Pathophysiology of hypertension and endothelial dysfunction in patients with diabetes mellitus

There is compelling evidence for endothelial dysfunction in patients with t ype 1 and type 2 diabetes. This dysfunction is manifest as blunting of the biologic effect of a potent endothelium-derived vasodilator, nitric oxide, and increased production of vasoconstrictors such as angiotensin II, Et-1, and cyclooxygenase and lipoxygenase products of arachidonic acid metabolism . These agents and other cytokines and growth factors whose production they stimulate cause acute increases in vascular tone, resulting in increases i n blood pressure, and vascular and cardiac remodeling that contributes to t he microvascular, macrovascular, and renal complications in diabetes. Many adverse vascular consequences are associated with endothelial dysfunction i n diabetes mellitus. Treatment with antioxidants and with inhibitors of the renin-angiotensin system may reverse some of the pathologic vascular chang es associated with endothelial dysfunction.