The relationship of type 2 diabetes mellitus, hypertension and cardiac arrhythmias

Aim. To summarize existing literature on the pathogenetic and clinical interrelations of type 2 diabetes mellitus, hypertension and cardiac arrhythmias. Key points. The mechanisms through which type 2 diabetes mellitus affects the development of arrhythmias are metabolic disturbances, diabetic cardiovascular autonomic neuropathy, structural heart changes, electrolyte imbalance, atherosclerosis, coronary heart disease, inflammatory processes and psychoemotional stress. Hypertension contributes to arrhythmias through similar key mechanisms: structural heart changes (hypertrophy, left atrial enlargement, myocardial ischemia, fibrosis, and remodeling), reduced heart rate variability, sympathetic nervous system activation and inflammatory processes. Presented are the findings from large studies such as ORBIT-AF and HDS, which showed the frequency of arrhythmias in type 2 diabetes mellitus and hypertension, and the genes associated with arrhythmia development are described. Conclusion. Many aspects of the relationship between type 2 diabetes mellitus, hypertension and cardiac arrhythmias remain incompletely understood, but further accumulation of fundamental knowledge and clinical data on the molecular mechanisms of arrhythmia development in hypertension and type 2 diabetes mellitus should improve screening, risk stratification and management tactics for such patients, aiming for enhancing their quality of life and prognosis. Keywords: essential hypertension, diabetic neuropathies, cardiac arrhythmias, type 2 diabetes mellitus, coronary disease.