Intended for healthcare professionals

Clinical Review

Prevention and early detection of vascular complications of diabetes

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:475

Prevention and early detection of vascular complications of diabetes

Hypertension in a critical determinant of the development and
progression of both the macrovascular and microvascular complications of
diabetes. Importantly, hypertension is common in the setting of insulin
resistance; 70% of patients with type 2 diabetes have a blood pressure
greater than or equal to 140/90 mmHg. Multiple clinical trials have
demonstrated a close correlation between blood pressure and cardiovascular
events and mortality, development and progression of nephropathy, and
progression of retinopathy and development of blindness. For example, in
the United Kingdom Prospective Diabetes Study (UKPDS), every 10 mmHg
decrease in mean systolic pressure was associated with reduced risk by 12%
for any diabetic complication, 15% for diabetes-related deaths, 11% for
myocardial infarction, 13% for macrovascular complications, and a no risk
threshold was found for any end-point studies [1]. In addition,
hypertension exacerbates diabetic cardiomyopathy, enhancing the
progression to heart failure, which occurs commonly in patients with
diabetes. Because of these pathophysiological relationships to renal and
cardiovascular disease, hypertension increases mortality in diabetes by 4
–5 fold.

1. Adler, A.I., et al., Association of systolic blood pressure with
macrovascular and microvascular complications of type 2 diabetes (UKPDS
36): prospective observational study. Bmj, 2000. 321(7258): p. 412-9.

Competing interests:
None declared

Competing interests: No competing interests

07 September 2006
Consultant Surgeon