THERAPEUTIC MANAGEMENT OF ARTERIAL HYPERTENSION, DYSLIPIDEMIAS AND OBESITY IN DIABETIC PATIENTS

Abstract

The main death cause in diabetic patients is cardiovascular disease. Atherosclerosis in these patients is more extense and involves a greater number of vessels, probably due to the simultaneous presence of several risk factors and hyperglycemia itself. In this paper, we review the diagnosis and treatment of several risk factors often found in type 2 diabetic patients: arterial hypertension, dyslipidemia and obesity. Arterial hypertension is present in about 50% of the patients and the recommended ideal blood pressure levels are below 130x80 mm of Hg. In order to achieve this goal, it is usually necessary to employ 2 or 3 antihypertensive agents. Particularly useful drugs are: angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, beta-blockers or thiazide diuretics. Obesity involves the majority of type 2 patients and a weight reduction such as 10 kg is associated to a significant improvement in glycemic, pressoric and lipidic profile. Anti-obesity drugs like orlistat and sibutramine are safe and when associated to life style changes can promote a 6% to 10% weight reduction. In patients with morbid obesity and no response to these agents, prescription of one of the several kinds of bariatric surgery should be considered. Dyslipidemia, characterized by elevated serum triglycerides and low HDL cholesterol levels, is typically present in diabetic patients, who also frequently show high serum LDL. To reach the recommended levels of LDL (< 100 mg/ dl), the majority of patients will need to use statins. Some patients with persistent hypertriglyceridemia despite initial dietary treatment, will require a fibric acid prescription. The treatment of the several risk factors in diabetic patients, associated with the use of cardioprotective drugs (aspirin, converting enzyme
inhibitors and beta-blockers) can reduce cardiovascular risk in 80%.