Perin P C, Maule S, Quadri R
Department of Internal Medicine, University of Turin, Torino, Italy.
Clin Exp Hypertens. 2001 Jan-Feb;23(1-2):45-55. doi: 10.1081/ceh-100001196.
Hypertension is twice as frequent in diabetic patients than in the general population. Its prevalence is higher in Type 2 than in Type 1 diabetes: in the former, the onset of hypertension often precedes the diagnosis of diabetes, whereas, in the latter it is strictly related to the presence of nephropathy. Sympathetic nerve overactivity is crucial in the pathogenesis of hypertension in diabetes. It can be related to the activation of the renin-angiotensin-aldosterone (RAA) system in Type 1 diabetic patients with chronic renal failure, or to a condition of insulin resistance/hyperinsulinemia in Type 2 patients with the metabolic syndrome. In patients with early autonomic neuropathy, vagal impairment can lead to a relative predominance of sympathetic activity in the sympatho-vagal balance. In these patients, the onset of hypertension is frequently preceded by reduced nocturnal dipping. Sympathetic overactivity stimulates RAA activity, promotes sodium reabsorption, and increases heart rate, stroke volume and peripheral vascular resistance, thus inducing hypertension and increasing cardiovascular risk. A number of drugs acting either directly or indirectly on sympathetic activity are available for the treatment of hypertension in diabetic subjects. Opinions on the potential advantages of the metabolic profile of some of these drugs are as yet conflicting.
高血压在糖尿病患者中的发病率是普通人群的两倍。2型糖尿病患者的高血压患病率高于1型糖尿病患者：在前者中，高血压的发病往往先于糖尿病的诊断，而在后者中，高血压与肾病的存在密切相关。交感神经活动过度在糖尿病高血压的发病机制中起关键作用。它可能与1型糖尿病慢性肾衰竭患者肾素-血管紧张素-醛固酮（RAA）系统的激活有关，或者与2型代谢综合征患者的胰岛素抵抗/高胰岛素血症状态有关。在早期自主神经病变患者中，迷走神经功能受损可导致交感-迷走神经平衡中交感神经活动相对占优势。在这些患者中，高血压的发作之前常常出现夜间血压下降减弱。交感神经活动过度会刺激RAA活动，促进钠重吸收，并增加心率、心输出量和外周血管阻力，从而诱发高血压并增加心血管风险。有多种直接或间接作用于交感神经活动的药物可用于治疗糖尿病患者的高血压。关于其中一些药物对代谢状况的潜在优势的观点尚无定论。
