Diabetes and High Blood Pressure

High blood pressure (hypertension) is an important risk factor for the development and worsening of many
complications of diabetes, including diabetic eye disease and kidney disease. It affects up to 60% of people with
diabetes.
Having diabetes increases your risk of developing high blood pressure and other cardiovascular problems, because
diabetes adversely affects the arteries, predisposing them to atherosclerosis (hardening of the arteries).
Atherosclerosis can cause high blood pressure, which if not treated, can lead to blood vessel damage, stroke, heart
failure, heart attack, or kidney failure.
Compared to people with normal blood pressure readings, men and women with hypertension have an increased risk
of:

• Coronary artery disease (heart disease)

• Strokes
• Peripheral vascular disease (hardening of the arteries in the legs and feet)
• Heart failure

Even high yet normal blood pressure or pre-hypertension (defined as 120-139/ 80-89) impacts your health. Studies
show that people with normal yet high range blood pressure readings, over a 10 year period of follow up time, had a
two to three fold increased risk of heart disease.
What Should Blood Pressure Be if You Have Diabetes?
Blood pressure readings vary, but in general your blood pressure should not go above 130/80. The first number is the
"systolic pressure" or the pressure in the arteries when your heart beats and fills the arteries with blood. The second
number is the "diastolic pressure" or the pressure in the arteries when your heart rests between beats, filling itself with
blood for the next contraction.
Having a normal blood pressure is as important to managing diabetes as having good control of your blood sugars
when it comes to preventing diabetes complications.

What Are the Symptoms of High Blood Pressure?

Usually, high blood pressure has no symptoms. That's why it's so important to have your blood pressure checked on a
regular basis (during all visits with your health care provider) and to follow your health care provider's
recommendations on home blood pressure monitoring.
How Is High Blood Pressure Treated?
ACE (angiotensin converting enzyme) inhibitors are a group of medications that are often used to treat high blood
pressure in people with diabetes. Although other high blood pressure medicines are available, ACE inhibitors have
been shown to not only to be a useful drug to treat high blood pressure, but it has been shown to prevent or delay the
progression of kidney disease in people with diabetes.
Note: Some blood pressure medicines may adversely affect your blood sugar level. Blood pressure medicines can
also cause impotence. Talk with your doctor about the side effects of prescribed medicines.
Some blood pressures medications also seem to work better on certain populations of people. Diuretics for example
seem to be particularly beneficial in the elderly and may also be beneficial in people with hypertension that is salt
sensitive as is frequently seen in African Americans.
Other drugs used to treat high blood pressure in people with diabetes include a class of drugs known commonly as
'water pills' or diuretics.
Because adequate control of blood pressure usually requires more than one medication, most doctors use ACE
inhibitors first then add other anti-hypertension drugs.
How Do You Prevent High Blood Pressure?
To help prevent high blood pressure:

• Stop smoking
• Eat healthy
• Maintain a healthy body weight
• Exercise
• Limit salt intake in the diet
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• Diabetes can present two main categories of problems, in the form of short term ill-effects
and longer term harm. Minimizing both areas requires discipline.

Rapid spikes or dips in blood glucose level can result in several unpleasant effects: dizziness,
disorientation, muscle weakness, nausea and others. For some diabetics, it's very difficult to prevent
this from happening at some time. But there are practices that can improve the odds.

Regular and careful monitoring is a must. It's no picnic to endure a finger prick three times a day. For
those who simply can't muster the will, it is worthwhile to look into some of the newer glucose
monitoring devices that don't require it.

Some contain tiny, powerful lasers that create a hole through which blood oozes. They produce only
a mild tingling sensation. One recent device senses glucose level through the skin using an infrared
beam, requiring no blood sample at all.

The goal is to keep the glucose-insulin balance as close to normal levels as possible. Non-diabetics
have a fasting glucose level under about 99 mg/dL. Even after a heavy meal, when glucose may rise
to over 200 mg/dL, insulin is released which brings it back down within a couple of hours. That
means that keeping the glucose level right isn't so much achieving a static number as maintaining the
correct dynamic balance.

Part of a long-term glucose monitoring strategy should encompass regular physician visits with a
quarterly A1C test. Several tests exist to measure blood glucose level at a given time. The A1C test
provides a picture averaged over a period of months. The name comes from HbA1c, an abbreviation
for glycated hemoglobin.

