hhigh blood pressure – also known as hypertension— and type 2 diabetes are two of the most common medical conditions in the United States. Unfortunately, they are often found together. Some research has found that 85 percent of middle-aged or older people who have type 2 diabetes also have hypertension, and both conditions increase the risk of heart disease, stroke, and kidney disease.
These increased risks are significant, and in some cases serious. Researchers have found that people with type 2 diabetes are up to four times more likely to develop cardiovascular disease than those without the condition. People with diabetes are also twice as likely to die from cardiovascular problems. The spikes in rates of stroke, kidney failure and other deadly complications are also significant for people who have both high blood pressure and diabetes.
Why do these conditions so often occur in tandem? Experts are still trying to determine the exact links, but say being overweight may play a role. Many people who have hypertension and type 2 diabetes also have obesity, and this “triumvirate,” as some researchers call it, is associated with metabolic and endocrine problems that overlap and promote the disease. “Obesity appears to be fertile ground for both,” says Dr. Srinivasan Beddu, professor of internal medicine at the University of Utah School of Medicine.
Also, the common incidence of hypertension almost guarantees that most people with type 2 diabetes will develop both. Approximately half of all adults in the United States have hypertension, and this percentage increases with age. “It can develop as early as [ages] 30 to 42, but in most cases, by the time you’re in your 50s, it’s there,” says Dr. George Bakris, a professor of medicine at the University of Chicago. Although hypertension often precedes Type 2 diabetes, says Bakris, diabetes is increasingly common in young adults and even children. It’s more important than ever to keep an eye on both conditions, perhaps especially if you’re overweight or obese.
Here, experts explain how high blood pressure and type 2 diabetes cause problems in combination, and how to manage the conditions and reduce their associated risks.
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Understanding the relationship
Every time the heart beats, it sends blood around the body through the circulatory system. Between beats, the heart fills with blood. A person’s blood pressure refers to two different but related measurements of this cycle. The first, known as systolic blood pressure, is the pressure inside the arteries when the heart beats and pumps blood. The second measurement, known as diastolic blood pressure, is the pressure inside the arteries when the heart is resting and filling with blood. These two numbers usually appear together and almost always rise and fall in unison. In the US, blood pressure values above 130/80 mm Hg are considered hypertension.
Bakris says hypertension is often called the “silent killer” because it may cause no symptoms. Even when a person’s blood pressure is dangerously high, the symptoms that develop are so common and nonspecific—meaning they occur for a variety of reasons—that you may not associate them with high blood pressure. Dizziness, headache and blurred vision are among these non-specific symptoms. By the time they occur, a person’s blood pressure may have been elevated — and causing harm — for several years. What kind of damage? High blood pressure can stretch or injure your arteries in ways that increase your risk of heart disease, artery disease, stroke, and other cardiovascular complications. High blood pressure also increases stress on the kidneys and some other organs.
Type 2 diabetes is a medical condition defined by high blood sugar levels. These high levels are caused by problems with insulin, which is a hormone that signals the body’s cells to absorb blood sugar. In people with type 2 diabetes, cells become ‘resistant’ to insulin, meaning they don’t absorb blood sugar properly. As with hypertension, the early symptoms of type 2 diabetes — frequent urination, blurred vision, dramatic spikes in hunger — may not immediately raise alarm flags. If someone doesn’t keep their doctor’s appointments, they may not know that one or both of these conditions are present.
How do these conditions combine in ways that contribute to health problems? “Both affect the small blood vessels,” says Dr. Mattias Brunstrom, a hypertension specialist and research physician at Umea University in Sweden. “Diabetes affects the vessels in ways that make them stiffer, and high blood pressure impairs their function.” This accumulation of arterial damage helps explain why the combination of the two conditions is associated with cardiovascular problems, including higher of heart disease and stroke.
At the same time, both hypertension and type 2 diabetes can also stimulate higher than normal blood sugar levels. High blood sugar can damage kidney cells (as well as the heart and blood vessels). Kidney disease— and eventually kidney failure — is a common complication among people with both conditions. “If you have [systolic] blood pressure consistently over 180, within 12 to 15 years, you’ll be on dialysis,” Bakris says, referring to a medical procedure that removes, filters and returns blood to someone whose kidneys can no longer handle it. The high blood sugar caused by type 2 diabetes further damages kidney cells and makes it more likely that the kidneys will struggle or fail to do their job.
