This was another blog post I did for physiology about the prevalence of high blood pressure in people with Diabetes.  Kinda nuts how just regulating blood sugar may possibly have a profound impact on blood pressure!  AND, very upsetting that these patients are not having their blood pressure managed appropriately by their medical providers.  Not a risk I would be willing to take when I’m practicing!! -K

 

Studies have shown that people with Diabetes Mellitus are twice as likely to also have hypertension as people without Diabetes. This indicates that complications of Diabetes include all those associated with hypertension, not just those associated with the reactivity of glucose causing the hardening of arteries, etc. Research indicates that the correlation between patients with hypertension and Diabetes must be attributed to more than just obesity statistics, even though patients with Diabetes are more likely to be obese than those without, and obesity is linked to hypertension. Some of the vascular complications in hypertensive Diabetic patients include renal disease, autonomic neuropathy, sexual dysfunction, orthostatic dysfunction, eye disease, cardiac disease, cerebrovascular disease, and peripheral vascular disease (note: some of these complications are associated with or exacerbated by certain drug therapies). Although many of these are listed as common with Diabetes, the important thing to note is that they are all because of hypertension in the diabetic patient.
The association between blood glucose control and hypertension is startling; research showed a dramatic increase in mean arterial pressure within a day of “uncontrolled” chemical blood glucose levels. The study included a discussion of how hyperglycemia affects the osmotic fluid shifts at the capillary level, but concluded that the fluid shifts likely were not enough to be responsible for the complete rise in mean arterial pressure. They also discussed the effects of insulin on sodium and water retention in the kidneys, as well as its vasodilation properties in order to flesh out their findings and pose new hypotheses. Their initial findings merits discussion however, that indeed over four day periods of hyperglycemia, mean arterial pressures rose immediately indicating a strong correlation between hyperglycemia and hypertension.
Logic would assume that patients with Diabetes and hypertension need aggressive, if not more aggressive treatment than patients without, and yet studies indicate that is not reality. Diabetics were found to have higher blood pressures and less treatment than hypertensive patients without Diabetes. Clinicians are simply not treating hypertension aggressively, and the reasoning that they are “too busy with Diabetes management” was invalidated. Only 27% of patients actually meet the National Committee on Prevention, Detection, Evaluation and Treatment of Hypertension’s recommendations of maintaining a blood pressure below 140/90, which is even higher than their recommendation for Diabetic hypertensive patients (130/85). Patients with Diabetes fared even worse, indicating that they are far from controlling their hypertension appropriately. One group of researchers blame “clinical inertia,” which poses three main factors as possible reasons for undertreatment: “Clinician overestimation of the intensity of care they provided, clinician lack of training and the absence of organizational supports necessary in order to treat to target, and the use of “soft” reasons to justify not intensifying therapy.” In any case, improved control of hypertension must be a priority to clinicians. When patients with Diabetes have a scientifically proven increased risk for cardiovascular complications, it is inexcusable that one of the most common cardiovascular conditions, hypertension, is inappropriately addressed.

1. Hypertension Management in Patients With Diabetes
The need for more aggressive therapy

Dan R. Berlowitz, MD, MPH12,
Arlene S. Ash, PHD23,
Elaine C. Hickey, RN, MS12,
Mark Glickman, PHD3,
Robert Friedman, MD23 and
Boris Kader, PHD1
Diabetes Care February 2003
http://care.diabetesjournals.org/content/26/2/355.full
2. Poor Glycemic Control Induces Hypertension in Diabetes Mellitus
Michael W. Brands; Timothy E. Hopkins

From the Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson.
http://hyper.ahajournals.org/cgi/content/full/hypertensionaha;27/3/735
3. Controlling Hypertension in Patients with Diabetes

SHERRI L. KONZEM, PHARM.D., B.C.P.S.

Memorial Family Practice Residency and University of Houston College of Pharmacy, Houston, Texas

VICTORIA S. DEVORE, PHARM.D., University of Houston College of Pharmacy, Houston, Texas

DAVID W. BAUER, M.D., PH.D., Memorial Family Practice Residency, Houston, Texas

Am Fam Physician. 2002 Oct 1;66(7):1209-1215.
http://www.aafp.org/afp/2002/1001/p1209.html

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