Hypertension and diabetes, seemingly two unrelated diseases, one related to blood pressure and the other to blood glucose, but in fact, they are mutually causal; diabetes aggravates hypertension, and hypertension predisposes to diabetes.
The prevalence of hypertension is twice as high in diabetic patients as in those without diabetes, and the likelihood of diabetes is even higher in hypertensive patients, 2.5 times higher than in those with normal blood pressure.
Therefore, do not exist a fluke, life is the key to prevention.
1.Does hypertension and diabetes affect or aggravate each other?
First of all, the relationship between hypertension and diabetes is “mutual cause and effect”.
Diabetes can make the arteries less elastic and more brittle, once the peripheral resistance of the blood vessels increases, there will be an increase in blood pressure, while diabeticemia will also further aggravate hypertension.
Conversely, having hypertension also predisposes to diabetes mellitus, which can lead to hyperlipidemia and high blood viscosity.
In addition, the two are epidemiologically closely related and are often found together in the same patient.
The prevalence of hypertension is twice as high in patients with diabetes as in those without diabetes, and about 60%-80% of patients with type 2 diabetes have hypertension in combination, with a higher prevalence of hypertension when it is complicated by kidney damage.
Type 2 diabetes tends to coexist with hypertension early, with 20-40% of patients having hypertension by the time diabetes is detected.
Most patients with type 1 diabetes have normal blood pressure before the onset of proteinuria or hyperalgesia, but blood pressure increases significantly after the onset of nephropathy, with an average arterial pressure increase of 5%-8% per year after the onset of nephropathy.
And about 15% of hypertensive patients have diabetes, the likelihood of diabetes in hypertensive patients is higher, 2.5 times higher than in normotensive people.
2.When hypertension is combined with hyperglycemia, how to choose the antihypertensive target and drugs?
(1) For patients with both diabetes and hypertension, what is the best blood pressure control level?
First, let’s look at a data: for every 10 mmHg decrease in systolic blood pressure in patients with hypertension combined with diabetes, the risk of diabetes-related complications can be reduced by 12% and the risk of death can be reduced by 15%.
Therefore, for hypertensive patients with combined diabetes, the target for lowering blood pressure is 130/80mmHg; however, for elderly patients or patients with severe coronary artery disease, a more lenient target for lowering blood pressure of 140/90mmHg is appropriate.
(2) How to use medication and treatment for patients with high blood glucose and blood pressure?
Non-pharmacological treatment: When the systolic blood pressure is 130-139mmHg or diastolic blood pressure is 80-89mmHg, diabetic patients can undergo non-pharmacological treatment for no more than 3 months, including diet management, weight loss, sodium intake restriction, appropriate alcohol restriction and regular exercise of moderate intensity.
Pharmacotherapy: Patients whose blood pressure cannot reach the standard or whose blood pressure is ≥140/90 mmHg should start pharmacotherapy immediately on the basis of non-pharmacological treatment.
Pharmacologic therapy begins with consideration of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor antagonists (ARB), both of which are first-line agents for the treatment of hypertension in combination with diabetes mellitus.
When a single agent is effective, either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor antagonist (ARB) may be preferred, and when a combination is required, one of these should also be used as the basis. If the patient cannot tolerate it, the two can be interchanged. Angiotensin-converting enzyme inhibitors (ACEIs) are beneficial in preventing renal damage in type 1 diabetes.
Diuretics, beta-blockers, and calcium channel blockers (CCBs) can be used as secondary agents, or in combination.
Diuretics and beta-blockers should be used in small doses to avoid adverse effects on lipids and blood glucose. In type 1 diabetic patients with recurrent hypoglycemic episodes, beta-blockers should be used with caution so that they do not mask the symptoms of hypoglycemia. Alpha-blockers are generally not used unless blood pressure is poorly controlled or there is prostatic hyperplasia.
The antihypertensive treatment for elderly diabetic patients should be gradual and progressive to achieve the target, in order to avoid the sudden drop of blood pressure causing insufficient blood supply to the organs.
References
[1] Revision Committee of the Chinese Guidelines for the Prevention and Treatment of Hypertension. Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition) [J]. Chinese Journal of Cardiovascular Diseases,2019,24(1):46.
[2] by Li Na. Research on Chinese and Western medicine in hypertension [M]. Changchun:Jilin Science and Technology Press,2019(08):33-35.
[3]Wang LY, Zhang XY, Kong XS, Fu ZOTI, Zhao CRL, Wang LJ, Zhang YJ, Ji LN, Li YF. Analysis of the relationship between prediabetes and hypertension and its influencing factors[J]. Chinese Journal of Health Management,2019(04):308-313.