Although cardiovascular and kidney problems are two of the most common complications, hypertension and type 2 diabetes can cause or contribute to a wide range of health problems, from dementia to blindness. “Both affect the vasculature, which can damage the health of any organ system,” Brunstrom says.
Fortunately, there are effective ways to manage both conditions and therefore reduce all of these health risks.
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What can you do
As is the case with most common health problems, experts say a combination of lifestyle changes and prescription drugs are often an effective one-two punch for people with hypertension and type 2 diabetes.
“First, I would say that lifestyle changes are at the heart of all disease management,” Brunström says. It again highlights the strong associations linking hypertension and type 2 diabetes with obesity, and the role of overweight in exacerbation of many health complications. “Obesity or being overweight is a huge driver of both conditions, so weight management would be very important,” he says. “Diet, exercise – any way you can lose weight is good.”
Even if you don’t lose weight, exercise is still beneficial. “It increases blood circulation around the body and improves the function of the small vessels they can get.” [blood] pressure relief,” he says. “It may also improve insulin sensitivity and lower glucose.” These are all good things. Even without sweaty exercise, spending less time sitting or being sedentary—walking, for example, or doing housework on your feet—can be helpful.
When it comes to nutrition, Brunstrom emphasizes the DASH diet, which is approved by the National Heart, Lung, and Blood Institute for treating hypertension. (DASH stands for “Dietary Approaches to Stop Hypertension.”) The DASH diet involves limiting your intake of saturated fat, which is commonly found in red meat and full-fat dairy products, and reducing your intake of salt and sugary foods and beverages. Meanwhile, the DASH diet recommends eating plenty of fruits and vegetables. Other experts support these eating habits. “I always tell my patients to eat healthy, which means more fruits and vegetables, less red meat, less high-carb foods,” says Bedouw of the University of Utah.
Recently, some researchers have studied the benefits of intermittent fasting plans for treating type 2 diabetes. These approaches involve restricting or eliminating all caloric intake for an extended period of time—usually 16 hours or more. There is evidence that they can be helpful. They also appear to be safe for people with early or mild disease. “But if you have diabetes and are on medication, these diets can wreak havoc,” Bakris says. “If you want to try this, you need the help of a doctor or an accredited diabetes nutritionist.”
Weight loss surgery may be a treatment option worth considering. Recent research shows that bariatric surgery has helped both young people and adults achieve better control of their diabetes and hypertension. In some cases, especially those involving teenagers, weight loss surgery has eliminated the need for medication or even eliminated the disease altogether.
In addition to surgery and lifestyle interventions, experts agree that prescription drugs are almost always needed to manage these conditions. “You can reduce your pill burden if you’re really good about your lifestyle—so you eat right, you cut sodium, you exercise regularly,” Bakris says. “But even at the low end, most people with diabetes and hypertension will need four to six drugs.”
Others agree that pills are almost inevitable. “I’m always comparing [taking] paying your taxes or brushing your teeth,” says Dr. Tom Brauer, a cardiology resident and researcher at the University of Amsterdam Medical Centers in the Netherlands. “It’s not fun, but you have to do it.”
In the US, medical guidelines recommend that doctors aim to get people with hypertension and diabetes to lower their blood pressure below 130/80 mm Hg. There is ongoing debate as to whether targeting even lower numbers would be beneficial. Brauer has done research in this area and says that in many cases he advocates aiming for a systolic blood pressure of 120. “If the patient can tolerate it, I tend to try to get their blood pressure down to 120,” he says.
There are many different drugs used to treat people with hypertension and type 2 diabetes. But two of the most popular options are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, both of which help relax the arteries and thus help blood flow. In addition to being effective for hypertension, these drugs also help protect the kidneys. Diuretics (medicines that increase urination), as well as beta blockers and calcium channel blockers, are common treatments.
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“With these three drugs, the vast majority of patients reach their blood pressure target,” Brauer says.
For those at risk for hypertension, diabetes, or both, experts say all of the lifestyle measures above — a good diet, exercise, and maintaining a healthy weight — are among the best ways to reduce your risks. . By following your doctor’s medication recommendations and trying to live a healthier life, you can protect yourself from serious complications. “I tell patients: You can help yourself,” Bakris says. “But you have to make an effort.”
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