Srpski Arhiv za Celokupno Lekarstvo (Jan 2005)
The prevalence of hypertension and microalbuminuria in diabetes mellitus type 1 and type 2
Abstract
INTRODUCTION. The prevalence of hypertension is two times higher in diabetics than in non-diabetics. In type 1 diabetes mellitus (T1DM), the incidence of hypertension is similar to the incidence of nephropathy. In obese patients with type 2 DM (T2DM) there can be associated complications of hyperinsulinaemia, dyslipidaemia, and hypertension, which can lead to coronary artery disease and stroke. These associated complications are the result of a genetic defect that produces insulin resistance - Syndrome X. Increased microalbuminuria correlates with increased levels of blood pressure (BP) and increased LDL cholesterol, and this is why microalbuminuria is associated with an increase in cardiovascular deaths in diabetics, even in the absence of renal failure. AIM. The aim of this study was to research the influence of a patient's age, diabetes duration, and obesity on the frequency of hypertension and its association with microalbuminuria inT1DM and T2DM. METHOD. 168 hospitalized patients with DM (79T1DM, 89T2DM) were analyzed. The main outcome measures were: 24-hour urinary albumin excretion rate by radioimmunoassay (MA=30-30O mg/24h), arterial hypertension (systolic BP>140 mm Hg and/or diastolic BP>90 mm Hg), and body mass index (BMI). RESULTS. Microalbuminuria was detected in 42% of patients with T1DM and 47% of patients with T2DM. 34% of T1DM patients and 78% of T2DM patients were hypertensive. Patients were divided into four groups, according to the presence of hypertension and microalbuminuria; Group I - patients with hypertension and MA, Group II - patients with hypertension but without MA, Group III - patients without hypertension and MA, Group IV - patients without hypertension but with MA. 44% of T1DM patients were without hypertension and microalbuminuria, while the most frequent T2DM patients were those with hypertension (37% with and 41% without microalbuminuria). A significant correlation between BMI and diastolic BP in both types of DM (p<0.01 for T1 DM, and p<0.05 for T2DM) was discovered. T2DM hypertensive patients were obese and there was a significant correlation between a patient's systolic BP and his or her age (p<0.05). CONCLUSION. These results suggest that hypertension can be prevented in patients with T2DM with weight reduction. There was a significant association between hypertension and microalbuminuria, especially in T1DM patients. Tight control of blood pressure is essential for the reduction of microalbuminuria as well as further micro- and macro-vascular diabetic complications.
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