Hypertension in Diabetes - An Overview

What Is Hypertension?

The heart pushes blood into the body's blood arteries at high pressure, which is known as high blood pressure or hypertension. It refers to the amount of force applied as the blood is pumped against the arterial walls. As the blood pressure increases, arterial resistance against blood flow increases. Thus the heart needs to pump hard for blood circulation. Two numbers describe blood pressure. The number on the top denotes the systolic blood pressure, the pressure the heart exerts while pumping the blood. The number at the bottom marks the systolic blood pressure, the pressure inside the arteries when the heart is relaxed and blood fills. According to American Health Association, high blood pressure for adults has the below-mentioned range:

• 140mm Hg or more for systolic blood pressure.

• 90mm Hg or more for diastolic blood pressure.

A hypertensive crisis is a condition when the systolic blood pressure is 180mm Hg or more, and the diastolic blood pressure is 120mm Hg and above. It needs immediate medical attention.

What Are the Signs and Symptoms of Hypertension?

Blood pressure usually has no noticeable signs and symptoms; hence, it is also known as the silent killer. Patients may experience headaches, blurred vision, and dizziness. A healthcare professional should check the blood pressure to ensure the hypertensive condition.

What Is Diabetes and Its Types?

Diabetes is the presence of high glucose levels in the blood. There are three types of diabetes:

• Type 1 Diabetes Mellitus - It is an auto-immune condition where the body's cell destroys the pancreatic cells that produce insulin.

• Type 2 Diabetes Mellitus - This occurs due to the body's resistance to insulin. The body does not respond to insulin, so the blood glucose level increases.

• Gestational Diabetes - It occurs during pregnancy, and diabetes mainly disappears after delivery.

What Are the Signs and Symptoms of Diabetes?

The clinical manifestations of diabetes include excessive thirst and hunger, frequent urination, fatigue, and delayed wound healing. The patients may or may not experience these symptoms.

What Are the Linking Factors Between Diabetes and Hypertension? Diabetes and hypertension occur together in most patients. The common causes for both the disease are:

• Inactive Lifestyle - Sedentary or inactive lifestyles like sitting and lying down decrease energy expenditure and body metabolism. Decreased body activities lead to the inability of the body to regulate sugar levels and blood pressure.

• Intake of High-Calorie Food - Eating food rich in high calories leads to fat accumulation and decreased body activity. Fat deposition narrows the blood vessels and hence affecting blood pressure. Hence affecting the body's ability to regulate blood glucose levels.

• Obesity - Obesity leads to high-fat deposition in the body and is the leading cause of increased blood glucose levels and blood pressure.

• Resistance to Insulin - Insulin released by pancreatic cells helps absorb glucose; however, once the person becomes resistant to insulin, they cannot absorb glucose properly, which causes increased blood glucose, and other vascular conditions.

• Inflammation - Diabetes and heart disease have been related to chronic inflammation.

How Does Diabetes Cause Hypertension?

Pancreas, secrete insulin. In diabetes, the pancreas does not produce insulin, or the insulin does not work appropriately on glucose metabolism. As a result of inefficient glucose metabolism in the body, the glucose does not enter the body cells to provide energy and gets collected in the blood. Blood glucose levels that are too high harm bodily tissues and organs, including the blood vessels and kidneys, thus increasing the patient's blood pressure.

What Are the Complications Associated With Hypertension in Diabetes?

A person becomes more prone to cardiovascular diseases and renal (kidney) disease and develops other health issues if they have hypertension and diabetes together. Severe complications like eye problems, issues related to kidney function and kidney failure, heart attack, and stroke can occur in uncontrolled diabetes and hypertension.

What Are the Risk Factors Associated With Hypertension in Diabetes?

The risk factors associated with hypertension in diabetes include:

• Obesity.

• Inactive Lifestyle.

• Unhealthy or High-Calorie Food.

• Stress.

• High Alcohol and Tobacco Consumption

• Exposure to Air Pollution.

• High Sodium Diet Intake

• Low Level of Potassium in the Body.

What Are the Preventive Measures for Hypertension in Diabetes?

• Maintaining Ideal Body Weight - For overweight people, losing weight reduces the risk of blood pressure and diabetes. Maintaining an ideal body weight is thus necessary to stop the progress of pre-diabetes to diabetes and pre-hypertension to hypertension.

• Being Physically Fit and Active - Regular exercise and physical activities helps in managing blood glucose and blood pressure. Energy utilization by the body is improved, so the energy sources are consumed rather than stored.

• Eating and Following Healthy Diet - Green leafy vegetables, fresh fruits, high fiber-rich food, limiting sugar and salt intake, and avoiding fats help manage the patient's blood pressure and blood glucose.

• High Alcohol and Tobacco-Based Products - High alcohol intake increases the risk of high-calorie intake and obesity, thus increasing the risk of diabetes. Alcohol also thickens the arterial walls and thus increasing the chances of high blood pressure. Smoking causes constriction of blood vessels, increasing blood pressure. Furthermore, type 2 diabetes risk is increased.

What Is the Treatment for Hypertension in Diabetes?

Along with preventive measures, medicines are needed to control diabetes and hypertension.

Medication for Diabetes - Diabetes treatment depends on the type of diabetes a patient suffers from. For type 1 diabetes mellitus, the use of insulin is mandatory. Other medications are based on the kind of complication involved, like hypertensive medicine for high blood pressure. For type 2 diabetes, patients may use insulin or non-insulin drug like Metformin. Medications are also needed to manage hypertension and other cardiovascular problems. As per current health guidelines, sodium-glucose cotransporter two inhibitors (SGLT2) or glucagon-like peptide 1 (GLP-1) receptor agonists should be used in patients who have type 2 diabetes and are at a high risk of developing atherosclerotic cardiovascular disease.

Medication for Hypertension- Many drugs are available in the market, and the doctor may prescribe a combination of medicines to reduce elevated blood pressure.

• Angiotensin-Converting Enzyme (ACE) Inhibitors - It lowers blood pressure by dilating and relaxing the blood vessels by inhibiting the production of the hormone angiotensin.

• Angiotensin Receptor Blockers - These medicines block the effect of angiotensin and thus lower blood pressure.

• Beta-Blockers - These medicines reduce blood pressure by decreasing the blood output of the heart and by reducing the heart rate.

• Calcium Channer Blockers (CCB) - These medicines prevent the contraction of smooth muscles of arteries and the heart, thus preventing forceful heart contractions.

• Diuretics - Diuretics lower blood pressure by reducing sodium and water absorption.

• Vasodilators - These medicines cause muscles of the blood vessels to dilate; hence the blood's easy movement reduces blood pressure.

Conclusion

Diabetes and hypertension both have similar risk factors, and the patient will likely develop both diseases together. Treatment of high blood pressure in diabetic patients is necessary to prevent organ damage and limit any extra economic burden on the patient because of the condition. The doctor should choose the treatment plan wisely after weighing all the side effects and drug interactions. Bringing changes in the lifestyle helps to control the blood pressure and glucose levels in the body.