Arterial hypertension and type 1 diabetes mellitus

Abstract

Arterial hypertension in patients with type 1 diabetes, due to diagnosis and treatment, remains heavyweight clinical problem. In comparison with general population, hypertension in this group of patients, is more common and more malignant. It is connected with increased risk of macroangiopathy and microangiopathy, and cardiovascular deaths in young people. Pathogenesis of arterial hypertension in patients with type 1 diabetes, despite of the predominant role of diabetic nephropathy, is multifactorial and closely related to metabolic control of diabetes. Lack of big clinical trials considering this issue and unspecified guidelines of scientific associations, cause that treatment of hypertension in this group of patients has empirical character. Therefore at assortment of antihypertensive drugs in this patients we have to take under consideration, beside conclusions from studies on type 2 diabetes, also etiopathogenesis of the disease and usually young age of these patients and also particular conditionings (intensive insulinotherapy) and clinical situations typical for this group of patients e.g. higher risk of hypoglycaemia and possibility or plans of geting pregnant in young women. Antihypertensive drugs of first choice in DM 1 are ACEI, and ARB are only alternative in case of side effects. In medical care of patients with DM 1 and blood pressure disturbances cooperation between diabetologists and specialists in hypertension is necessary.