Treating Hypertension in Patients with Diabetes

May 29th, 2013

Hypertension, otherwise known as high blood pressure is an extremely common condition in diabetes affecting 20 to 60% of patients. Ethnicity, age and obesity are the factors that determine the prevalence of this condition.

Reasons why treatment of hypertension in diabetics is important.

Hypertension has been found to increase the risk of macrovascular and microvascular complications in diabetics.

Microvascular complications

1. Renal disease

Hypertension has been found to contribute to renal disease in patients with diabetes.

2. Autonomic neuropathy sexual dysfunction

Anti- hypertensive therapy and hypertension contribute independently to sexual dysfunction in diabetics.

3. Orthostatic hypotension

Due to autonomic dysfunction, supine hypertension with orthostatic hypotension can occur. Therefore, blood pressure should be measured while either sitting or standing.

4. Eye disease

The risk of having conditions such as glaucoma and diabetic retinopathy which has the potential to cause total blindness is increased by hypertension.

Macrovascular complications

1. Cardiac disease

The risk of developing congestive heart failure, coronary artery disease and cardiomyopathy increases exponentially due to hypertension.

2. Cerebrovascular disease

Getting a stroke is far more likely for diabetic patients with hypertension. Survival and recovery rates are also lowered as compared to people who do not have diabetes.

3. Peripheral vascular disease

Foot ulcers and the risk of amputation is higher in patients with diabetes suffering from hypertension.

How to treat hypertension in diabetics?

It has been found that restricted sodium and a higher potassium intake is beneficial in lowering blood pressure.

However, this strategy alone is insufficient when it comes to attaining the levels recommended for diabetics. Medications are far more helpful and act faster than a change in diet. Some of these include;

ACE INHIBITORS

Patients who have had congestive heart failure or a myocardial infarction have benefited greatly from ACE inhibitors. It is also beneficial to those who have had renal failure due to complications of diabetes.

This is the preferred therapy for diabetics with hypertension according to the World Health Organization among others. Drug trials have shown a 20 -30% decrease in the risk of heart failure, strokes and major cardiovascular complications. They also increase insulin sensitivity.

Diuretics

Several studies have shown that diuretics are an important basis for antihypertensive treatment. Combined with agents that inhibit the renin-angiotensin system, diuretics reduce the level of micro albuminuria in patients with type 2 diabetes.

Various anti-hypertensive drugs may be used but diuretics are an important factor in their effectiveness and many in-expensive generic diuretics are available.

Combination Therapy

Most diabetics with hypertension require more than one form of therapy to maintain the recommended levels of blood pressure.

ACE inhibitors and CCB's have been found to reduce cardiovascular events. ACE inhibitors and beta blockers have the potential to lower blood pressure.

Conclusion

High levels of blood glucose have been found to increase the incidence of vascular damage and abnormal vascular structure which makes patients more vulnerable to high blood pressure.

People with diabetes should have lower than normal blood pressure to reduce the risk of complications due to diabetes.