Hypertension (HTN) is a frequent problem in both type 1 and type 2 DM. Many people with type 2 diabetes present with HTN at their initial diagnosis, however in type 1, the incidence of HTN tends to rise with the duration of the disease. There is also a strong correlation between HTN and microalbuminuria, tiny amounts of protein in the urine caused by early kidney disease. Often, people with progressing microalbuminuria are diagnosed with HTN within a matter of years, and people with uncontrolled/untreated HTN tend develop microalbuminuria and subsequent kidney disease. HTN is also strongly associated with obesity and increased cardiac morbidity and mortality! It is certainly not something to ignore!
Why is HTN awareness in DM so important? What DM processes lead to a diagnosis of HTN?
Insulin resistance and hyperglycemia can lead to an increase in filtered glucose by the kidneys. When the excess glucose is reabsorbed so is excess sodium. An increase in salt leads to sodium retention and volume expansion (fluid overload) causing a rise in blood pressure. For this reason, people with HTN are often told to restrict their salt intake!
Additionally, due to the excess glucose bound to hemoglobin in uncontrolled DM (indicated by high HbA1c levels), blood vessels become stiff. When the stiffness of the vessel increases, the pressure required to pump blood through these vessels also must increase, hence increased BP.
Treatment of HTN is so important! Diabetes puts us at an increased risk for heart disease and kidney disease and HTN only amplifies those risks. So, how can we put decrease that risk?
According to the American Association of Clinical Endocrinologists (AACE), a person with diabetes' (PWD) BP should be consistently <130/<80mmHg. Early treatment is imperative and includes nonpharmacologic methods such as weight loss, smoking cessation, an increase in consumption of vegetables, and increased exercise.
Pharmacologic therapy should be initiated immediately if the BP is consistently >140/>80mmHg. Often in DM, the initial HTN treatment includes ACE-inhibitors (lisinopril, captopril, -pril) or ARB’s (losartan, -sartan) because these two classes can also act as kidney protectors! Other anti-hypertensives include thiazide diuretics, calcium channel blockers, beta blockers, alpha blockers, and many more. Often, combination therapy is needed to achieve an “at goal” blood pressure.
As I mentioned, treatment of HTN is essential. PWD need to do everything we can to set ourselves up for a lifetime of good health and success. If you do not yet have HTN, consider the previously discussed nonpharmacologic therapies. They can also be used for prevention! If you do have HTN I strongly encourage you to start checking your BP at home. BP machines can be purchased over the counter at any pharmacy. Check you BP in the morning as soon as you wake up and if your BP is consistently not at the goal of <130/<80mmHg have a discussion with your clinician! Remember, you are in charge of your own health. Take charge!
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