Hypertension (defined as a blood pressure ≥140/90 mmHg) is an extremely common comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance also including central obesity and dyslipidemia. In type 1 diabetes, hypertension may reflect the onset of diabetic nephropathy. Hypertension substantially increases the risk of both macrovascular and microvascular complications, including stroke, coronary artery disease, and peripheral vascular disease, retinopathy, nephropathy, and possibly neuropathy. In recent years, adequate data from well-designed randomized clinical trials have demonstrated the effectiveness of aggressive treatment of hypertension in reducing both types of diabetes complications.
Dear Dr. Taain,
your summary makes sense to me. I agree with the relationship of diabetic nephropathy and hypertension.
I also think that diabetes causes vascular problems, e.g. arterial stiffness. If the vessels become less elastic over time (a process even aggravated by diabetes), people are more likely to develop hypertension.
Another consideration is physical exercise. Several people with type 2 diabetes did not exercise regularly in their past. We all know that regular physical exercise makes hypertension less likely. I still remember the words of my first teacher in internal medicine. He said the most effective antihypertensive treatment ever is regular physical exercise (more effective than any medication). Of course this does not apply to all patients, and I do not know whether there is enough evidence for this, but he certainly has a point in arguing that physical exercise is associated with less hypertension.
Best wishes and kind regards,
Rainer
Hypertension known as the "silent killer," hypertension usually has no signs or symptoms and many people are not aware they have it.
Diabetes - patients long time may not have symptoms until their blood sugar levels reach dangerous levels.
Hypertension and diabetes: when H and DM co-exist, the effects of one disease tend to make the other worse. This makes for a deadly combination.
Diabetes does three things that may increase blood pressure:
- decreasing the blood vessels' ability to stretch
- increasing the amount of fluid in the body
- changing the way the body manages insulin
Classical studies such as UKPDS and HOT already demonstrated and spoke of such interrelationship.
Please review this document...
http://www.sciencedirect.com/science/article/pii/S0716864016300104
T2DM is due to multiple gene disorders leading to DM , HT & Lipid disorders occurring early . Macrovascular complications occur early & death is usually due to CAD , even at stage 2-3 CKD , which is a microvascular disease . In T1DM , CKD is the common cause of death & HT is due to diabetic nephropathy & occurs later at the onset of renal disease . It is essential to treat DM , HT & Lipid disorders early in T2DM to prevent or delay macrovascular & microvascular complications .
Both Diseases initially have no symptoms and most of the time coexist, if not in beginning than after few years. The cardiac ity and morbid mortality increases with combination of two. Both have common soil to develop
Diabetes is 2.5 tomes more common in hypertensives and Hypertension develops in 75 percent of diabetics that it selfe prooves thr asdociation and ARB and ACEI reduce the newonset of Diabetes in Hypertensive populations
High blood pressure is a condition that’s often present in people with type 2 diabetes. It’s unknown why there’s such a significant correlation between the two diseases although it’s believed that obesity, a diet high in fat and sodium, and inactivity contribute to both conditions.
Clinically I see hypertension present with hyperinsulinemia, which is type II diabetes. To verify this relationship, we have our patients fast, under clinic supervision, for two (2) days. In all patients, within two days, insulin levels dropped and blood pressure normalized. Patients then learn, when monitoring their B/P to fast to control their pressure. Clinically, all blood analyte values improve, except for a rise in triglycerides and urine ketones which indicates the utilization of body lipid stores.
The presence of one increases the risk of having the other. This close relationship between diabetes and hypertension suggests a possible common genetic or pathophysiological process or both. Hypertension and diabetes are associated with increased risk of cardiovascular disease and renal disease.