Hemoglobin molecules in the red blood cells carry oxygen to tissues. The extra glucose in the
bloodstream of a diabetic causes that hemoglobin to get glycated. That effect persists and allows an
A1C test to measure the accumulated result.

Long term the effects will accumulate, good or bad. Over 10-15 years or longer, many diabetes
patients of the past would endure blindness, kidney damage, nerve damage and other ill health
effects. That no longer has to be the case. With contemporary understanding of the disease and
modern technology it's possible to reduce the odds of those effects nearly to those without the
disease.

Exercise and diet are two key elements for the overwhelming majority of diabetes sufferers to help
achieve the right glucose-insulin balance.

Keeping body fat low through proper diet and exercise will help. Body fat plays a role in how the
body reacts to glucose levels, as well as affecting hormone production and release. While the
mechanisms are still being investigated, many studies show there is a clear correlation between body
fat and the severity of diabetes effects, as well.

Proper weight and body fat maintenance will also help keep Blood Pressure at the right level.
Chronic high Blood Pressure is one of the major elements in increasing the risk of common diabetes
problems: heart attack and stroke, eye and nerve damage, and others.

With diligence a diabetic can lead a normal life, one very much like those fortunate enough not to
have the condition. A little attention a few times a day can lead to not having to pay too much
attention at all.
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•

Diabetes
How Does Diabetes Affect My
Body?
People with Type 1 or Type 2 diabetes are at a much
higher risk than the general population for damage to the
eyes, kidney, nerves, and blood vessels. Because of
these serious risk factors, the American Diabetes
Association recommends regular screening for early signs
of damage. Many of these side effects can be delayed or
avoided altogether through careful blood sugar control. In
addition, a recent study has found that lowering blood
sugar levels also lowers treatment costs for people with
Type 2 diabetes.(For news about addition risks associated
with high blood sugar levels, see Related News below.)

 How Does High Blood Sugar Cause Damage?

 Eye Damage
 Kidney Disease
 Heart and Blood Vessel Disease

 Nerve Disease
How does Blood Sugar Cause Damage?
In people with diabetes, sugar (glucose) accumulates in
the blood to very high levels. The excess glucose can
attach to proteins in the blood vessels and alter their
normal structure and function. One effect of this is that the
vessels become thicker and less elastic, making it hard for
blood to squeeze through.

Eye Damage
Diabetic eye disease starts when blood vessels in the
back of the eye (the retina) balloon out into pouches.
Although this stage — called nonproliferative retinopathy
— generally does not affect vision, it can progress to a
more serious form called proliferative retinopathy. This
occurs when damaged blood vessels close off and new,
weaker vessels take their place. These new vessels can
leak blood, which blocks vision. They can also cause scar
tissue to grow and distort the retina.

Because the retina can be irreversibly damaged before

you notice any change in vision, and because retinopathy
can be effectively treated with lasers to minimize vision
loss, the American Diabetes Association recommends
screening for retinopathy yearly.

Kidney Disease
Kidney disease starts when the blood vessels in the
kidney become leaky. These leaky vessels allow protein
from the blood to be excreted with urine. (It's this protein
that doctors detect when they test for kidney function.)
Eventually, some vessels collapse and place more
pressure on those that remain. Under this increased load,
the remaining blood vessels are also damaged and the
kidney may fail. If the disease progresses to this point, a
person may have to go on dialysis — where a machine
performs the role of the kidney — or receive a kidney
transplant.

Because of the serious consequences of kidney disease,

the American Diabetes Association recommends
screening for protein in the urine every year starting at the
time of diagnosis, or five years after the diagnosis in Type
1 diabetics.

Heart and Blood Vessel Disease

High blood sugar damages blood vessels and can lead to
blockage. In the heart, this blockage can cause heart
attacks. In fact, people with diabetes have two to four
times the risk of developing heart disease or stroke than
the general population. Blocked vessels in the legs can
cause pain and can also impair circulation. With poor
circulation, small cuts or infections are less likely to heal.
Eventually, 0.6 percent of all diabetics have lower limb
amputations because of damage to the feet or lower legs.

Nerve Disease
In diabetes, the nerves that become damaged are the
ones that allow you to sense temperature, pressure,
texture, or pain on your skin. In most people with diabetes,
nerve disease (neuropathy) effects the feet and lower
legs, causing numbness or tingling. The real problem
arises when numbness allows injuries to the foot to go
unnoticed. For this reason, the American Diabetes
Association recommends that all people with diabetes
have a thorough foot exam every year.
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