Diabetes and High Blood Pressure (Hypertension)

Diabetes and high blood pressure often coexist. With obesity and high cholesterol levels, they make the diagnosis of metabolic syndrome.

Although the term metabolic syndrome is now less commonly used, it highlights the importance of these four highly prevalent conditions:

• Diabetes
• Hypertension
• Obesity
• High Triglycerides and low HDL levels.

A detailed discussion can be read here: What is Metabolic Syndrome?

High blood pressure can also develop in patients with diabetes without metabolic syndrome. In patients with long-standing diabetes, kidney functions start to decline.

The first clinical presentation of kidney disease is usually hypertension. Hypertension can occur with proteinuria or without proteinuria.

If you have diabetes and high blood pressure or hypertension, your risk of developing diabetic kidney disease increases manyfold.

What is Hypertension?

According to the American Heart Association (AHA), most patients with hypertension do not exhibit any symptoms. Following a regular blood pressure check, people frequently learn that they have hypertension.

Importantly, the systolic and diastolic blood pressures are represented by two separate sets of numbers in a blood pressure measurement.

Diastolic: This value is shown at the base. In between heartbeats and it symbolizes the pressure in the arteries.

Systolic: This value is displayed at the very top. It stands for the most pressure the heart may generate when beating.

In general, a blood pressure of more than 140/90 mmHg (140 systolic and 90 diastolic) is regarded as hypertension if the readings are taken on more than one occasion.

Basic info about Diabetes

The American Diabetes Association (ADA) asserts that not all people with diabetes exhibit symptoms of the condition.

If signs of elevated blood sugar levels do materialize, they could include:

• Delayed wound healing
• Frequent need to urinate
• Extreme fatigue
• Excessive thirst
• Excessive hunger
• Blurred vision

Diabetes can develop as a result of insulin deficiency, also called Type 1 Diabetes, or as a result of insulin resistance, called Type 2 Diabetes mellitus.

Type 2 Diabetes commonly coexists with other metabolic conditions, especially hypertension. However, long-standing Type 1 diabetics can develop hypertension because of renal failure.

Pathophysiology of High Blood Pressure in Diabetics:

It is possible to link the pathophysiology of hypertension in diabetes to maladaptive alterations and intricate interactions between the autonomic nervous system, a faulty immune system, increased renin-angiotensin-aldosterone system (RAAS) activation, as well as unfavorable environmental influences.

As we know, adiposity can grow as a result of a sedentary lifestyle and excessive calorie consumption, which has been linked to a higher chance of insulin resistance getting worse.

Then this insulin resistance has been associated with an increase in oxidative stress, inflammation, and endothelial dysfunction in the vascular system.

These factors all contribute to vascular stiffness, which in turn causes blood pressure to remain consistently elevated and promotes CVD. [Ref]

The risk of hypertension rises with family history, indicating a role for hereditary and environmental variables. Both type 1 and type 2 diabetes risk is further increased by a strong family history of the disease.

The risk of type 2 diabetes seems to rise with hypertension, while the risk of hypertension tends to increase with diabetes as well. [Ref]

Is Diabetes the Cause of High Blood Pressure?

A person with diabetes either has insufficient insulin or their insulin is ineffective in processing glucose (the hormone insulin makes it possible for the body to break down the glucose from food and use it as fuel).

In this case, glucose builds up in the bloodstream when a person has insulin issues because it cannot enter their cells to produce energy.

Blood sugar levels that are too high can harm a wide range of tissues and organs, including those that are essential for maintaining normal blood pressure.

Blood pressure might increase, for instance, if the kidneys or blood arteries are damaged.

Can High Blood Pressure Be the Cause of Diabetes?

Patients with hypertension frequently show signs of insulin resistance and are more likely to develop diabetes than people with normal blood pressure.

The strong association between diabetes and hypertension is probably due to shared mechanisms including oxidative stress, inflammation, and the body’s immune activation, as well as stimulation of the renin-angiotensin-aldosterone pathway.

