High Blood Pressure (Hypertension)

High blood pressure is known as “the silent killer” since almost half of the adult population has it but are unaware that they suffer from the condition.  This medical condition can increase the chance of heart attack, stroke, heart failure, dementia, neuropathy, and kidney disease. In fact, it is estimated that about 1.3 billion adults suffer from hypertension and this number is growing.

The causes of hypertension are complex and include both lifestyle & genetic factors. Genetic factors which include: body shape, gender, and family history. And lifestyle factors that include: excessive alcohol intake, an unhealthy diet, smoking, stress, and too little exercise.

Signs & Symptoms of Hypertension

Type 2 Diabetes

Type 2 diabetes is a chronic impairment of the way the body regulates and utilizes glucose as fuel. Insulin is the hormone in our body that enables glucose to enter the cells so that it can be used for energy.  For those with type 2 diabetes, the body either doesn’t produce enough insulin to process the body’s glucose or it isn’t effectively being utilized. As a result, glucose can’t enter the cells and accumulate in the bloodstream. High blood sugar levels begin to damage tissues and organs throughout the body including ones that regulate blood pressure (i.e. blood vessels and kidneys).

The incidence of type 2 diabetes is also on the rise as lifestyles associated with low energy expenditure and high-calorie intake are increasingly adopted. This is especially the case in low-income and developing countries. The CDC tells us that over 37 million people in the US alone have diabetes (type 1 and 2) and about 95% of these have type 2. That’s about 10% of the population! It has been predicted that the global number of type 2 cases of diabetes will increase from 415 million to 642 million by 2040.

While not every type 2 diabetes sufferer is overweight (although 90% are), the most common causes of this metabolic disease are lack of exercise and being overweight. It is estimated that about 95% of US diabetes cases are caused by these two factors alone. Cigarette smoking has also been earmarked by the CDC as one of the causes of type 2 diabetes.

Are the Two Diseases Linked?

Some of the symptoms of hypertension and type 2 diabetes are the same. So, is there a link? The short answer is yes, and not only are the two linked but often occur together in the same patients.

Over 80% of people with type 2 diabetes go on to develop high blood pressure, and around 20% of people with high blood pressure go on to develop diabetes. The two are so connected that they’ve been given the umbrella term “metabolic syndrome”.

Strikingly, hypertension and diabetes track each other consistently – people at high risk for either share the same metabolic abnormalities such as abdominal obesity, high blood insulin levels, and high triglycerides. Weight gain is a major factor that contributes to the development of both diseases. Someone who has one of these conditions is at a higher risk of developing the other. Also, patients with both often find that each condition makes the other worse. High blood pressure may not directly cause diabetes but it probably increases the risk of a person developing Type 2 diabetes.

Type 2 diabetics are twice as likely to suffer from hypertension than non-diabetics. Around 33% of adults with type 2 diabetes have a blood pressure of 130/80 mmHg or more or control it with medication.

Some of the causes of type 2 diabetes and hypertension are the same, including:

  • Too little exercise
  • Too high a calorie intake
  • Overweight or obesity
  • Insulin resistance
  • Inflammation in the body
  • Stress
  • Smoking (people who smoke cigarettes are up to 40% more likely to develop type 2 diabetes)

Although both type 2 diabetes and hypertension are straightforward for a doctor to diagnose, both are extremely complex to manage.

Diabetes is associated with an increased cardiovascular disease risk already which is further increased when hypertension is present. Doctors need to perform a juggling act to control both conditions while at the same time targeting strategies to promote vascular health to prevent diabetic complications and cardiac events.

Elderly Woman Checking Blood Pressure

How is Blood Pressure Affected by Diabetes?

Just being on insulin medication can increase the risk of developing hypertension. The body uses nitric oxide to increase the diameter of blood vessels and decrease blood pressure if necessary. Unfortunately, insulin blocks the body’s ability to produce nitric oxide. If a diabetic is using insulin, it inhibits the body’s ability to regulate blood pressure using the nitric oxide method. This further increases the patient’s risk of developing hypertension. Of course, the answer isn’t to stop using insulin. However, a physician will need to carefully monitor their patient’s condition including their blood pressure to find the optimal balance of medications. A patient can also ensure they don’t need high doses of insulin by incorporating a healthy diet, exercising regularly, and other lifestyle-optimizing measures.

Another reason that diabetes can increase the risk of developing hypertension is that the body can overproduce insulin in situations of high blood glucose. Insulin causes the body to retain extra salt and fluid. This in turn increases blood pressure.

Diabetes in the long term can cause damage to small blood vessels in the body. The vessel walls harden, increasing resistance and therefore pressure.

