Diabetes and Hypertension – Diabetes Resource Center | NewYork-Prebsyterian 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.
- 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.
Why does diabetes affect hypertension?
Causes and risk factors of high blood pressure – For most people, there’s no single cause of high blood pressure. But we know some things can make you more at risk. These are called risk factors, and one of these is having diabetes. High levels of sugar in your blood can lead to something called atherosclerosis.
- This is when there’s a build-up of fatty material inside your blood vessels, narrowing them.
- The narrower the blood vessels, the more the pressure builds up.
- The more stress your blood vessels are under, the harder it is to push blood around the important areas of your body.
- This means your feet, eyes and heart are seriously at risk.
There are other risk factors you can’t do much about:
your agea family history of high blood pressureif your ethnic background is African-Caribbean or Black African
And there are risk factors you do have control over:
too much salt in your dietbeing overweightnot being activesmokingdrinking too much alcoholhow you cope with stressdrinking too much caffeine, such as coffee
If you make changes to your diet and lifestyle, you can reduce your risk of developing high blood pressure. We’re not saying it’s easy, but it’s vital you understand how you can do this. There’s lots of support to help you bring your levels down and achieve your goals.
How does sugar increase blood pressure?
Though sodium (salt) is known to lead to high blood pressure, or hypertension, sugar can actually play a role too. Eating too much sugar can inhibit the production of nitric oxide (NO) in blood vessels. Nitric oxide normally helps with vasodilation (expanding of the blood vessels).
Is blood sugar connected to blood pressure?
Diabetes and high blood pressure commonly co-exist. In fact, a person with diabetes is twice as likely to have high blood pressure as someone who is diabetes free. Similarly, patients with high blood pressure are more resistant to insulin-stimulated glucose uptake than matched control groups with normal blood pressure.
Do these two medical conditions simply share common risk factors? Or is there a deeper relationship between blood pressure and blood sugar? BLOG: New Research on Omega-3 Dosage and Blood Pressure Blood Sugar Basics When people eat foods, primarily carbohydrates, the digestive system breaks food down into sugar, which enters the blood.
Blood sugar, or glucose, is the primary energy source for all cells in your body. Multiple hormones are in charge of regulating blood sugar levels on a regular basis. If blood sugar falls too low, known as hypoglycemia, the body will produce ” gluco-counter-regulatory ” hormones, including catecholamines.
These hormones, such as epinephrine, cortisol, growth hormone, and glucagon, act through different mechanisms to increase blood sugar levels. On the other hand, if blood sugar rises too high, referred to as hyperglycemia, the body produces insulin, This hormone drives sugar out of the bloodstream into the muscle, fat, and liver cells, ultimately decreasing blood sugar.
Sometimes the intricate system that controls blood sugar stops functioning effectively. Often, this leads to chronic hyperglycemia. Hyperglycemia, by definition, is blood glucose greater than 125 mg/dL while fasting or blood glucose greater than 180 mg/dL two hours after eating.
- Moreover, if fasting glucose ranges from 100-125 mg/dL, this is considered impaired fasting glucose and may indicate pre-diabetes.
- Early symptoms of hyperglycemia include increased thirst/hunger, blurred vision, rapid heart rate, frequent urination, and headache.
- Hyperglycemia over time can lead to symptoms like fatigue, weight loss, increased risk for infection, and slow healing capabilities.
BLOG: Is Blood Sugar Higher During Pregnancy? Reasons for hyperglycemia can be acute, such as physical stress (illness or infection), emotional stress (dealing with a breakup or new job), or due to certain medications (steroids or diuretics). Hyperglycemia can also be caused by chronic conditions such as endocrine or pancreatic diseases like Cushing syndrome or long-term insulin resistance.
- Insulin resistance occurs when insulin’s ability to stimulate glucose uptake by the tissues is impaired.
- Often when the body stops responding to insulin, the pancreas will have to produce higher amounts of insulin, termed hyperinsulinemia, to get the same results.
- Prolonged high blood sugar levels can damage blood vessels and nerves, lead to heart disease, and permanently damage the eyes or kidneys.
Blood Pressure Basics Blood pressure is the force of blood pushing against your blood vessel walls. Maintaining a healthy blood pressure is important because it allows for adequate amounts of oxygen and nutrients to be pushed around the circulatory system and delivered to the body’s organs and tissues.
- But like blood sugar, blood pressure can fluctuate and is managed through several mechanisms by many of the same hormones that help manage blood sugar.
- Hormones that can increase blood pressure include adrenal hormones and catecholamines like aldosterone, cortisol, adrenaline, and insulin.
- Hormones and regulators that can decrease blood pressure include nitric oxide, natriuretic peptides, and vasodilator peptides.
BLOG: Can a Low Vitamin D Level Affect Blood Pressure? Hypertension, or high blood pressure, is when the heart must use high force to pump blood through the heart and blood vessels. When measuring blood pressure, the first, or top, number is “systolic pressure,” which is the pressure in your arteries when your heart contracts.
