Managing hypertension in diabetic patients: Dr. V Mohan

M3 India Newsdesk Nov 05, 2019

In the second article of the exclusive diabetes series, Dr. V Mohan writes on managing hypertension, the most common co-morbid condition present along with diabetes- a major risk factor for both microvascular as well as macrovascular complications.


Diabetes increases risk of developing high blood pressure and other cardiovascular problems, because diabetes adversely affects the arteries, predisposing them to atherosclerosis (narrowing of the arteries).

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.


Staging of hypertension

Stages

Systolic BP

(mmHg)

Diastolic BP

(mmHg)

Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 hypertension 140-159 90-99
Stage 2 hypertension >160 >100


High systolic BP is a more important risk factor for cardiovascular disease (CVD) than diastolic BP. The risk of CVD doubles with increment of 20 mmHg of systolic BP and 10 mmHg of diastolic BP, beginning at 115/75mmHg.

Both essential Hypertension and DM affect the same major target organs. The common denominator of hypertensive/diabetic target organ-disease is the vascular tree.


Types of Hypertension

Essential hypertension: This is the most common type of hypertension with no symptoms, some experience of frequent headaches, tiredness, dizziness, or nose bleeds. Although the cause is unknown, research has shown that obesity, smoking, alcohol, high calorie diet, and heredity plays an important role in essential hypertension.

Secondary hypertension: This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than primary hypertension. Various conditions and medications can lead to secondary hypertension, including the following:

  1. Obstructive sleep apnoea
  2. Kidney problems
  3. Adrenal gland tumours
  4. Thyroid problems
  5. Congenital defects in blood vessels
  6. Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  7. Illegal drugs, such as cocaine and amphetamines
  8. Alcohol abuse

In about 95% cases, it is essential hypertension and the rest may be secondary hypertension. In some cases, both hypertension and DM may be present at the time of initial diagnosis . The Hypertension in Diabetes Study (HDS)-I conducted to determine the prevalence of hypertension in newly diagnosed type 2 diabetic patients reported that 39% of the patients were hypertensive at the time of diagnosis of DM.


Risk factors for hypertension

  • Age
  • Race
  • Family history
  • Being overweight or obese
  • Not being physically active
  • Using of tobacco
  • Too much salt (sodium) in the diet
  • Stress
  • Drinking too much alcohol
  • Certain chronic conditions such as diabetes, kidney disease, sleep apnea

Prevention of hypertension

Lifestyle changes can help you control and prevent high blood pressure, even if one is taking blood pressure medication. Here's what one can do:

  • Have a periodic review with the doctor to fine-tune the dose of medications for hypertension as well as diabetes
  • Eating healthy foods
  • Decreasing salt in the diet
  • Maintaining a healthy weight
  • Increasing physical activity
  • Limiting alcohol
  • Quitting smoking
  • Monitoring blood pressure at home
  • Practicing relaxation or slow, deep breathing
  • Controlling blood pressure during pregnancy

The “rule of halves” has shown that more than 50% of people with DM or hypertension remain undiagnosed, among those detected, 50% do not take treatment, and finally among those who take treatment, over 50% are not under control. Thus overall only 6–8% of subjects with DM or hypertension remain adequately controlled . This poses a huge challenge and underscores the need to urgently raise awareness in the community at large. Attempts should be made to detect DM/hypertension early before irreversible organ damage.

The next step after having the high risk group detected is to advise lifestyle modifications (primary prevention). Sticking to lifestyle changes can be difficult, especially when there are no symptoms of high blood pressure. We should motivate patients by telling them about the risks associated with uncontrolled high blood pressure. This would help to enlist the support of patients to achieve the goals.

Remember that a combination of diabetes and hypertension constituting a ‘double whammy’ can be detrimental to the heart, brain, kidneys, and eyes. The good news is that if both diabetes and hypertension are controlled along with lipids and cessation of smoking, cardiovascular disease can be almost entirely prevented in people with diabetes.


 

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. V Mohan is the Chairman & Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India

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