Cardiovascular diseases (CVDs) are the major causes of mortality in persons
with diabetes, and many factors, including hypertension, contribute to thi
s high prevalence of CVD. Hypertension is approximately twice as frequent i
n patients with diabetes compared with patients without the disease. Conver
sely, recent data suggest that hypertensive persons are more predisposed to
the development of diabetes than are normotensive persons. Furthermore, up
to 75% of CVD in diabetes may be attributable to hypertension, leading to
recommendations for more aggressive treatment tie, reducing blood pressure
to < 130/85 mm Hg) in persons with coexistent diabetes and hypertension. Ot
her important risk factors for CVD in these patients include the following:
obesity, atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysf
unction, platelet hyperaggregability, coagulation abnormalities, and "diabe
tic cardiomyopathy." The cardiomyopathy associated with diabetes is a uniqu
e myopathic state that appears to be independent of macrovascular/microvasc
ular disease and contributes significantly to CVD morbidity and mortality i
n diabetic patients, especially those with coexistent hypertension. This up
date reviews the current knowledge regarding these risk factors and their t
reatment, with special emphasis on the cardiometabolic syndrome, hypertensi
on, microalbuminuria, and diabetic cardiomyopathy. This update also examine
s the role of the renin-angiotensin system in the increased risk for CVD in
diabetic patients and the impact of interrupting this system on the develo
pment of clinical diabetes as well as CVD.