Komorbidität von Hypertonie und Typ-2-Diabetes

Zusammenfassung

Hypertonie ist ein eigenständiger kardiovaskulärer und renaler Risikofaktor. Das absolute Risiko einer Hypertonie wird aber im Wesentlichen durch Komorbiditäten bestimmt. Dabei nimmt der Diabetes mellitus eine Schlüsselrolle ein, da er die Prognose hypertensiver Patienten dramatisch verschlechtert. Epidemiologische Daten zeigen, dass Hypertoniker etwa doppelt so häufig wie Normotensive einen Diabetes mellitus entwickeln. Andererseits weisen Patienten mit Diabetes mellitus mit 70–90% eine erhöhte Hypertonieprävalenz auf. Unter den möglichen, zugrunde liegenden Mechanismen dieser häufigen Komorbidität von Hypertonie und Diabetes mellitus nimmt die Konstellation Übergewicht/Adipositas eine Schlüsselrolle ein. Die Mechanismen sowohl einer Adipositas-assoziierten Hypertonie als auch die Verknüpfung von Adipositas und Typ-2-Diabetes sind mittlerweile zum Teil aufgeklärt. Nach Manifestation eines Diabetes kann dieser, insbesondere durch das Auftreten einer diabetischen Nephropathie, die Entwicklung einer Hypertonie weiter begünstigen. Andererseits kann eine Hypertonie, möglicherweise vermittelt durch strukturelle Veränderungen der Mikrozirkulation, die Insulinsensitivität peripherer Gewebe, z.B. der Muskulatur, weiter einschränken. Prävention als auch Therapie von Übergewicht/Adipositas kommen daher in der kardiovaskulären und renalen Prävention eine Schlüsselrolle zu.

Summary

Hypertension is an independent cardiovascular and renal risk factor. However, the absolute risk associated with hypertension is largely dependent on comorbidities. In this context diabetes is a key factor to dramatically increase the risk for cardiovascular and renal events in patients with hypertension. Epidemiological data demonstrate that the prevalence of diabetes in hypertensive patients is approximately twice that in the general population. On the other hand, patients with diabetes exhibit high rates of hypertension ranging between 70–90%. Among the underlying mechanisms of this prevalent comorbidity of hypertension and diabetes, overweight/obesity has been identified to play a crucial role. The mechanisms of both obesity associated hypertension and diabetes have in part been elucidated. After manifestation of diabetes hypertension may also be promoted by renal functional changes due to diabetic nephropathy. Hypertension, on the other hand, may further impair insulin sensitivity by structural changes within the microcirculation. Prevention and therapy of overweight/ obesity thus play a key role in cardiovascular and renal prevention.

Schlüsselwörter

Hypertonie - Diabetes mellitus - Adipositas - Übergewicht

Keywords

Hypertension - diabetes mellitus - obesity - overweight

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