intern Med, 157 (1997), pp. 2.413-2.446
[72.]
D.B. Jacobs, J.R. Sowers, A. Hmeidan, T. Niyogi, L. Simpson, P.R. Standley.
Effects on weight reduction on cellular cation metabolism and vascular resistance.
Hypertension, 21 (1993), pp. 308-314
[73.]
K. Pyorala, T.R. Pedersen, J. Kjekshus, O. Faergeman, A.G. Olsson, G. Thorgeirsson.
Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A sub-group analysis of the Scandinavian Simvastatin Survival Study (4S).
Diabetes Care, 20 (1997), pp. 614-620
[74.]
West of Scotland Prevention Group. Influence of pravastatin and plasma lipids on clinical events in the West of Scotland Coronary Prevention Study (WOSCOPS.
Circulation, 97 (1998), pp. 1.440-1.445
[75.]
F.M. Sacks, M.A. Pfeffer, L.A. Moye, J.L. Rouleau, J.D. Rutherford, T.G. Cole, et al.
The effect of pravastatin on coronary events after miocardial infarction in patients with average cholesterol levels.
N Engl J Med, 335 (1996), pp. 1.001-1.009
[76.]
B.L. Kasiske, R.S. Kalil, J.Z. Ma, M. Liao, W.F. Keane.
Effect of antihypertensive therapy on the kidney in patients with diabetes: A meta-regression analysis.
Ann Intern Med, 118 (1993), pp. 129-138
[77.]
P. Weidmann, L.M. Boehlen, M. De Courten.
Effect of different antihypertensive drugs on diabetic proteinuria.
Nephrol Dial Trasplant, 8 (1993), pp. 582-584
[78.]
M. Ravid, H. Savin, I. Jutrin, T. Bental, B. Katz, M. Lishner.
Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients.
Ann Intern Med, 118 (1993), pp. 577-581
[79.]
Y. Lacourciere, A. Nadeau, L. Poirier, G. Tancrede.
Captopril or conventional therapy in hypertensive type II diabetics: Three year analysis.
Hypertension, 21 (1993), pp. 786-794
[80.]
G.L. Bakris, J.B. Copley, N. Vicknair, R. Sadler, S. Leurgans.
Calcium channel blockers versus other antihypertensive therapies on progression of NIDDM associated nephropathy.
Kidney Int, 50 (1996), pp. 1.641-1.650
[81.]
T. Lejmert, I. Lubrich-Birkner, K. Dreyling, P. Scholmeyer.
Effect of captopril and diltiazem on proteinuria: A cross-over double-blind study (abstract.
J Am Soc Nephrol, (1996), pp. 1.322
[82.]
J. Tuomilehto, D. Rastenyte, W.H. Birkenhager, L. Thijs, R. Antikainen, C. Bulpitt, et al.
for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Effects of calcium- channel blockade in older patients with diabetes and systolic hypertension.
N Engl J Med, 340 (1999), pp. 677-684
[83.]
R.O. Estacio, B.W. Jeffers, W.R. Hiatt, S.L. Biggerstaff, N. Gifford, R.W. Schrier.
The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with noninsulin dependent diabetes and hypertension.
N Engl J Med, 338 (1998), pp. 645-652
[84.]
P. Tatti, M. Pahor, R.P. Byington, P. di Mauro, R. Guarisco, G. Strollo, et al.
Outcome results of the fosinopril versus amlodipine cardiovascular events randomized trial (FACET) in patients with hypertension and NIDDM.
Diabetes Care, 21 (1998), pp. 597-603
[85.]
J.D. Curb, S.L. Pressel, J.A. Cutler, P. Savage, W.B. Applegate, H. Black, et al.
for the Systolic Hypertension in the Elderly Cooperative Research Group. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension.
JAMA, 276 (1996), pp. 1.886-1.892
[86.]
UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes; UKPDS 39.
BMJ, 317 (1998), pp. 713-720
[87.]
L. Hansson, L.H. Lindholm, L. Niskanen, J. Lanke, T. Hedner, A. Niklason, et al.
Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPP) randomised trial.
Lancet, 353 (1999), pp. 611-616
[88.]
P.S. Meheler, R.W. Schrier.
Antihypertensive therapy in patients with diabetic nephropathy.
Kidney Blood Pres Res, 20 (1997), pp. 74-81
[89.]
A. Remuzzi, N. Perico, C.S. Amuchastegui, B. Malanchini, M. Mazerska, C. Battaglia, et al.
Short- and long-term effect of angiotensin II receptor blockade in rats with experimental diabetes.
J Am Soc Nephrol, 4 (1993), pp. 40-49
[90.]
M. Phol, M. Cooper, J. Ulrey, J. Pauls, R. Rohde.
Safety and efficacy of irbesartan in hypertensive type II diabetics.
Am J Hypertens, 10 (1997), pp. 105a
Copyright © 2000. Sociedad Española de Hipertension-Liga Española para la Lucha de la Hipertensión Arterial (SEH-LELHA)