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High Blood Pressure in Diabetes by Shu Golda.The coexistence of diabetes and hypertension or high blood pressure is highly prevalent. Also, Diabetics are more prone to high blood pressure than healthy people. Prevalence of hypertension amongst Diabetics is dependent on the duration of diabetes, age, sex, body mass index, among other factors. These pathologies are both independent risk factors for cardiovascular diseases, and the death rate increases when they co-exist. In this article, we will discuss how hypertension is associated with diabetes.

What should your blood pressure be?

High blood pressure is the inability of the blood to be pumped through the heart with ease, and blood vessels have to force it through. If this continues for a long time, the high pressure can stress and enlarge heart muscles.

Blood pressure readings vary; however, we recommend Diabetics should not have a blood pressure of above 130/80

The top number represents the systolic pressure, which is the pressure in arteries when the heart squeezes blood and fill these vessels. The bottom number is the diastolic pressure, which is the pressure in arteries when your heart rests between beats feeling itself with blood for the next contraction.

Normal blood pressure is just as key as blood sugar control in the prevention of diabetes complications.

What to do.

  • Check blood pressure at every routine clinical care visit.
  • Patients found to have elevated blood pressure (≥140/90 mmHg) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension.
  • All hypertensive patients with diabetes should have home blood pressure monitored to identify white-coat hypertension.

Blood pressure targets

What to do:

· Patients with diabetes and hypertension should target a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg.

· Lower systolic and diastolic blood pressure targets, such as <130/80 mmHg, may be proper for patients at high risk of cardiovascular disease if they can be achieved without an extra treatment burden.

The relationship between diabetes and high blood pressure        

  1. They both have the same predisposing factors such as family history, inactivity, and obesity
  2. The frequency of occurrence of both diseases increases with age
  3. In type 1 diabetes, hypertension is secondary to diabetic complications such as nephropathy
  4. Hypertension in type 2 diabetes= can occur before or result from diabetic nephropathy

Risk Factors Associated with Diabetes and High Symptoms of Diabetes and hypertension by Akon HermannBlood Pressure

Diabetics should be aware of high blood pressure. Type 2 diabetes is caused by resistance to insulin, a hormone that regulates blood sugar metabolism in the body. Resistance to this hormone causes a surge of blood sugar levels called hyperglycemia. Thus the body makes more insulin, which is not used up, causing an increase in salt and fluid retention in the body. This increases blood pressure. Also, high blood sugar concentrations can damage blood vessels over time, causing their walls to stiffen. This leads to an increase in blood pressure.

The coexistence of diabetes and hypertension increases the risk of cardiovascular diseases, heart attack, and stroke. They also facilitate the development of diabetes complications, such as glaucoma and kidney disease.

TREATMENT

Lifestyle management is essential in the treatment of hypertension. It lowers blood pressure and increases the effectiveness of hypertensive drugs. Lifestyle changes also promote metabolic and vascular health. These changes help reduce the risk of developing high blood pressure in patients with systolic blood pressure >120 mmHg or diastolic blood pressure >80.

These lifestyle changes include:

  • Dietary changes; increase intake of vegetables and fruits, high fiber foods, whole grains, and decrease or complete avoidance of refined carbohydrates and fats
  • Decrease intake of sodium and increased intake of potassium. Sodium increases blood volume.
  • Weight loss to attain a desirable body mass index.
  • Increase physical activity. Begin physical activity gradually and then increase the intensity with time.
  • For more information on diabetes and lifestyles, kindly open this door.

Dietary changes

Hypertensive patients should be conscious of the fact that whatever they eat affects their blood pressure levels. As such, the type of food they eat and the quantity of food they eat is important. The general advice is to eat food low in fats and refined sugar and high in dietary fiber by eating more vegetables, fruits, and beans.

Overweight patients should decrease portion sizes in other to curb the number of calories consumed.

