Hypertension and Diabete - Diabetes and Hypertension

Hypertension and Diabete

Hypertension and Diabetes
Francine Kaufman, MD.
May 2, 2008
dLife

Up to 65% of people with diabetes also suffer from hypertension, or high blood pressure. Blood pressure increases when arteries are narrowed, due to atherosclerosis or to chronically high blood glucose levels, and blood flow is restricted. The long-term stress of high blood pressure levels increases the risk of other diabetic complications such as stroke, coronary artery disease (CAD), diabetic retinopathy, and nephropathy (kidney disease).

Blood pressure is measured with a cuff device. The numbers that are given as your blood pressure results (e.g., 130 over 80) are systolic and diastolic pressure readings, respectively. The systolic reading represents your blood pressure as your heart beats, while the diastolic is the pressure between beats. With hypertension, both systolic and diastolic readings may be high, or the systolic alone may be high, a condition known as isolated systolic hypertension (ISH). Both types can lead to serious complications if not treated appropriately.

Normal blood pressure is defined as 120/80 mmHg for people without diabetes and <130/80 mmHg for those with diabetes and/or chronic kidney disease. The National Heart, Lung, and Blood Institute (NHLBI) has established the following clinical levels of hypertension1:

* Stage one hypertension. Consistent (i.e., two or more consecutive) readings of 140-159/90-99 mmHg.
* Stage two hypertension. Consistent readings of 160/100 mmHg or higher.
* Prehypertension. Consistent readings of 120-139/80-89 mmHg. (Editor's note: prehypertension is a clinical category for people without diabetes; blood pressure goals for people with diabetes remain < 130/80 mmHg).

Since high blood pressure is frequently a "silent" condition with few to no symptoms, it's important to have your blood pressure taken every time you visit your diabetes care provider. You can also purchase a blood pressure cuff device to take home readings. Talk to your doctor about recommendations for equipment and testing.

Symptoms

In most cases of mild or even moderate hypertension, there are no symptoms. However, people with extremely elevated blood pressure may experience:

* Headache
* Vision problems
* Abdominal or chest pain
* Shortness of breath
* Dizziness
* Nausea

Treatment and Prevention

Medications that may be prescribed to reduce blood pressure include diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel blockers. The American Diabetes Association also recommends that most adults (i.e., over 21) with diabetes who have a history of risk factors for CAD, PVD, hypertension, or heart attack take a daily dose of coated aspirin.

Other strategies for prevention:

* Stay at a healthy body weight. Excess pounds promote hypertension.
* Keep active. Exercise can help lower your blood pressure.
* Eat a balanced diet low in saturated and total fat, cholesterol, and sodium and rich in vegetables, fruit, and nonfat dairy (the DASH, or Dietary Approaches to Stop Hypertension, diet).
* Quit smoking. Nicotine raises blood pressure.
* Keep alcohol intake at a moderate level.
* Practice good stress management. Emotional or physical stress can raise blood pressure; talk to your provider about relaxation techniques and strategies.