Article Hypertension and Diabetes Mellitus
Diabetes mellitus and hypertension are common diseases that coexist at a greater frequency than chance alone would predict. Hypertension in the diabetic individual markedly increases the risk and accelerates the course of cardiac disease, peripheral vascular disease, stroke, retinopathy, and nephropathy. Our understanding of the factors that markedly increase the frequency of hypertension in the diabetic individual remains incomplete. Diabetic nephropathy is an important factor involved in the development of hypertension in diabetics, particularly type I patients. However, the etiology of hypertension in the majority of diabetic patients cannot be explained by underlying renal disease and remains "essential" in nature. The hallmark of hypertension in type I and type II diabetics appears to be increased peripheral vascular resistance. Increased exchangeable sodium may also play a role in the pathogenesis of blood pressure in diabetics. There is increasing evidence that insulin resistance/hyperinsulinemia may play a key role in the pathogenesis of hypertension in both subtle and overt abnormalities of carbohydrate metabolism. Population studies suggest that elevated insulin levels, which often occurs in type II diabetes mellitus, is an independent risk factor for cardiovascular disease. Other cardiovascular risk factors in diabetic individuals include abnormalities of lipid metabolism, platelet function, and clotting factors. The goal of antihypertensive therapy in the patient with coexistent diabetes is to reduce the inordinate cardiovascular risk as well as lowering blood pressure.
A link seems to be high insulin levels. Consider this study: J Clin Invest. 1985 Mar; 75(3): 809–817. doi: 10.1172/JCI111776 PMCID: PMC423608 PMID: 3884667 Hyperinsulinemia. A link between hypertension obesity and glucose intolerance: From abstract:
We conclude that insulin resistance and/or hyperinsulinemia (a) are present in the majority of hypertensives, (b) constitute a common pathophysiologic feature of obesity, glucose intolerance, and hypertension, possibly explaining their ubiquitous association, and (c) may be linked to the increased peripheral vascular resistance of hypertension, which is putatively related to elevated intracellular sodium concentration.
Diabetes and hypertension together can increase risk of strok and heart attack
All answers are correct. Beside the genetic factors and age there is a very important risk factor which is chronic stress, since it causes DM, immobilized lipids, CVDs, insulin resistance and hypertension.
These patients suffer from the "Metabolic Syndrome": central obesity, also known as visceral obesity, (obesity that predominates in the abdomen with increased girth, not in the extremities), hypertension, dyslipidemia with high levels of triglycerides and low High density lipoprotein cholesterol(HDL colesterol), insulin resistance, hyperuricemia, fatty liver. They have an increased risk of developping cardiovascular diseases.
The insulin resistance may go through three stages: normal fasting blood sugar (FBS), and 2hour post-prandial blood sugar (2hrPPBS), normal to mildly elevated Hemoglobin A1c (HgA1c); second phase: prediabetes, with mild elevations of FBS and/or 2hrPPBS and/or HgabA1c; third phase diabetes.
Weight loss is a very important part of the treatment, as well as regular aerobic exercises, like walking a total of 5 hours per week. If the patient is already a diabetic, this should be treated in addition to the diet and exercise, with drug therapy as necessary to obtain a level of HgA1c below 7
diabetes condition increase blood pressure because its increase the stiffness of vascular
Diabetes is an endocrine driver for metabolic diseases. carbohydrate , protein and lipid metabolism are messed up in diabetics. Hyperlipidemia will definitely affect the heart and associated blood vessels due to high profile of LDL-C and low profile of HDL-C in diabetics.
Insulin resistance leads to higher levels of sugar in the blood, plus high blood pressure and high cholesterol. Eating fat does not cause this to happen – it has more to do with eating foods high in sugar and carbohydrates. The accumulation of excessive body fat especially in the abdomen, causes continuous (chronic), low levels of abnormal inflammation that alters insulin’s action and contributes to the disease.
As type 2 diabetes starts to develop, the body becomes less sensitive to insulin and the resulting insulin resistance and high blood sugar contributes to inflammation and the production of extra cytokines – inflammatory chemicals. They interfere with our ability burn fat, so we store it instead.
Stress hormones like adrenaline and cortisone increase blood sugar and if the stress is continuous the high blood sugar becomes a problem. If one is deficient in magnesium, zinc, chrome and other nutrients that produce insulin, the accumulated blood sugar can attack our blood vessels, causing damage that increases homocysteine levels. A magnesium deficiency also causes blood vessels to contract, so the blood pressure increases. People with cardiovascular disease, diabetes and cholesterol problems have high homocysteine levels. Stress also increases sugar cravings.
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