Diabetes and Hypertension: A Dangerous Duo

If you have diabetes, you already know about the importance of controlling your blood sugar levels.  But you may not be aware of another problem that can go hand-in-hand with diabetes — high blood pressure or hypertension.

“There is a strong connection between diabetes and hypertension,” explains Jai Radhakrishnan, MD, Director of Clinical Services of the Nephrology Division and Co-Director of the Hypertension Center at Columbia University Medical Center. “Two out of every three people with Type 2 diabetes also have high blood pressure or take prescription medications to lower their blood pressure. Both are diseases of lifestyle and aging and share common risk factors. The good news is that diabetes and hypertension can be modified through behavior, including eating a healthful diet, exercise, weight control and, if your doctor prescribes it, medication.”

People with diabetes either do not have enough insulin to process glucose or their insulin does not work effectively. As a result, glucose accumulates in the bloodstream, which can cause widespread damage to the blood vessels and kidneys.

“Diabetes is the number one cause of kidney failure in the US, and one third of diabetics develop kidney disease”

“Diabetes is the number one cause of kidney failure in the US, and one third of diabetics develop kidney disease,” says Dr. Radhakrishnan. “Diabetes causes damage by scarring the kidneys, which in turn leads to salt and water retention, which in turn raises blood pressure.  Over time, diabetes damages the small blood vessels, causing the walls of the blood vessels to stiffen and function improperly. These changes contribute to high blood pressure.”

People with both diabetes and hypertension have approximately twice the risk of heart attack and stroke as nondiabetic people with hypertension. Hypertensive diabetic patients are also at increased risk for complications including retinopathy (damage to the blood vessels in the tissue at the back of the eye) and kidney disease.

People with both diabetes and hypertension have approximately twice the risk of heart attack and stroke as nondiabetic people with hypertension. Hypertensive diabetic patients are also at increased risk for complications including retinopathy (damage to the blood vessels in the tissue at the back of the eye) and kidney disease.

“The blood vessels in the brain are also susceptible to the damage of high blood pressure,” adds Dr. Radhakrishnan. “Chronic high blood pressure can lead to the early onset of conditions such as dementia and stroke.

”Most people with diabetes should have a blood pressure of no more than 130/80. To achieve this, many diabetics need to take hypertension medications. “Some hypertension are more useful in the treatment of diabetes, especially diabetes resulting from kidney disease,” explains Dr. Radhakrishnan. “These include ACE (Angiotensin-converting enzyme) inhibitors, angiotensin II blockers, ACE 2 inhibitors. A new class of drugs called SGLT2 inhibitors are beneficial to diabetics in ways other than sugar control, such as slowing kidney and heart damage. They also help control blood pressure and weight gain.”

Lifestyle modifications such as eating a healthy diet and getting regular exercise can reduce complications from diabetes as well as high blood pressure.

Lifestyle modifications such as eating a healthy diet and getting regular exercise can reduce complications from diabetes as well as high blood pressure. “Living with diabetes requires monitoring blood sugar levels daily, diligently taking medications, exercising regularly, maintaining a healthy weight, and watching what you eat every day,” says Dr. Radhakrishnan. “To avoid hypertension, diabetics need to restrict their salt intake as well. The average American diet has 5 grams of sodium per day, and the recommended is 2.3 grams per day, which is about a teaspoon of salt. It is important to eat plenty of fruits, vegetables, fish, healthy fats and whole grains.”

Another key to keeping both diabetes and hypertension under control is self-monitoring both conditions at home and regularly seeing your healthcare provider. “We tell diabetics to self-monitor their blood sugar but we completely ignore the importance of self-monitoring blood pressure,” says Dr. Radhakrishnan. “In the long term, controlling blood pressure is equally or even more important for reducing the risk of stroke, heart attacks and kidney failure.”

At the Hypertension Center at Columbia University Medical Center, a multidisciplinary team of specialists provides personalized and comprehensive care to prevent and treat hypertension and manage the wide-ranging impact of hypertension on the human body. The Center offers in-person, telehealth and virtual visits to enable patients to easily connect with their providers and obtain immediate feedback regarding their blood pressure control.

“Our Center offers a remote home monitoring program in which a patient can be wirelessly connected”

“Our Center offers a remote home monitoring program in which a patient can be wirelessly connected,” says Dr. Radhakrishnan. “This enables us to proactively manage a patient’s blood pressure without the need for an in-patient office visit. We also offer a state-of-the-art diagnostic program with ambulatory blood pressure monitoring, radiologic imaging techniques and minimally invasive surgery for treatable causes of hypertension.”

“Armed with knowledge, healthy lifestyle modifications and a wide variety of telemedicine and ambulatory self-monitoring devices, people living with diabetes can prevent the many complications that arise from hypertension,” says Dr. Radhakrishnan. “Self-awareness and self-monitoring both diseases is key to defeat this dangerous duo.”

 

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