Abnormalities of glucose, insulin, and lipoprotein metabolism are comm
on in patients with hypertension. This constellation of risk factors m
ay be recognized at a young ages and is, at least in part, inheritable
. Insulin resistence and compensatory hyperinsulinemia may be primary
events, and enhanced sympathetic activity and diminished adrenal medul
lary activity could be important links between the defect in insulin a
ction and the development of hypertension and the associated metabolic
abnormalities. But not all hypertensive patients have insulin resiste
nce. It is possible that insulin resistence, and compensatory hyperins
ulinemia have major roles in the regulation of blood pressure in susce
ptible subjects predisposed to hypertension by hereditary or environme
ntal factors. Considerable evidence, both in experimental animal model
s and in humans, points to hypertension as being of critical importanc
e in the pathogenesis of severe diabetic heart disease. In diabetic hy
pertensive cardiomyopathy, coronary artery disease as well as structur
al and functional abnormalities are more pronounced than would be expe
cted from either process alone. The hypertension increases the risk of
diabetic nephropathy in non-insulin-dependent diabetic patients. Micr
oalbuminuria is a powerful predictor of mortality in these patients. I
t seems that angiotensin-converting-inhibitors have efficacy in postpo
ning nephropathy in hypertensive non-insulin-dependent diabetic patien
ts. In patients with hypertension and diabetes, additional clinical tr
ials are required to identify the interventions that will most effecti
vely reduce not only overall risk but also improve cardiovascular dise
ase prognosis.