The second, or bottom, number is the “diastolic pressure,” which is the pressure in your arteries when your heart rests. The American Heart Association (AHA) categorizes normal blood pressure as 120/80 or below. Hypertension usually has no signs or symptoms, which is why it’s often referred to as the “silent killer.” It’s estimated that half of Americans over the age of 20 have high blood pressure, and half of those don’t even know it.
However, some may experience episodes of headache, dizziness, or blurred vision when blood pressure is significantly elevated. Reasons for hypertension can vary. Primary hypertension may be caused by diverse reasons, including genetics, excessive salt intake, obesity, lack of exercise, or use of tobacco and alcohol.
- Secondary hypertension is due to particular medical conditions such as kidney disease, Cushing’s syndrome, or prescription medications.
- If untreated, hypertension can lead to life-threatening complications such as heart attack, heart failure, stroke, or kidney failure.
- Can Blood Sugar Affect Blood Pressure? Yes.
It turns out that hyperglycemia can contribute to hypertension. High blood sugar can increase blood pressure through two primary means. First, untreated hyperglycemia can lead to nerve and blood vessel damage. Damage to the blood vessels causes the walls to stiffen, narrow, and accumulate plaque.
Plaque buildup narrows the vessels, increasing pressure and contributing to hypertension. Second, chronic hyperglycemia leads to chronic hyperinsulinemia. Hyperinsulinemia can increase blood pressure by (1) increasing renal sodium and water reabsorption, (2) activating the sympathetic nervous system, which increases heart rate and contracts the blood vessels, (3) altering transmembrane ion transport leading to intracellular accumulation of sodium and sensitizing the arteriolar smooth muscle to pressor hormones, and (4) increasing vascular resistance by leading to hypertrophy of the vascular walls and narrowing of the blood vessels.
Therefore, it’s high insulin levels that lead to high blood pressure. But the best way to manage insulin levels is by managing blood sugar levels. BLOG: What Blood Sugar Level is Normal Finally, since the same hormones (catecholamines) are used for increasing blood sugar and increasing blood pressure, it’s important to note that hypoglycemia can also lead to high blood pressure.
If blood sugar falls too low the body releases hormones like adrenaline to increase blood sugar back to normal levels. Adrenaline, and similar hormones, are also responsible for increasing heart rate and constricting blood vessels, leading to elevated blood pressure. Ultimately, when blood sugar falls too far in either direction, blood pressure may be affected.5 Ways to Support Healthy Blood Sugar and Blood Pressure Maintain a healthy weight – If overweight, weight loss may prevent disease progression.
The Centers for Disease Control and Prevention ( CDC ) notes that a 5-7% loss of body weight can stop pre-diabetes from developing into diabetes. Similarly, the National Heart, Lung, and Blood Institute (NHLBI) indicates that a 3-5% loss of body weight can improve blood pressure.
- Be physically active – Regular physical activity can lower blood pressure and blood sugar levels.
- Current CDC guidelines recommend 150 min of moderate-intensity exercise or 75 minutes of vigorous exercise each week.
- Adopt a healthy dietary lifestyle – It’s essential to find a dietary lifestyle that fits your goals and values, is suitable for you financially, and feels sustainable.
The DASH, Mediterranean, or MIND diet lifestyles have been found to support blood pressure, blood sugar, and physical and cognitive functioning. All focus on high intakes of vegetables and include lean proteins, unsaturated fats, high-fiber carbohydrates, and limited salt intake.
TOOL: How to Test Your Blood Sugar Level Manage stress – Stress can raise both blood sugar and blood pressure. Managing and coping with stress can improve your mental and physical health. Relaxation and meditation apps are available to aid with stress. Other great options include mental health counseling, support groups, time spent with loved ones, or an activity that helps downregulate stress hormones and find rest.
Quit smoking – Smoking can increase the risk of type 2 diabetes by 30-40%. Due to nicotine’s ability to decrease the cellular response to insulin and increase systemic inflammation, cigarette smoking has been found to increase blood sugar. Similarly, nicotine can increase blood pressure by stimulating the release of epinephrine and norepinephrine.
- Smoking cessation programs have found that both systolic and diastolic blood pressure improve and decrease your risk for type 2 diabetes.
- Conclusion Evidence demonstrates that hyperinsulinemia, most often caused by hyperglycemia and insulin resistance, can lead to hypertension.
- Furthermore, the bodies response to low blood sugar, the release of catecholamine hormones, can also lead to high blood pressure.
Therefore, blood sugar instability in either direction may increase blood pressure levels. It’s important to note that you don’t have to have a diabetes diagnosis to struggle with blood sugar control and be affected by these negative health consequences.
Recent evidence from the University of Alabama at Birmingham found that nearly 40% of young adults without diabetes experience unhealthy blood sugar levels and insulin resistance. With the acknowledgment that fluctuations in blood sugar levels may lead to a cluster of health concerns, including high blood pressure, it’s vital to monitor and regulate blood sugar and blood pressure levels when possible.
BLOG: How Does Blood Pressure Affect Vision?
Does hyperglycemia cause high blood pressure?
