Welcome to this special issue of Cardiovascular Endocrinology focused on hypertension in patients with type 2 diabetes 1. Both disorders are highly prevalent on a global basis and often cosegregate in individuals. This conjunction elevates the risk of the development and progression of long-term microvascular and macrovascular complications 2. Hence, we believe that this is a topic worthy of in-depth consideration.
Hypertension and diabetes have been described in terms of ‘bad companions’ (Professor Ele Ferrannini, University of Pisa) 3 and ‘a fatal attraction’ (Professor Bryan Williams, University College Hospital, London) 4. Researchers and clinical specialists in both diabetes and hypertension have long been engaged in efforts to delineate the aetiopathogenesis and best treatment for elevated blood pressure in the context of diabetes 5,6. The intimate association between these disorders sits securely within the aims of the journal – that is, to highlight aspects of medicine wherein endocrinology and metabolism intersect with cardiovascular disease.
Optimal management of hypertension requires a sound understanding of pathophysiology (including endothelial dysfunction, arterial remodelling, vascular inflammation and increased vascular stiffness) allied to an in-depth appreciation of the efficacy, safety and mechanisms of action of antihypertensive pharmacotherapy 7. Crucial to the clinical objective of reducing morbidity and mortality is certainty about optimal blood pressure targets 8,9. It may come as something of a surprise to nonspecialists (who treat the great majority of patients with diabetes and/or hypertension) that despite the accumulation of data from major clinical trials the latter issue remains controversial 10.
The articles in this special edition – each written by acknowledged experts – provide a state-of-the-art overview of aspects of hypertension in type 2 diabetes. We start with a scene-setting editorial from Rhian Touyz, immediate past-president of the International Society for Hypertension; the evidence base for current blood pressure targets is considered by Mattias Brunstrom and Bo Carlberg and also by Michael Cryer and colleagues; Peter M. Nilsson proposes focuses on arterial stiffness as a biomarker of early vascular ageing and as a treatment target; Andrew Krentz considers the effects of glucose-lowering drugs on blood pressure; Niklas Rossen and Klavs Hansen review novel diagnostic markers and the emerging role of chronotherapy.
Rounding off the contents of the special issue are papers on hypertension in patients with type 2 diabetes that were presented at the September 2016 European Association for the Study of Diabetes 52nd Annual Meeting in Munich, together with highlights of a scientific debate based on the clinical implications of the recently published Systolic Blood Pressure Intervention Trial 11. Systolic Blood Pressure Intervention Trial was a study in patients at risk but excluding diabetes. Nevertheless, a heated debate has started on the methods 12 used and the applicability of blood pressure targets for patients with type 2 diabetes.
We thank the authors for their contributions and hope the special issue will provide a valuable update for clinicians and clinical researchers working in the fields of hypertension and diabetes.
Conflicts of interest
There are no conflicts of interest.
1. Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes Metab Syndr Obes 2013; 6:327–338.
2. Stratton IM, Cull CA, Adler AI, Matthews DR, Neil HA, Holman RR. Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75). Diabetologia 2006; 49:1761–1769.
3. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet 2012; 380:601–610.
4. Williams B. Blood pressure and diabetes: a fatal attraction. Eur Heart J 2013; 34:3395–3397.
5. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities – the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334:374–381.
6. Sowers JR. Insulin resistance and hypertension. Am J Physiol Heart Circ Physiol 2004; 286:H1597–H1602.
7. Cameron AC, Lang NN, Touyz RM. Drug treatment of hypertension: focus on vascular health. Drugs 2016. [Epub ahead of print].
8. Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015; 313:603–615.
9. Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ 2016; 352:i717.
10. Horr S, Nissen S. Managing hypertension in type 2 diabetes mellitus. Best Pract Res Clin Endocrinol Metab 2016; 30:445–454.
11. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373:2103–2116.
12. Kjeldsen SE, Lund-Johansen P, Nilsson PM, Mancia G. Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension 2016; 67:808–812.