Hypertensive Diabetes

A review article by

Dr. Somedatta Ghosh (Pal)

Hypertension is very common in diabetes affecting 20 to 60% of the patients. Its prevalence depends on age, race, ethnicity, obesity, etc. Diabetics have a 1.5 to 3 times higher chance of developing hypertension compared to non-diabetics.

A combination of these two health issues is a risk factor for cardiovascular problems, stroke, ischemic attack, angina, and many other problems. Thus treatment of hypertension in diabetes should be an important consideration.

Cause of Hypertension in Diabetes

The most common reasons for the simultaneous prevalence of this pair of diseases are a sedentary lifestyle, obesity, inflammation, oxidative stress, and insulin resistance. Excess sugar in the blood can damage the vascular structure, deposit plaques inside the arteries, and increase the body’s fluid content. All of these elevate the blood pressure.

Target Blood Pressure

For patients with hypertension and diabetes, the target blood pressure (BP) should be <140/90 mm Hg.

Active BP control in diabetes significantly reduces the risk of heart failure, other cardiovascular problems, and microvascular complications.

Symptoms

Mostly high blood pressure does not show any symptoms and is called a silent killer. Thus a chronic diabetes patient must regularly check blood sugars.

Required Lifestyle Modification

Lifestyle modification contributes significantly to the control of these two diseases.

• Weight Loss

Obesity is a common factor that can cause high BP and blood sugar levels. A 7% reduction in body weight can reduce the chance of diabetes and hypertension by more than 50%.

• Healthy Diet

The patients should prefer a diet with low carbohydrates, and high fiber (e.g., millet, fruits, vegetables, etc.).

• Physical Activity

Regular physical exercise along with a healthy diet can reduce the risk of diabetes and hypertension.

• Restrict Alcohol Consumption

Excess alcohol consumption causes the thickening of arteries and weight gain. Thus it needs to be limited to keep high sugar and BP away.

If needed, counselling should be provided to the patients to make them understand the importance of lifestyle changes. For better patient care, sometimes family counselling is also required.

Medications

Patients should intake the prescribed medications for the long term to avoid high sugar and BP-related complications. Sometimes only one medication for high BP is not enough to reach the target BP. If BP remains higher than 160/100, then usually a combination of two hypertensive drugs is prescribed.

Recently some anti-diabetic medications have been launched in the market having mild anti-hypertensive properties.

Home Monitoring

A hypertensive diabetes patient must keep a glucometer and a machine for pressure measurement. Home monitoring of blood glucose and blood pressure levels provides a clear idea about the status of the disease. It becomes easy for a physician to plan a treatment strategy for the patient.

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References:

1. Shaikh A. A Practical Approach to Hypertension Management in Diabetes. Diabetes Ther. 2017 Oct;8(5):981-989.
2. Ian H. de Boer, Sripal Bangalore, Athanase Benetos, Andrew M. Davis, Erin D. Michos, Paul Muntner, Peter Rossing, Sophia Zoungas, George Bakris; Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care 1 September 2017; 40 (9): 1273–1284.
3. Ganesh J, Viswanathan V. Management of diabetic hypertensives. Indian J Endocrinol Metab. 2011 Oct;15 Suppl 4(Suppl4):S374-9.
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5. Koopman RJ, Wakefield BJ, Johanning JL, Keplinger LE, Kruse RL, Bomar M, Bernt B, Wakefield DS, Mehr DR. Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned. Telemed J E Health. 2014 Mar;20(3):253-60.s