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PARTICIPANTS William B. White, MD, FACP University of Connecticut Health Center Domenic Sica, MD Medical College of Virginia of Virginia Commonwealth University

Joining me today to discuss the strong connection between hypertension and diabetes are Dr. Dominic Sica from the Medical College of Virginia Campus of Virginia Commonwealth University, and also Dr. William White from the University of Connecticut School of Medicine.

Dr. White, let's start with you. What is the link between hypertension and diabetes?

WILLIAM WHITE, MD: Well, there's two links. One link is based on the simple numbers. There's a lot more patients who have diabetes in the hypertensive population compared to people who have normal blood pressure. Similarly, people with diabetes have a tendency to get high blood pressure, so there's an epidemiological or population-based increase within each of those disease groups.

There also seems to be a metabolic link between diabetes and high blood pressure due to a resistance in the way the body reacts to insulin, and insulin is not only a good thing, because it causes sugar to go into cells, but it also has some perhaps bad effects in the sense that it causes too much salt retention because of its effect on the kidney.

MABEL JONG: What effects do these somewhat chronic conditions have on the body overall?

WILLIAM WHITE, MD: The major issue with diabetes and high blood pressure together would be the fact that both of them are risks for the development of atherosclerosis or the lining of the arteries getting diseased. So therefore, the risk of heart attack, stroke and kidney disease are all accentuated fairly dramatically when an individual has both high blood pressure as well as diabetes versus having either of those alone.

MABEL JONG: Dr. Sica, it seems like more and more people know someone or have a friend who has diabetes and hypertension. Are there some people that are more susceptible to these conditions than others?

DOMINIC SICA, MD: Yes. I think we've got issues of race, age and inheritance patterns that drive what we see in diabetes. Also, how we gain weight is a very important risk factor, so people whose weight gain tends to localize around the tummy really have a much greater risk of developing diabetes.

MABEL JONG: Dr. White, how apparent is it to someone if they have high blood pressure?

WILLIAM WHITE, MD: Well, the big problem with this disorder is that unless you get your blood pressure checked, you really probably are not going to know you have high blood pressure. So screening programs and going to see a physician annually or every other year becomes somewhat critical to get the proper diagnosis.

MABEL JONG: Once you have discovered that you have it, what should you do about it?

WILLIAM WHITE, MD: You know, there's a lot of options. I think it depends on how severe it is when it is first diagnosed and what else actually is wrong with you. So if you have just high blood pressure with no other morbidities, that is, not diabetes, not heart disease, no evidence of stroke, no cholesterol problems, you don't smoke. In that instance, I think there's a true role for non-drug therapy, that is, using exercise, appropriate diets, watching salt intake, increasing other nutrients that might benefit the person from the standpoint of blood pressure effects.

Now, you take that same individual with the lower blood pressures, the more milder, stage I types, as we use in our terminology nowadays, and you add in other morbidities, such as a high cholesterol, a history of smoking a history of any kind of heart or kidney disease, a history of diabetes, then you really have to kind of accelerate the idea of using medications in that kind of individual.

MABEL JONG: Interesting. What are the risks of not controlling your blood pressure if you are indeed diagnosed with high blood pressure, Dr. Sica?

DOMINIC SICA, MD: Well, with high blood pressure, the risks are ominous. If you just have high blood pressure, as Dr. White just alluded to, you're a little bit safer with the disease and how it creates a specific risk, the risk then being stroke, development of coronary artery disease, congestive heart failure, peripheral vascular disease and end-stage renal disease or chronic renal failure.

MABEL JONG: Go over the normal levels and how a patient might be able to achieve those levels.

WILLIAM WHITE, MD: There's new guidelines that have been developed based on both the epidemiology, or population studies of diabetes and hypertension, and the results of treatment effects, and nowadays we look at the top number, the systolic blood pressure, as 130. We look at the diastolic blood pressure as about 80. So these are much lower values than in the past.

MABEL JONG: What public health or education challenges do these problems pose?

WILLIAM WHITE, MD: Well, if we take, let's say, the younger population in the United States, most young people after they finish college don't go to the doctor anymore. They don't have any reason, unless you are a woman going to see a gynecologist for routine care. So for about 20 years, many people don't get their blood pressure checked and they don't get their blood sugar checked.

One piece of advice that I would give to patients is that if you have a family history of diabetes or hypertension, your risk of developing these diseases is greater at an earlier age. We see increasingly, especially due to the obesity problem, a substantial number of individuals developing elevated blood sugars and blood pressures at much younger ages than in the past. Because of this, and because of poor dietary habits, we know that it needs to be screened and checked.

MABEL JONG: What about the elderly? Any special considerations there?

WILLIAM WHITE, MD: The elderly tend to go to the doctor a lot more, so they actually are diagnosed. But the issue with the elderly is the level of aggressiveness with which they and their physicians treat them.

MABEL JONG: Dr. Sica, do you have anything to add there?

DOMINIC SICA, MD: I think the substrate for much of heart disease is youth. The earlier we attend to matters and issues in life, the less likely it is when you get to the adult stage you can have a fully manifest disease.

MABEL JONG: Dr. White, some closing comments from you?

WILLIAM WHITE, MD: Well, I think that basically the new recognition of these new levels are important among physicians and their patients. We can tell you, as practicing physicians and as physicians who specialize in these disorders, that the treatment clearly links to improved outcome, that is, less morbidity, less strokes, less heart attacks, less heart failure, less kidney disease.

MABEL JONG: Important information. Dr. Sica, Dr. White, thank you again, for joining us today. And thank you for watching our webcast. I'm Mabel Jong.