Chances are that high blood pressure might not be the sole cause of diabetes, however, due to the close association, it can co-exist with diabetes.

Risk Factors of Diabetes and High Blood Pressure

Some similar risk factors apply to both type 2 diabetes and hypertension.

These consist of:

• Obesity or being overweight
• Having a sedentary lifestyle, eating poorly, and being under constant stress
• Having a bad sleeping routine
• Smoking cigarettes
• Being exposed to pollution in the air

Some risk factors that are specific to hypertension

• Alcohol consumption
• High salt diet
• Low potassium levels

How to Prevent Diabetes and High Blood Pressure?

The following methods are applicable to preventing both high blood pressure and high blood glucose levels.

Physical activity:

Along with other health advantages, regular exercise can reduce blood pressure and aid in blood sugar management.

A baseline of 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity exercise per week is advised by the most recent CDC guidelines.

Brisk walking and swimming are examples of moderate exercise. People ought to think about engaging in muscle-strengthening activities.

If a person hasn’t exercised in a while, they should talk to their doctor about a good fitness regimen.

Healthy weight:

Even a slight weight loss can assist those who are overweight lower their chances of developing diabetes and high blood pressure.

A 3% to 5% weight reduction can lower blood pressure, according to the National Heart, Lung, and Blood Institute (NHLBI).

In a similar case, the CDC reports that a 5-7% weight loss can prevent pre-diabetes from progressing to diabetes. For a person who weighs 200 pounds, this translates to a loss of 10–14 pounds.

Refrain from smoking:

There are many reasons why one must abstain from smoking including:

Smoking tobacco causes blood vessels to tighten, temporarily raising blood pressure. Additionally, it causes more plaque to accumulate in the arteries, which over time may result in a rise in blood pressure.

Diabetes type 2 risk can also be increased by tobacco use. Smokers with diabetes are more likely to experience severe consequences.

Follow a healthy diet:

The right food plan can be discussed with your doctor if you have diabetes or high blood pressure.

The Dietary Approaches to Stop Hypertension (DASH) diet is frequently advised by medical professionals for the management of blood pressure and general well-being.

Typically, this comprises:

• Consuming a lot of fresh vegetables and fruit
• Putting an emphasis on meals high in fiber, such as whole grains
• Minimizing salt and sugar additions
• Trans fats and animal fats should be avoided or limited.

To make sure their blood glucose stays within the healthy range, a person with diabetes will need to control their carbohydrate consumption and check their blood glucose levels.

Treatment of Diabetes and High Blood Pressure:

Treating diabetes and high blood pressure requires managing both conditions at the same time. The targets should be set for the patients which include:

• A1C: <6.5%
• Fasting glucose: <120 mg/dl
• BSR or 2 hours post-meal glucose: <160 mg/dl
• Blood pressure: <130/85. For patients with proteinuria, the target blood pressure should be kept at 120/80 mmHg or lower.

The two diabetes medications that may lower blood pressure and are recommended by the ADA for diabetics with ASCVD (atherosclerotic cardiovascular disease) are:

• GLP-1 agonists with cardiovascular benefits:
  • Liraglutide
  • Dulaglutide, and
  • Semaglutide
• SGLT-2 Inhibitors:
  • Empagliflozin
  • Dapagliflozin
  • Canagliflozin, and
  • Ertugliflozin

SGLT2 inhibitors are one of the best medicines that can treat both conditions simultaneously. However, in patients with very high blood pressure, a BP-lowering medicine is usually indicated.

For the treatment of Hypertension in diabetics, drugs that block the RAAS (renin-angiotensin-aldosterone-system) system are recommended.

These include:

• ACE-Inhibitors (angiotensin-converting enzyme inhibitors):
  • Ramipril
  • Captopril
  • Lisinopril
• ARBs (Angiotensin Receptor Blockers):
  • Losartan
  • Valsartan
  • Telmisartan
  • Irbesartan
  • Olmesartan