Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Diabetes Mellitus And Hypertension As Risk Factor For Cardiovascular Disease

Risk factor generally applies to a variable that can predict a future cardiovascular event, but some of these predictors are also potential target for intervention. Several risk factors such as diabetes mellitus (DM) and hypertension, are modifiable, and trials have demonstrated that lowering these factors reduces vascular risk. DM causes microvascular diseases such as nephropathy, neuropathy and retinopathy, and macrovascular disease (atherosclerosis). Atherosclerosis of the coronary, cerebral, and peripheral arteries account for approximately 80% of mortality and for 75% of hospitalization in persons with DM. Patients with DM at similar risk to no diabetes with prior myocardial infarction. The HbAlc (glicated hemoglobin) remains a major focus of therapy. A meta-analysis of cardiovascular outcomes in three trials (ACCORD, ADVANCE, and VADT) suggested that every HbAlc reduction of 1% may be associated with a 15% relative risk reduction in nonfatal myocardial infarction but without benefits o stroke or all-cause mortality. There were suggestive in these trials that patients without overt coronary artery disease, with shorter duration of DM and lower baseline HbAlc , benefited from the more intensive strategies. Not everyone benefits from aggressive glucose management. It is important to individualize treatment targets. Hypertension often co-exists with DM, such that 80% of patients with DM are hypertension, and up to 20% of subjects with hypertension are diabetic. Patients with DM and hypertension are at high risk and require effetive BP lowering. Indeed, DM doubles the risk of cardiovascular events in patients with hypertension. There are two critical parts to the treatment of hypertension in patients with DM. According to contemporary guidelines, BP should be reduced to below 140/80 mmHg or < 130/80 mmHg for certain individuals and the primary antihypertensive drug should be a blocker of the renin-angiotensin system (RAS), either an angiotensin receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACED. Studies have consistenly demonstrated that elevated systolic or diastolic blood pressure (BP) is associated with an increased risk of cardiovascular disease. A meta-analysis of 61 prospective observational studies suggested that BP reduction of 2 mmHg associated with 7-10% risk reduction in cardiovascular events. Initiate therapy with two drugs either as separate prescription or in fixed-dose combination should be given when BP more than 20 mmHg above systolic goal or 10 mmHg above diastolic goal. A Proactive management plan should include patient-centered care not only for controlling glycemia and hypertension. Lipid lowering, lifestyle cganges and daily aspirin also important variables that contribute to risk reduction of cardiovascular event.