Hypertension in Diabetics Patient

Q1. What is Hypertension? How common is it in people with diabetes?

The definition of hypertension varies depending on the age, region and co-existing co-morbidities. As per the ACC/AHA guidelines (American), hypertension is defined as systolic BP ≥ 130 mm Hg and/or diastolic BP ≥ 80 mm Hg in office/clinic measurement. On the other hand, ESC/ESH guidelines (European) give the same figure as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg. In patients with diabetes, ADA guidelines (American) defines hypertension as sustained BP ≥ 140/90 mm Hg.

Hypertension and Diabetes are among the most common co-existing co-morbidities, with either one preceding the other or often being diagnosed simultaneously. Nearly 60% to 75% of patients with diabetes concomitantly suffer from hypertension and its consequent complications.

Q2. How does diabetes cause high blood pressure?

Diabetes causes high blood pressure by following mechanisms:

1. Endothelial dysfunction and arteriosclerosis eventually leads to vascular remodelling and luminal narrowing.
2. Insulin stimulates increased sodium transport.
3. Hyperglycaemia-induced hyperosmolarity increases circulatory fluid volume.
4. Hyperinsulinemia stimulates sympathetic nervous system and renin secretion which eventually leads to increased sodium retention in body.

Q3. Why is high blood pressure a problem in diabetes?

The co-existence of hypertension and diabetes increases the risk of adverse cardiovascular events by 6 fold. Further, hypertension also accelerates the progression of diabetic nephropathy by worsening the glomerular hypertension that is consequent to afferent arteriolar medial and intimal thickening (blood vessels within the kidney). Besides, the retinal arteries are susceptible to the double injury caused by co-existing diabetes and hypertension.

Q4. What is dyslipidaemia? How often do you find diabetes patients with dyslipidaemia?

Dyslipidaemia is defined as elevated total or low-density lipoprotein (LDL) cholesterol or low levels of high-density lipoprotein (HDL) cholesterol. But for diabetes patients, the lifestyle management and optimising glycemic control often starts for elevated triglyceride levels (≥ 150 mg/dl) and/or low HDL cholesterol (< 40 mg/dl for men and < 50 mg/dl for women).

In my clinical practice, almost all poorly controlled diabetic patients have one or more abnormalities in their lipid profile. Studies also mention that nearly 80% diabetic patients in India suffer from co-existing dyslipidaemia, commonest pattern being increased levels of atherogenic small LDL cholesterol particles, high triglycerides and low HDL cholesterol levels.

Q5. What can a diabetic eat if he/she has high cholesterol?

Following dietary advices to be taken care by diabetic patients suffering from co-existing dyslipidaemia:

1. Fruits: Eat more fruits (except Watermelon, Grapes, Banana and Pineapple). Avocado is good source of healthy fat.
2. Vegetables: Consume more green leafy vegetables and avoid potatoes, pumpkin and sweet potatoes.
3. Milk: Choose skim milk over whole milk.
4. Non-vegetarian food: Avoid red meat and increase intake of fishes (salmon, tuna, mackerel and herring).
5. Oil: Use Soya bean oil, ground nut oil or Sunflower oil for cooking. Avoid Ghee and Vanaspati.
6. Nuts: consume Walnuts, Almonds and Pistachios.
7. Eggs: Do not consume Egg yolk. Only take Egg white.
8. AVOID: Fast foods, Bakery foods and Processed foods.
9. Butter: Peanut butter is a source of healthy fat.
10. Increase fibre intake: green leafy vegetables, carrots, turnips, apricots, apples, pears and berries.

Q6. What lifestyle measures will you suggest to diabetic patients with co-existing conditions like Hypertension or Dyslipidaemia?

Lifestyle modification is the cornerstone of therapy for such patients. Along with dietary modification, it can be a game changer for diabetic patients with co-existing co-morbidities. Following exercise regimens to be followed by patients:

1. At least 150 minutes of moderate-to-vigorous aerobic activity per week.
2. Spread over at least 3 days/week.
3. No more than 2 days of gap between activity days.
4. 2 – 3 sessions of resistance training on non-consecutive days (body weight training, elastic bands and weight lifting).
5. Prolonged sitting to be interrupted after every 30 minutes.
6. Yoga is also good specially for older adults.
7. Moderate intensity aerobic activity: walking briskly, bicycling at your own pace, tennis (doubles) and general gardening.
8. Vigorous intensity aerobic activity: running, jogging, swimming laps, tennis (singles), bicycling fast, jumping rope and hiking uphill.