If you’ve ever had a physical check-up with your doctor, you may have wondered why they insist on putting a cuff on your arm and squeezing it full of air. The reason for this procedure is to check your blood pressure – a very important measurement in determining your overall level of health and well being. The importance of this measurement can be particularly significant in diabetic patients, a topic which we will explore in greater depth in this article.
What is Hypertension?
Though your body may seem dry and solid from the exterior, the picture on the inside is very different. Over 60% of your body weight consists of fluids, most of which are circulating throughout your body’s circulatory system. Your circulatory system is made up of your heart, which acts as a powerful pump, and a vast and intricate network of arteries and veins that carry your blood from your heart, to every single cell in your body, and then back to your heart.
Blood pressure refers to the amount of force that the blood exerts against the walls of your arteries and veins while flowing through the system. There are two numbers that make up a blood pressure measurement: the diastolic and the systolic pressure. The systolic, which appears as the “top” number, represents the amount of pressure exerted at the moment your heart contracts and pumps blood through the system. The diastolic, which is presented on the bottom, represents the blood pressure between contractions, as your heart refills in preparation for the next beat. Both measurements are typically presented together (e.g., 120/70 mm Hg), and are both important indicators of health.
So long as your blood pressure falls below 120/80 mm Hg, it is classified as within a healthy range. However, as it climbs beyond that point, it enters the pre-hypertensive range, and if it crosses the threshold of 140/90 mm Hg, it is considered to be high, or hypertensive.
High blood pressure can lead to all sorts of negative health consequences. The strain that higher blood pressures place on the lining of your arteries and veins can cause damage over time. This can accumulate into chronic damage that can lead to strokes, heart attacks, and other severe medical events that can potentially be fatal.
What are Hypertension Symptoms?
While high blood pressure can sometimes cause noticeable symptoms, it is also entirely possible for it to go unnoticed in patients. Some patients may also experience symptoms that mimic other medical conditions, making an accurate diagnosis of high blood pressure difficult without testing it directly. That is why the only reliable indicator of blood pressure is to measure it with a special instrument, usually involving a cuff that measures how much pressure is required to cut off blood supply to your arm. Fortunately, these tests are standard practice for most medical professionals, and can even be performed at home or in some pharmacies by patients without the need for any medical personnel to be present.
Some individuals with high blood pressure, particularly those with more severely elevated cases, may experience headaches, dizziness or vertigo, or impaired vision.
Are Diabetes and Hypertension Connected?
People with diabetes should take extra caution regarding their blood pressure, because diabetes can greatly increase the risk of hypertension. In fact, diabetics are more than twice as likely to develop high blood pressure than their non-diabetic counterparts. The connection may also exist in the opposite direction – people with high blood pressure are more than twice as likely to develop type 2 diabetes. Though it’s unknown whether there is a causal link between the two conditions, people with high blood pressure do tend to have a greater resistance to the function of insulin, a trait which is strongly associated with the development of type 2 diabetes.
The high co-morbidity between diabetes and high blood pressure may have to do with the fact that the two conditions share many overlapping effects within the body, such as the damage they cause to arteries and veins. Just as high blood pressure can stress and degrade these tissues over time, so too can the presence of high levels of blood sugar in diabetics. Over time, both conditions can cause blood vessels to become rigid and narrowed, leading to a host of negative health outcomes.
Preventing and Reducing High Blood Pressure in Diabetics
Fortunately for diabetics and non-diabetics alike, there are many practical steps to take that can reduce the risk of developing high blood pressure. Many of these involve simple lifestyle changes that can have a protective effect over time, and are relatively straightforward to put into place.
Ensure a low-sodium diet
Limiting sodium intake can play a large role in blood pressure management. Sadly, many foods in the modern American diet, particularly fast food and highly-processed foods, are packed full of sodium – more commonly known as table salt. Setting a daily guideline for salt intake is a good way to ensure you are not consuming dangerous levels – around 1500 mg is generally a good guideline, but your individual needs may vary. Checking food labels for salt content, and generally avoiding overly processed foods, are two great ways to help keep your blood pressure in check.
Maintain a healthy weight
Obesity, hypertension, and diabetes (type 2 in particular) frequently occur in common. Each can increase the likelihood of developing or worsening the symptoms of the others, which means that those with one or more of these conditions should exercise additional caution with respect to the others. One straightforward (but not always easy) way to help manage both diabetes and blood pressure is therefore to stay physically active and maintain a healthy body weight.
