Mahler R J
Department of Medicine, Cornell University Medical Center, New York.
Horm Metab Res. 1990 Dec;22(12):599-607. doi: 10.1055/s-2007-1004983.
Diabetes mellitus and hypertension constitute two powerful independent risk factors for cardiovascular, renal and atherosclerotic disease. The frequent occurrence of the two diseases in the same individual doubles the risk of cardiovascular death, as well as substantially increasing the frequency of transient ischemic attacks, strokes, peripheral vascular disease with lower extremity amputations, as well as end-stage renal disease and blindness. Although hypertension usually occurs in IDDM in association with renal disease, in NIDDM the evolution of hypertension appears to be multifactorial and independent of renal disease. Obesity appears to be dissociable from hypertension and NIDDM with a common link between obesity, hypertension and NIDDM appearing to be hyperinsulinism and insulin resistance. It has been suggested that hyperinsulinism and insulin resistance may lead to hypertension through altered intracellular calcium metabolism, enhanced renal sodium reabsorption, or through an effect of insulin upon lipid and/or catecholamine metabolism. Further, insulin itself may have a direct effect upon the atherosclerotic process in the hypertensive diabetic patient. These considerations have been taken into account in the structuring of antihypertensive therapy in Type I and Type II Diabetes Mellitus.
糖尿病和高血压是心血管、肾脏及动脉粥样硬化疾病的两大独立高危因素。这两种疾病在同一个体中频繁并发，会使心血管疾病死亡风险加倍，同时也会显著增加短暂性脑缺血发作、中风、伴有下肢截肢的外周血管疾病、终末期肾病及失明的发生频率。虽然高血压通常在胰岛素依赖型糖尿病（IDDM）中与肾病并发，但在非胰岛素依赖型糖尿病（NIDDM）中，高血压的发展似乎是多因素的，且与肾病无关。肥胖似乎与高血压和NIDDM没有关联，肥胖、高血压和NIDDM之间的共同联系似乎是高胰岛素血症和胰岛素抵抗。有人提出，高胰岛素血症和胰岛素抵抗可能通过改变细胞内钙代谢、增强肾脏对钠的重吸收，或通过胰岛素对脂质和/或儿茶酚胺代谢的影响而导致高血压。此外，胰岛素本身可能对高血压糖尿病患者的动脉粥样硬化进程有直接影响。在制定I型和II型糖尿病的抗高血压治疗方案时，已考虑到这些因素。
