Hypertension and Diabetes: The killer tag team

Diabetes, as one may argue, is probably the worst human disease because of its slow, but relentless damage of multiple organs systems. Hypertension on the other hand is a ‘Silent killer’ causing major risk of adverse cardiac and brain events without producing clinical symptoms. High blood pressure multiplies the troubles significantly in diabetic patients.

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Why diabetes is the worst human disease?

Hypertension – The silent killer

Is diabetes and hypertension inter-related?

Diabetes and high blood pressure often coexist. More than half of diabetics have high blood pressure. Whether it is occurrence of two different diseases at same time or manifestation of some common underlying metabolic disorder is a matter of speculation. However, some researchers now believe that the co-occurrence of these disease is more than chance. Certain genetic or environmental factors may be responsible for causing both the diseases.[1]

What are the problems of having diabetes and hypertension together?

The presence of high blood pressure in patients with diabetes mellitus greatly increases the risk of myocardial infarctions or heart attack, stroke, and an early likelihood of dying from all causes.  As both the conditions cause damage to small blood vessels like those in eye, kidneys, heart and brain, these patients also have higher chances of complications like retinopathy, vision loss, and kidney dysfunction.[2]

Hypertension and diabetes have another common friend, called obesity. All these three are closely linked to each other and may also possibly have a common etiologic origin. Obesity also puts enormous stress on the organ systems and increase the risk burdens for cardiovascular and stroke events.

collection of heart attack

How should we tackle this combination of problems?

When a patient has both diabetes and hypertension, a combination of lifestyle modification and medication is required. All the problems need to be tackled simultaneously, as controlling only one may not translate into satisfactory overall results.

Lifestyle modification includes a shift towards healthy balanced diet and physical activity during daily routine like use of stairs instead of elevators, walking or cycling instead of driving.

American Heart Association(AHA) recommends at least 150 minutes of moderately intense aerobic activity like brisk walking per week or 75 minutes of vigorous aerobic activity like running or aerobic dancing per week.

Weight loss in obese patients helps in improving both sugar control and high blood pressure. Regular exercise, diet, limitation on extra calories and restriction of carbohydrates help achieve a 3-5%  weight loss, which is considered sustainable.

Regular visits to your doctor is must to keep blood sugars and high blood pressures under good control. Glycosylated haemoglobin or HbA1c levels are used as a reference to index quality of control in diabetics. It tells about the average blood sugar levels over the last three months and a value of less than 6.5% is considered very good control, even though levels <7.0% are considered good control to reduce complications.[3]

What should my blood pressure be if i have Diabetes?

For blood pressure in patients with diabetes, the target is below 140/90mmHg. 140 is the systolic blood pressure and 90 mmHg is the diastolic blood pressure. [4] For younger patients a more aggressive target is 130/80mmHg. Having a blood pressure below these levels goes a long way in reducing the complications associated with diabetes and hypertension. Increased physical activity helps in improving blood vessel contractility and overall cardiac health. Weight loss and medications further help in improving control of high blood pressure.

Doctor checking blood pressure

Patients with diabetes should get their blood pressures monitored regularly, at least a couple of times every month and visit a physician regularly.

Disclaimer– This article is meant for only general public awareness and education. The text can not substitute expert medical advice. Please consult your doctor and follow advice accordingly.

References:

  1. Bernard MY Cheung, Chao Li: Diabetes and Hypertension: Is There a Common Metabolic Pathway? Curr Atheroscler Rep. 2012 Apr; 14(2): 160–166.
  2. Caroline S. Fox, Sherita Hill et al.: Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Diabetes Care. 2015 Sep; 38(9): 1777–1803.
  3. Inzucchi SE, Bergenstal RM, Buse JB, et al. .; American Diabetes Association (ADA);European Association for the Study of Diabetes (EASD) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364–1379
  4. Go AS, Bauman MA, Coleman King SM, et al. .; American Heart Association; American College of Cardiology; Centers for Disease Control and Prevention . An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. 2014;63:878–885.

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2 thoughts on “Hypertension and Diabetes: The killer tag team

  1. Very good and informative article. Just curious to know one thing: as per general understanding, the normal blood pressure should be 120/80 in younger adults. As per the article above, maintaining it around 130/80 is good sign.
    In reality is 130/80 is so high than 120/80 that medication is needed?

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