Marre M, Berrut G, Bouhanick B
Service de Médecine B, Centre Hospitalier Universitaire, Angers, France.
Biomed Pharmacother. 1993;47(2-3):61-6. doi: 10.1016/0753-3322(93)90292-s.
The association of arterial hypertension and diabetes mellitus is frequent: one third of patients attending a diabetic clinic. Excess hypertension frequency is marked in type II, non insulin-dependent diabetes, a condition often associated with other vascular risk factors such as obesity and lipid disorders. Insulin resistance is a common feature between type II diabetes, hypertension and other risk factors. In type I, insulin-dependent diabetes, hypertension is often linked to diabetic nephropathy. There is a genetic basis for diabetic nephropathy, which may share a common background with familial hypertension. Apart from possible genetic predispositions to hypertension diabetes association, chronic hyperglycaemia can lead to alteration in functional and structural properties of blood and vessels, which both contribute to elevated vascular resistance and blood pressure. From a therapeutic viewpoint, blood pressure values above 140/90 mmHg are not tolerable in diabetic subjects under 40 years of age. Due to their renal haemodynamic effects, angiotensin I converting enzyme inhibitors may be of special interest to protect kidney function in diabetic subjects.
在糖尿病诊所就诊的患者中有三分之一患有这种疾病。在II型非胰岛素依赖型糖尿病中，高血压的发生率过高，这种疾病常与肥胖和脂质紊乱等其他血管危险因素相关。胰岛素抵抗是II型糖尿病、高血压和其他危险因素的共同特征。在I型胰岛素依赖型糖尿病中，高血压常与糖尿病肾病有关。糖尿病肾病存在遗传基础，可能与家族性高血压有共同的背景。除了高血压与糖尿病关联可能存在的遗传易感性外，慢性高血糖会导致血液和血管的功能及结构特性发生改变，这两者都会导致血管阻力和血压升高。从治疗角度看，40岁以下的糖尿病患者血压值高于140/90 mmHg是不可耐受的。由于其对肾脏血流动力学的影响，血管紧张素I转换酶抑制剂可能对保护糖尿病患者的肾功能特别有意义。
