ABSTRACT
Hypertension as a risk factor for microangiopathy Although diabetic microangiopathy is undoubtedly multifactorial in origin, numerous studies have demonstrated a relationship between hypertension and the risk of development of microangiopathy. Most compelling are recent data from the UKPDS showing that tight blood pressure control retards the development of microangiopathic complications in patients with type II diabetes.1 The Pima Indian study demonstrated that over a 5-year period the incidence of retinal exudates in diabetic subjects with systolic pressures 145 mmHg2 was more than twice that of subjects whose systolic pressure was 125 mmHg of mercury. As far as diabetic nephropathy is concerned, controversy has raged as to whether hypertension is an initiating factor or develops concurrently with the appearance of increased protein leak. The latter view is currently favoured,3 although there are conflicting data suggesting that patients prone to nephropathy more commonly have a family history of hypertension.4,5 However, the link with hypertension and nephropathy is emphasised by the fact that hypotensive therapy delays the progression of the nephropathic process.6