Both Conditions Have Similar Complications

The combination of diabetes and hypertension increases the risk of heart disease, kidney disease, and more. If left untreated, serious complications may result namely eye issues, kidney failure, heart attack, or stroke.

Decreasing high blood pressure in diabetic hypertensive patients decreases the incidence of cardiovascular events. The reason behind this is complex but an important component is a low-grade inflammatory process. Angiotensin II may induce oxidative stress which triggers vascular inflammation.

What Can Be Done?

The fact that these two life-threatening conditions are linked is both good and bad news. It’s bad news because having one immediately puts one at risk of developing the other and the situation often snowballs from there. It’s good news because many lifestyle changes can be made that are known to prevent, improve, and sometimes halt both conditions in their tracks. Keeping blood sugar levels and blood pressure under control reduces the risk of complications. Because the two conditions are linked, lifestyle changes made for one will benefit the other. These highly effective changes include:

  • Get thirty minutes of moderate-intensity exercise each day. This includes activities such as brisk walking, cycling, hiking, aqua-aerobics, or swimming.
  • Achieving gradual weight loss until a healthy body mass index is reached (between 18.9 and 24.5). Those with a BMI of more than 30 might be referred by their doctor to a dietician or a structured weight loss program.
  • Dietary improvements. These include eating more plant-based foods, replacing refined carbohydrates with unrefined whole grains, and reducing the amount of saturated fats and salt. Processed meats should be avoided and protein sources should be lean. Healthy cooking methods such as grilling or steaming should be preferred to frying.
  • Stress is a known risk factor for both type 2 diabetes and hypertension. When a person is stressed, hormones are released that raise blood pressure, increase blood glucose levels, and activate the immune system. A state of chronic stress makes blood sugar regulation difficult. Stress prevents the body from releasing insulin as it should. Therefore, practicing stress management techniques such as yoga or meditation can help control stress and indirectly, hypertension and type 2 diabetes.
  • Stopping smoking. It is now known without a doubt that smoking is one of the causes of type 2 diabetes. The more cigarettes a person smokes, the higher their chances of developing the condition. The mechanism is as follows: Insulin helps glucose to enter the cells. Nicotine causes cell inflammatory changes, preventing them from responding to insulin, thereby increasing blood glucose levels.

Obese woman exercising with trainer

Treatment with Medication

Doctors may prescribe their patient medications such as ACE inhibitors (angiotensin converting enzyme inhibitors) or ARBs (angiotensin II receptor blockers) first. There are several drugs available on the market which can effectively treat high blood pressure.  In addition, these drugs can also slow down kidney disease in patients with diabetes.

It’s possible that some drugs may cause blood sugar and lipid levels to worsen and lead to complications such as erectile dysfunction. However, you should discuss medications and their associated side effects with your doctor.

To Conclude

Type 2 diabetes and hypertension often occur together. There is a large overlap between the two in both causes and disease mechanisms. Studies have shown that not only does the presence of high blood pressure predict future type 2 diabetes in a person but also the incidence of high blood pressure increases significantly in the presence of diabetes.

The major common pathways are believed to be obesity, inflammation, and insulin resistance. Knowing about the common causes and mechanisms allows us to more effectively and proactively approach their prevention and treatment. type 2 diabetes and hypertension are two of the main risk factors for atherosclerosis and its consequences, including strokes and heart attacks.

Whether you have high blood pressure or diabetes, or perhaps both conditions, it is vital to monitor them both regularly and follow your physician’s advice carefully. Making lifestyle changes can improve both conditions dramatically so this is always a good place to start.

References:

https://www.medicalnewstoday.com/articles/317220#link

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977406/

https://pubmed.ncbi.nlm.nih.gov/1425110/

https://www.cdc.gov/diabetes/basics/type2.html#:~:text=More%20than%2037%20million%20Americans,adults%20are%20also%20developing%20it

https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html#:~:text=We%20now%20know%20that%20smoking%20is%20one%20cause%20of%20type%202%20diabetes.&text=In%20fact%2C%20people%20who%20smoke,people%20who%20don’t%20smoke.&text=People%20with%20diabetes%20who%20smoke,and%20with%20managing%20their%20condition.

https://www.cdc.gov/diabetes/library/features/smoking-and-diabetes.html#:~:text=Chemicals%20in%20cigarettes%20harm%20cells,if%20they%20aren’t%20overweight.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314178/

https://www.ahajournals.org/doi/10.1161/hypertensionaha.117.10546

https://pubmed.ncbi.nlm.nih.gov/17324119/#:~:text=More%20than%2080%25%20of%20patients,of%20cardiovascular%20morbidity%20and%20mortality.