Over 50% of patients with
diabetes mellitus, either type 1 or 2, ultimately develop
hypertension as a complication. In diabetics, this further increases the incidence of
cardiovascular disease (CVD) by 2- to 3-fold and accelerates the progression of
diabetic nephropathy.
Arteriosclerosis, a clinical feature of
hypertension in diabetics, develops and advances from a young age. Therefore, in providing treatment, it is necessary to evaluate the degree of
arteriosclerosis. Diabetic patients are encouraged to strictly control their
blood glucose levels. Recently developed drugs, such as
GLP-1 receptor agonists,
DPP-4 inhibitors and
SGLT2 inhibitors, also have hypotensive actions, making them ideal for use in diabetics with
hypertension.
SGLT2 inhibitors and
GLP-1 receptor agonists reportedly suppress the onset and progression of CVD, as well as
diabetic nephropathy. The possibility of
hypoglycemia triggering blood pressure elevation and
arrhythmia has been noted, so a key point here is not to cause
hypoglycemia. In selecting hypotensive agents, we must choose types that do not aggravate
insulin resistance and engage in hypotensive treatment that also considers both nocturnal and morning
hypertension. In addition, facing the onset of an aging society, there is a growing need for treatments that do not cause excessive blood pressure reduction or
hypoglycemia. Favorable lifelong blood pressure and
glucose control are increasingly important for the treatment of diabetes accompanied by
hypertension.