Conclusions – Hyperglycemia is a risk factor for incident hypertension in type 1 diabetes, and intensive insulin therapy reduces the long-term risk of developing hypertension. Hypertension, an established and modifiable risk factor for cardiovascular disease and mortality, is among the most prevalent chronic health conditions worldwide.1 Hypertension is particularly common among people with diabetes mellitus.2 The close association of diabetes with hypertension is commonly thought to be due to underlying obesity, insulin resistance, and/or hyperinsulinemia.2 – 5 Hyperglycemia itself may also cause changes in vascular function and structure that lead to hypertension.6, 7 However, the long-term effect of hyperglycemia on blood pressure is not known.
In type 1 diabetes mellitus, hyperglycemia is predominantly due to insulin deficiency, and intensive insulin therapy can effectively control blood glucose concentrations.8 Reducing glucose concentrations may help prevent vascular changes leading to hypertension, but it is also possible that the modestly greater quantities of insulin used to control hyperglycemia and the weight gain often associated with intensive insulin therapy may adversely affect blood pressure.5, 9 This potential trade-off has important clinical consequences because hypertension is an important contributor to both the microvascular and the macrovascular complications of diabetes.10, 11 We examined the effects of intensive insulin therapy and hyperglycemia on the development of hypertension in the Diabetes Control and Complications Trial (DCCT) and its observational extension, the Epidemiology of Diabetes Intervention and Complications (EDIC) study.
In the DCCT and EDIC study, participants have been followed up for more than 2 decades, with blood pressure recorded every 3 months to 1 year, frequent and detailed measurements of relevant clinical characteristics, and minimal unavailability for follow-up.8, 12, 13 Moreover, participants were randomly assigned to either conventional or intensive insulin therapy, with a wide separation in hemoglobin A 1c level achieved during the mean 6.5 years of the DCCT, allowing assessment of the effect of glucose lowering on the development of hypertension.
Is high sugar related to blood pressure?
Heart and Vascular High Blood Pressure/Hypertension Diabetes High blood pressure is twice as likely to strike a person with diabetes than a person without diabetes. Left untreated, high blood pressure can lead to heart disease and stroke, In fact, a person with diabetes and high blood pressure is four times as likely to develop heart disease than someone who does not have either of the conditions.
How does insulin resistance cause hypertension?
Abstract – Insulin resistance and compensatory hyperinsulinaemia commonly occur in patients with untreated essential hypertension. The coexistence of insulin resistance and hypertension can be viewed as a cause-effect relationship (insulin resistance as a cause of hypertension or vice versa) or as a noncausal association.
- Insulin can increase blood pressure via several mechanisms: increased renal sodium reabsorption, activation of the sympathetic nervous system, alteration of transmembrane ion transport, and hypertrophy of resistance vessels.
- Conversely, hypertension can cause insulin resistance by altering the delivery of insulin and glucose to skeletal muscle cells, resulting in impaired glucose uptake.
For example, hypertension can impair vasodilation of skeletal muscle as a result of vascular structural changes and rarefaction, and increased response to vasoconstrictor stimuli. Also, the prevalence of muscle type 2b fibres (fast twitch fibres) may contribute to the development of insulin resistance.
What is the pathophysiology behind hypertension?
The pathophysiology of hypertension involves the impairment of renal pressure natriuresis, the feedback system in which high blood pressure induces an increase in sodium and water excretion by the kidney that leads to a reduction of the blood pressure.
Does low insulin cause high blood pressure?
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Does diabetes cause resistant hypertension?
Background and Aims – Resistant hypertension is an increasingly clinical problem that is often heterogeneous in etiology, risk factors, and comorbidities, A proportion of poorly controlled hypertensive subjects have resistant hypertension, defined as failure to achieve the goal BP <140/90 mmHg when patients adhere to an appropriate regimen of three or more than three antihypertensive agents of different classes or controlled blood pressure with four or more medications. Ideally, one of the three agents should be a diuretic and all agents should be prescribed at optimal dose amounts, Although resistant hypertension is quite common, the exact prevalence remains unknown. Data derived from cross-sectional studies and post hoc analyses of clinical trials have estimated that the prevalence of resistant hypertension is about 10%–35% of all patients being treated for hypertension, Data from NHANES indicate that the prevalence of resistant hypertension was 9–12%, In the ACCOMPLISH study between 25% to 28% of subjects remained uncontrolled during the study in spite of treatment intensification, Resistant hypertension has been linked with type 2 diabetes, obesity and chronic kidney disease, The presence of diabetes and/or chronic kidney disease can be both causes and consequences of resistant hypertension. These associations predispose resistant hypertension subjects to high risk of cardiovascular events and mortality rates compared to controlled hypertension subjects, Evidence from randomized controlled trials show that blood pressure lowering treatment reduces the risk of cardiovascular morbidity in hypertensive subjects, regardless of the classes of antihypertensive drugs used, Recent guidelines recommend angiotensin-converting enzyme inhibitors or angiotensin II receptors blockers as first-line antihypertensive agents for their favorable outcomes in subjects with chronic kidney disease and diabetes, Therefore, we aimed at assessing the prevalence of resistant hypertension and to describe a type 2 diabetes population with resistant hypertension.