Studies have shown that exercise can sometimes be just as effective as medications in people with high blood pressure; it’s no surprise then that the AHA recommends all patients get a minimum of 150 minutes of moderate intensity aerobic exercise each week, where possible. This doesn’t need to involve anything overly strenuous – it could be as simple as taking a 20 minute walk or bike ride each day. By exercising regularly and losing as little as 5 to 10 lbs, some patients can expect to see significant reductions in their blood pressure, according to the AHA.
Avoid harmful substances
Certain substances like nicotine, some illicit drugs like amphetamines or cocaine, and alcohol, can directly increase blood pressure. Cutting these out completely, or as much as possible, can help avoid further aggravating high blood pressure in hypertensive patients (as well as realizing many other health benefits).
Pharmaceutical Options for Treating Hypertension
While lifestyle interventions can serve as powerful tools in diabetics’ efforts to maintain healthy blood pressure levels, sometimes they just aren’t enough. In such cases, a variety of pharmaceutical options exist that can help turn the tides of high blood pressure back towards healthier levels. This section will outline some of the more common blood pressure medications that are prescribed specifically to diabetic patients. You should always discuss starting or stopping any medication with a trusted healthcare professional before making any changes to your treatment.
ACE Inhibitors and ARBs
This class of medications is often a first choice for diabetics with high blood pressure. Not only can these medications help reduce blood pressure by dilating blood vessels, but they can also prevent or slow the progress of kidney damage, which is a common co-morbidity for diabetes. Studies comparing ACE Inhibitors against ARBs found they were similarly effective at producing the progression of diabetic kidney disease.
Like all medications, ACE Inhibitors and ARBs do carry risks of side effects and complications. These can include excessively low blood pressure that causes dizziness and weakness, high potassium levels (hyperkalemia), and swelling of the face (which can require urgent treatment if sufficiently severe).
Calcium Channel Blockers
Calcium channel blockers, sometimes called calcium antagonists, can help reduce the force with which the heart and arteries contract, thereby lowering blood pressure. They cause this effect by limiting the amount of calcium that enters the cells of the circulatory system. Because calcium signals to these muscular cells to contract strongly, lowering the presence of calcium can weaken contractions. One advantage to calcium channel blockers is that they are available in both short- and fast-acting formulations, allowing for greater flexibility in treatment depending on the specific needs of the patient.
Common examples of medications in this class include Amlodipine, Diltiazem, Felodipine, and Isradipine.
Side effects of calcium channel blockers may include constipation, dizziness, heart palpitations, and fatigue, among others. Patients should avoid consuming grapefruit, grapefruit juice, or any other product containing grapefruit, to avoid interactions with the drug.
Beta blockers, short for beta-adrenergic blocking agents, are a class of medications that are used to treat a variety of loosely-related conditions, including migraines, chronic anxiety, glaucoma, and high blood pressure. Their mechanism of action is to interfere with the activity of norepinephrine, a chemical messenger that communicates to the heart to beat faster and with greater force. Blocking the activity of norepinephrine allows the heart to beat slower and with less force, thereby reducing overall blood pressure.
Common examples of beta blocker medications include Sectral, Tenormin, Kerlone, and Levatol.
While beta blockers can be an effective treatment option for diabetics with high blood pressure, they can make other aspects of diabetes management more difficult. In particular, beta blockers have a tendency to mask the typical signs and symptoms that would otherwise alert you to low blood sugar levels (such as a rapid heartbeat). This effect of beta blockers mandates greater vigilance in diabetic patients who take them in order to more diligently monitor blood sugar levels to ensure they do not drop below a healthy range.
Due to its many co-morbid complications, diabetes can often be a tricky condition to manage. High blood pressure is only one example of the various secondary conditions that can make life for diabetic individuals more complicated. However, simple lifestyle changes can go a long way towards simultaneously improving symptoms of diabetes and high blood pressure, as well as other diabetes complications. Where these lifestyle interventions fail, medications like ACE inhibitors, calcium channel blockers, and beta blockers can sometimes be helpful in controlling blood pressure. Be sure to consult with your team of healthcare providers to develop a diabetes and high blood pressure treatment plan that works for you.