New Research: A Physiological Link Between Hypertension and Diabetes

Two of the most prevalent disorders are hypertension and diabetes. Hypertension affects 30% of the population in the world or approximately 1 billion persons.¹ About 460 million persons are living with diabetes around the world.² These 2 disorders, if physiologically linked, could provide an opportunity for a major research breakthrough to develop novel therapeutic targets, either with currently available therapies or with new agents.

High levels of sympathetic nerve activity are present in hypertension and type 2 diabetes.³ The high sympathetic tone, over time, leads to altered regulation of carotid baroreceptors.⁴ Alterations in the carotid bodies are important to blood pressure control.⁵ However, the role of carotid bodies in glucose control has yet to be well defined.⁶

Researchers in the United Kingdom investigated molecular targets implicated in energy metabolism mediated by carotid bodies, which were associated with regulation of sympathetic outflow of experimental hypertension.⁶ They discovered that activation of glucagon-like peptide 1 receptors (GLP1R), which are expressed in hypoxia-sensing glomus cells of the carotid bodies, suppresses sympathetic and arterial pressure responses. Reduction of the GLP1R in the carotid body is associated with increased sympathetic drive in a model of cardiometabolic disease.

The importance of this finding may explain, in part, the antihypertensive effects of GLP1R agonist therapy, which may serve in the near future as a therapeutic target for controlling abnormal sympathetic activity in hypertension and diabetes. A potential singular treatment for both disorders would be most welcome to treat worldwide cardiometabolic disease.

References:

1. Alexander MR. What is the global prevalence of hypertension (high blood pressure)? Medscape. Accessed February 2, 2022. https://www.medscape.com/answers/241381-7614/what-is-the-global-prevalence-of-hypertension-high-blood-pressure
2. Elflein J. Diabetes—Statistics and Facts. Statista. Published February 18, 2021. Accessed February 2, 2022. https://www.statista.com/topics/1723/diabetes/
3. Carmethon MR, Jacobs DR Jr, Sidney S, Liu K. Influence of autonomic nervous system dysfunction on the development of type 2 diabetes: the CARDIA study. Diabetes Care. 2003;26(11):3035-3041. doi:10.2337/diacare.26.11.3035
4. McBryde FD, Abdala AP, Hendy EB, et al. The carotid body as a putative therapeutic target for the treatment of neurogenic hypertension. Nat Commun. 2013;4:2395. doi:10.1038/ncomms3395
5. Niewinski P, Janczak D, Rucinski A, et al. Carotid body resection for sympathetic modulation in systolic heart failure: Results from the first-in-man study. Eur J Heart Fail. 2017;19(3):391-400. doi:10.1002/ejhf.641
6. Pauza AG, Thakkar P, Tasic T, et al. GLP1R attenuates sympathetic response to high glucose via carotid body inhibition. Circ Res. Published online February 1, 2022. doi:10.1161/CIRCRESAHA.121.319874