For people with diabetes, changes in blood sugar levels can mean the difference between good health and serious danger, so controlling these levels is a crucial part of daily life. But a large percentage of people with diabetes also develop high blood pressure, or hypertension, which can also pose significant risk.
Below, Dr. William White from the University of Connecticut School of Medicine discusses this dangerous duo, and offers sound advice to people with diabetes who are in seek of good blood pressure health.
What is the real danger of having both diabetes and hypertension?
The major danger of having both diabetes and high blood pressure is that both are risks for the development of atherosclerosis, or the lining of the arteries getting diseased. So 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 conditions alone.
Is hypertension treatment different in people with diabetes?
If you just have high blood pressure alone, with no other chronic problems, then I think there's a true role for non-drug therapy, that is, using exercise, appropriate diets, watching salt intake, and increasing other nutrients that might have a positive impact on blood pressure.
But for people with diabetes or other risk factors already in place, even with the lower blood pressures, or milder, stage I types, you really have to accelerate the idea of using medications in that kind of individual.
What is a normal blood pressure range that people with diabetes should set as their goal?
When you have both high blood pressure and diabetes, it's kind of like a double whammy, because you are now at enhanced risk for coronary disease, vascular disease, kidney disease and so forth. So we've become more aggressive in recent years, because results of large studies suggest normalization is more important than ever before. So we are now trying to shoot for blood pressure that is normal i.e., less than 130 for the systolic pressure, which is the top number, and less than 80 for the diastolic, the number on the bottom. If you have significant renal or kidney disease, we're even looking for lower target values than that, if possible-less than 125 systolic and 75 diastolic.
What's the first step in achieving some of those levels?
Exercise, diet, and careful salt intake are all important steps, but we've learned that you really need to have multiple drugs used in a thoughtful combination as well.
Are there side effects that come with anti-hypertensives?
Every class of anti-hypertensive drug has some of its own distinct little side effects. Fortunately, the medications have gotten so much better during the last 20 years that we actually see many of the new drugs having no more side effects than placebo pills or sugar pills.
So with lifestyle modifications and drug treatment, is high blood pressure manageable for people with diabetes?
This is not a curable disorder, but a treatable disorder, and that is, in fact, a big difference. In many cases, though, it's a serious problem, because the end result of having uncontrolled diabetes and uncontrolled hypertension is just as bad as having uncontrollable or untreated cancer.
We've learned an awful lot just in the last couple of years about the management of the hypertensive patient with diabetes. We've learned specific new information about certain classes of drugs, and therefore we are able to provide to patients a more refined drug treatment plan, even though it's a lot of drugs, that will actually reduce their morbidity, and that's a very positive thing, considering what we knew a few years ago.
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