Is hypertension a risk factor for diabetes

Introduction

Diabetes and hypertension frequently occur together. These two conditions are risk factors for atherosclerosis and complications, including heart attacks and strokes. There is a significant association between these two conditions with respect to etiology. Oxidative stress, obesity, and insulin resistance are frequent pathways. Physical activity plays a protective role in these two diseases.

Statistics

Hypertension occurs in around 30% and 50-80% of patients with type 1 and type 2 diabetes.

Causes

1. Genetics

Genetic variations in the gene encoding angiotensinogen, adrenomedullin, apolipoprotein, and α-adducin have been associated with these conditions.

2. Obesity

Obesity is identified as a prominent risk factor and obese persons were found to have an increased risk for both these conditions.

3. Inflammation and Oxidative Stress

Low-grade inflammation occurs in both these conditions and there was a rise in the inflammatory markers (C-reactive protein)

4. Mental Stress

Chronic mental stress, resulting from the modern lifestyle, is associated with psychological disturbances and leads to both these conditions.

Clinical features

Diabetes mellitus is characterized by a triad of symptoms; polydipsia, polyphagia, and polyuria. This includes excessive thirst, increased appetite, and frequent urination. Other correlated signs include fatigue, blurred vision, and poor wound healing.

Hypertension is an asymptomatic disease with no apparent signs and symptoms. It is defined as systolic blood pressure (SBP) above 140 mmHg and diastolic blood pressure (DBP) above 90 mmHg. Symptoms associated with this condition include tiredness, confusion, vision changes, irregular heartbeat, and angina-like chest pain.

Complications

Left ventricular hypertrophy and coronary artery disease are more common in diabetic hypertensive patients.

Diagnosis

It is observed that these two conditions often exist together in an individual due to the common metabolic pathway. Any individual presenting with high blood sugar should always be investigated for high blood pressure or vice versa. The following are the diagnostic tests that are commonly performed.

Hypertension is established if the blood pressure is consistently higher than 140/90 mm Hg. A sphygmomanometer is a device routinely used by practitioners to determine blood pressure. It can also be evaluated using the automatic blood pressure monitor. The practitioner often takes a few readings over days and weeks to confirm that the reading is consistent and not related to anxiety or any other reason.

Tests for High Blood Sugar levels
1. Glycated haemoglobin (HbA1c)

This test determines the average blood sugar level over the past 2 to 3 months. Glycated haemoglobin levels (A1C ≥6.5%) confirm the presence of this condition.

2. Fasting plasma glucose level (FPG)

Fasting is defined by the criteria of no calorie intake for a minimum of 8 hrs. FPG ≥126 mg/dl is the threshold level for high blood sugar levels.

3. Oral glucose tolerance test (OGTT)

2-hr plasma glucose level ≥200 mg/dl during oral glucose tolerance test is the standard therapy for a diagnosis of this condition. This test is performed after the administration of 75 g anhydrous glucose dissolved in water.

4. Random plasma glucose

Random plasma glucose ≥200 mg/dl in a patient with symptoms of high blood sugar indicates that the individual is diabetic.

Blood Pressure Targets

ADA recommends a target blood pressure of less than 140/80 mmHg for patients with high blood sugar levels.

Treatment

Once hypertension has been confirmed in a diabetic patient the following treatment measures should be followed.

Lifestyle Modification

Lifestyle alterations are necessary for the treatment of high blood pressure & blood sugar levels. Changes in lifestyle which were shown to have health benefits include:
  • Reduction of salt intake (<1.5 grams/day)
  • Increased consumption of fruits and vegetables (8-10 servings per day)
  • Restricting the consumption of low-fat dairy products (2-3 servings per day)
  • Engage in regular aerobic physical activity (e.g., brisk walking 30 min/day)
  • Lose excess weight
  • Avoid excessive alcohol consumption (less than 2 drinks daily for men and less than 1 drink/day for women)

Lifestyle changes may be the only treatment for patients with blood pressure <140/80, but ideally should be combined with drugs in patients with systolic blood pressure (SBP) ≥ 140 and or diastolic blood pressure (DBP) ≥ 80

Diabetes Medications with Antihypertensive Effects

The medications that promote glycemic control in individuals with high sugar levels include
  • Thiazolidinediones (Pioglitazone, Rosiglitazone, metformin)
  • Dipeptidyl diphosphatase inhibitors (Vildagliptin, Sitagliptin, Linagliptin)
  • Glucagon peptide receptor agonists (liraglutide, albiglutide, dulaglutide, exenatide)
  • Sodium-glucose cotransporter 2 (SGLT 2) inhibitors (Canagliflozin, dapagliflozin, empagliflozin)

These medication classes, glucagon receptor agonists have a tremendous effect on blood pressure reduction. Exenatide, a GLP -1 receptor agonist, has shown to decrease systolic blood pressure (SBP) by approximately 6 mm Hg. The other classes of medications have shown decreases in SBP of less than 5 mm Hg.

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