What to do: 

  • Reduce total fat intake, especially saturated fats found in biscuits, crisps, and chips. Choose lean meat such as skinless chicken and turkey. Also, replace pork and beef with fish. It is advised to eat less processed meat.

Alternatively, grill and steam food instead of frying or roasting them. This will decrease the uptake of saturated fats.

· Make your meals balanced. As much as possible, plan for every meal to have a good mix of starches, fruits and vegetables, proteins, and fats. Low glycemic index carbohydrates are better than refined sugars. Whole grains, beans, and lentils will increase the bulk of dietary fibers and help to maintain target blood sugar levels and also in weight loss

  • Coordinate your meals and medications. Your food intake should be proportionate to hypertensive medications. Your doctor or counselor will help with the coordination.
  • Reduce salt intake. Salt contains sodium, which increases blood volume and blood pressure.

Physical activity.

For patients with a sedentary lifestyle, it is recommended that they begin the exercise with low intensity and gradually increase the intensity and time. Your goal should be 30 minutes of activity that makes you sweat and breathe a little harder most days of the week. Lower blood pressure, necessitating dose adjustment of antihypertension medications. It also lowers your chances of getting heart disease. Plus, it can help with weight loss and decrease anxiety. The type and intensity of physical activities should be adapted to the preferences and functional status of the patient.

What to do:

  • The doctor will perform some relevant assessments like heart health, especially if you have very high blood pressure and blocked arteries.
  • Also worth considering will be diabetes-related complications like neuropathy. The doctor will help you figure out which exercise routine best suits the patient’s needs.
  • Ease into it. Set realistic goals before beginning with exercise. Start slow and gradually increase the amount and intensity of physical activity. If you’re inactive, you can begin with 15minutes of exercise and then gradually work up to 25 and 40 minutes a day.

Weight loss.

Overweight hypertensive patients are advised to lose weight gradually until they attain a healthy body mass index (BMI). The loss of 1 kg in body weight has been associated with a decrease in blood pressure of ∼1 mmHg

The range for a healthy BMI is between 18.5 and 24.9

With a BMI above this range, it is recommended that you lose weight gradually until you reach the target. A loss in weight by 5% to 10% over a year is impressive.

Weight loss is mainly achieved by food portion control, and in some rare cases where BMI is greater than 30, weight loss pills might be prescribed.

Alcohol

Drink alcohol only on the doctor’s approval. Alcohol can aggravate hypertension and diabetes complications, such as heart failure, nerve damage, and eye disease. Do not smoke

Medications.

Upon diagnosis, antihypertensive and other medications are prescribed to patients. These medications, together with diet and exercise, help to lower blood pressure to target levels. Patients with confirmed office-based blood pressure ≥140/90 mmHg should, in addition to lifestyle therapy, have timely titration of pharmacologic therapy to achieve blood pressure goals.

Patients with confirmed office-based blood pressure ≥160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes.

Treatment for hypertension should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes, such as angiotensin receptor blockers.

Get constant checkups.

See your doctor regularly. Check for factors that can lead to complications of hypertension and diabetes such as heart disease, kidney disease, and blood cholesterol. 

Hypertension is a risk factor for macrovascular and microvascular complications in diabetes. Lower blood pressure targets are beneficial for patients at risk of cardiovascular diseases in diabetics. Lifestyle changes and hypertensive medications will help in the attainment of blood pressure targets. Treatments and lifestyle changes should be individualized to the patients based on their needs.

References.

https://care.diabetesjournals.org/content/40/9/1273
Diabetes and Hypertension: A Position Statement by the American Diabetes Association

https://www.canopyhealth.com/en/members/articles/high-blood-pressure-and-type-two-diabetes.html

F Contreras, M Rivera, J Vasquez, MA De la Parte and M Velasco (2000) Diabetes and hypertension physiopathology and therapeutics. Macmillan Publishers Ltd All rights reserved 0950-9240/00 $15.00 www.nature.com/jhh