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Diabetes is a chronic metabolic disease of high blood sugar. Abnormally high amounts of sugar can cause a variety of complications in almost all organs of the body, since all organs need blood. Blood that is high in sugars is concentrated, and the heart has to pump with a greater force to circulate blood throughout the body. This leads to high blood pressure, a condition that affects almost 80% of type 2 diabetics. Persistent high blood pressure can cause damage to the heart and lead to its failure. It can also increase the risks of a stroke, retinopathy (eye disease) and kidney disease. Let’s look at the connection between diabetes and high blood pressure, their risk factors and tips for preventing these conditions.
Diabetes and high blood pressure overlap substantially in their causes and mechanism of disease. Both these conditions are often seen together. People with high blood pressure are 2.5 times more likely to develop type 2 diabetes than those with normal blood pressure. This means that both these conditions are risk factors for each other.
Part of the problem of overlap of the two conditions lies in the genes. All of us have DNA in our cells. Genes are functional units of DNA controlling every single metabolic activity in our cells and eventually our body. While all humans have the same gene for a particular activity, subtle differences in the genes’ sequence creates a variant. These genetic variants can be used as predictors of diseases. Researchers have found that a large number of genes with small effects create common conditions for both diabetes and high blood pressure. In another study, genetic variants that that can predict the risk of development of diabetes were also found to predict the development of hypertension.
Research has also shown that insulin resistance, which is the underlying cause of type 2 diabetes, also leads to hypertension. Through a complex biochemical reaction that includes various proteinic messengers and their receptors, as insulin resistance increases, blood pressure also increases.
Insulin does not simply play the role of allowing glucose in the blood inside the cells; it is an important hormone that has a wide range of activities. Apart from suppressing glucose synthesis and glycogen breakdown in the liver, insulin secreted after a meal also activates the heart to increase its output. Through a complex process, insulin resistance leads to overproduction of pro-inflammatory chemicals (chemicals that induce an inflammatory response). Inflammation is at the root of chronic diseases like type 2 diabetes and hypertension. Thus insulin resistance is an important common link between diabetes and hypertension.
Since the two conditions share so much in terms of the disease mechanism, it is obvious that risk factors for both these conditions also overlap.
Apart from genetic factors, environmental factors such as the time spent within the mother’s womb (gestational diabetes, fetal malnutrition and high birth weight) and lifestyle factors, like diet and physical activity can also increase the risk of diabetes and hypertension.
A high intake of sodium, alcohol consumption, smoking and lack of physical activity are also risk factors for these two conditions. Obesity is the most important risk factor for diabetes and hypertension. Obesity is a combined result of an imbalance in the feeding center of the brain, imbalance in energy intake and how it is expended by the body as well as genetic variations. Approximately 50% to 90% of variation in weight is because of genetics.
In recent years, type 2 diabetes is being recognized not only as a disease of insulin resistance, but also of chromic low-grade inflammation and oxidative stress. A similar condition occurs in hypertension as well. Certain proteins, called inflammatory markers, are found at high levels in patients of diabetes and high blood pressure. An analysis of these markers can also help us in assessing the risks of diabetes and high blood pressure.
Oxidative stress has been found to be a key underlying molecular mechanism in both diabetes and high blood pressure. A complex gene-regulated cascade has been decoded that is the common link between diabetes and hypertension.
High blood pressure, or hypertension, is referred to by doctors as a “silent killer” because there are no apparent signs and symptoms. Many people are blissfully unaware of this condition. Rare symptoms are seen only when blood pressure spikes suddenly and extremely. These symptoms include:
If a patient experiences these symptoms, it is considered a medical emergency. Prompt treatment is needed to bring blood pressure down.
A hypertensive crisis (a medical emergency due to sudden and extreme spiking of blood pressure) is said to occur when the blood pressure reading is 180/110 or above. The figure 180 denotes systolic pressure. This is the pressure (measured by a device called manometer) when the heart contracts to force blood out of its chambers. The second figure (110) denotes the diastolic pressure or the pressure inside the arteries when the heart is at rest between beats. Normal blood pressure levels for a healthy adult are systolic pressure of below 120 and diastolic pressure of below 80.
High blood pressure, along with diabetes increases the risks of:
Even slightly high blood pressure levels, defined as prehypertension (120-139/80-89 mmHg) can increase your risks of heart disease by as much two to three times over a long period of time.
Conventional treatment of high blood pressure in people with diabetes includes medications like ACE (angiotensin converting enzyme) inhibitors. While there are other blood pressure reducing drugs, ACE inhibitors are preferred because they have been found to delay the progression of kidney disease in diabetics. Diuretics (“water pills”), ARBs (angiotensin receptor blockers), beta blockers and calcium channel blockers are also used to bring down blood pressure.
Lifestyle changes can help in lower your blood pressure. The best food for diabetes and high blood pressure is low in sodium. Such a diet is key to controlling blood pressure in diabetes. Your diet should consist of sufficient amount of fruits and vegetables. Choose lean meats and sea food. Avoid processed meats and foods. Avoid fried foods, and try baking or grilling instead. Eat more whole grains and avoid refined and processed flours. Always control your portion sizes. Never skip breakfast.
Physical activity is also recommended for controlling both blood sugar as well as blood pressure. A disciplined regimen of daily exercises has been shown to control blood pressure effectively. Brisk walking for 30-40 minutes daily or 150 minutes per week of moderate-intensity or 90 minutes per week of high intensity aerobic exercising can help regulate cardiac output and control blood pressure. Exercising also strengthens heart muscles and reduces arterial stiffening.
An exercise plan should be prepared with the help of your doctor or a trained physical instructor. Start slowly and then move on to more strenuous exercises. Start with 5 minutes of brisk walking a day, take the stairs instead of the lift and increase your daily movement by participating in household work. This will help your heart and body get used to the exercise regimen. You can also try yoga for diabetes and high blood pressure.
Genetic studies have shown that type 2 diabetes and hypertension have a common pathway and therefore a common disease mechanism. Chances of both the conditions occurring together are often greater. While conventional treatment options like ACE inhibitors and other drugs are available, they have their own side effects and can do more harm than good in the long run. Lifestyle changes that include stress management, diet and physical activity can help keep diabetes and high blood pressure under control.