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Type 2 Diabetes and Hypertension

Overview

Highlights

  1. If you have hypertension, it means that your blood is pumping through your heart and blood vessels with too much force.
  2. Hypertension has no obvious symptoms and many people are unaware that they have it.
  3. Those with hypertension have an increased risk of stroke and Alzheimer’s disease.

High blood pressure, or hypertension, is a condition that’s often present in people with type 2 diabetes. It’s unknown why there’s such a significant correlation between the two diseases. It’s believed that obesity, a diet high in fat and sodium, and inactivity contribute to both conditions.

Hypertension is known as a “silent killer” because it has no obvious symptoms and many people are unaware that they have it. A 2013 survey by the American Diabetes Association (ADA) found that fewer than half of people at risk for heart disease or type 2 diabetes reported discussing biomarkers, including blood pressure, with their care providers.

If you have hypertension, it means that your blood is pumping through your heart and blood vessels with too much force. Over time, consistently high blood pressure tires the heart muscle and can enlarge it. In 2008, 67 percent of adults aged 20 and over with self-reported diabetes had blood pressure rates of greater than 140/90.

In the general population and in people with diabetes, a blood pressure reading of less than or equal to 140/90 is considered normal.

What does this mean? The first number (140) is called the systolic pressure. It indicates the highest pressure exerted as blood pushes through your heart. The second number (90) is called the diastolic pressure. This is the pressure maintained by the arteries when the vessels are relaxed between heartbeats. Healthy people should get their blood pressure checked several times a year. People with diabetes need to be even more vigilant. If you have diabetes, you should have your pressure checked at least four times each year. If you have diabetes and high blood pressure, the ADA recommends that you self-monitor at home, record the readings, and share them with your doctor.

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Risk factors

Risk factors for hypertension with diabetes

According to the ADA, the combination of hypertension and type 2 diabetes is particularly lethal and can significantly raise your risk of having a heart attack or stroke. Having type 2 diabetes and high blood pressure also increases your chances of developing other diabetes-related diseases, such as kidney disease and retinopathy. Diabetic retinopathy may cause blindness.

There is also significant evidence to show that chronic hypertension can speed the arrival of cognitive problems associated with aging, such as Alzheimer’s disease and dementia. That is because the blood vessels that supply the brain can weaken just like the heart. In a 2009 Clinics in Geriatric Medicine article, Dr. Thomas Obisesan wrote, “hypertension is recognized as the most consistent risk factor for stroke and, importantly, AD [Alzheimer’s disease].”

Uncontrolled diabetes is not the only health factor that increases risk for high blood pressure. Remember, your chances of having a heart attack or stroke increase exponentially if you have more than one of the following risk factors:

  • family history of heart disease
  • stress
  • high-fat, high-sodium diet
  • sedentary lifestyle
  • advanced age
  • obesity
  • a history smoking
  • too little potassium or vitamin D
  • too much alcohol
  • chronic diseases like kidney disease, diabetes, or sleep apnea
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Prevention

Preventing hypertension with diabetes

There are many minor lifestyle changes that can lower your blood pressure. Most are dietary, but daily exercise is also recommended. Most doctors advise walking briskly for 30 to 40 minutes every day, but any aerobic activity can make your heart healthier. The American Heart Association recommends a minimum of “150 minutes per week of moderate-intensity and/or 90 minutes per week of vigorous cardio-respiratory exercise.” In addition to lowering blood pressure, physical activity can strengthen the heart muscle and may reduce arterial stiffness, which happens as people age but is often accelerated by type 2 diabetes.

Work directly with your doctor to develop an exercise plan, especially if you haven’t exercised before, are trying something more strenuous, or if you’re having trouble meeting your goals. Start with five minutes of brisk walking each day and increase it over time. Take the stairs instead of the elevator, or park your car farther from the store entrance.

You may be familiar with the need for improved eating habits, such as removing sugar from your diet, but eating heart-healthy also means cutting out salt, high-fat meats, and dairy products. The DASH Diet (Dietary Approaches to Stopping Hypertension) is specifically designed to help lower blood pressure. Try these DASH-inspired tips for improving the standard American diet:

  • fill up on several servings of vegetables at meal times
  • switch to low-fat dairy products
  • make sure processed foods contain less than 140 milligrams of sodium per serving (400 milligrams per serving for a meal)
  • avoid table salt
  • choose leans meats and fish, or meat substitutes
  • cook using low-fat methods like grilling and baking (avoid fried foods)
  • eat more fruit
  • eat more whole (not processed) foods
  • switch to whole-grain pastas, breads, and brown rice
  • eat smaller meals
  • don’t skip breakfast
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Treatment

Treating hypertension with diabetes

While some people can improve their type 2 diabetes and hypertension with lifestyle changes, most require medication. Depending on their overall health, some people may need more than one medication to help manage their blood pressure. High blood pressure medications fall into five distinct categories: ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and diuretics. Some medications produce side effects, so keep track of how you feel and be sure to discuss any other drugs you’re taking with your doctor.

Pregnancy and hypertension
Studies have shown that those who have gestational diabetes are more likely to have hypertension. However, women who manage their blood sugar levels during pregnancy are less likely to experience hypertension.

If you have gestational hypertension, your doctor will monitor your urine protein levels. Preeclampsia is diagnosed if you have high blood pressure and protein in the urine. Treatment depends on the severity of this condition. For mild conditions, your doctor may recommend bed rest, drinking lots of water, and reduced salt intake.
– Peggy Pletcher, M.S., R.D., L.D., CDE
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