How Diabetes and High Blood Pressure Are Linked - TIME
High blood pressure—also known as hypertension—and Type 2 diabetes are two of the most common medical conditions in the U.S. Unfortunately, they often occur together. Some research has found that 85% of middle-aged or older adults who have Type 2 diabetes also have hypertension, and both conditions elevate a person's risk for heart disease, stroke, and kidney disease.
These increased risks are significant, and in some cases grave. Researchers have found that people with Type 2 diabetes are up to four times more likely to develop cardiovascular disease than those who don't have the condition. People with diabetes are also twice as likely to die of cardiovascular problems. The leaps in rates of stroke, kidney failure, and other deadly complications are also substantial for people who have both high blood pressure and diabetes.
Why do these conditions so often show up in tandem? Experts are still trying to nail down the precise connections, but they say excess weight may play a part. Many people who have hypertension and Type 2 diabetes also have obesity, and this "triumvirate," as some researchers have termed it, is associated with metabolic and endocrine problems that overlap and promote disease. "Obesity seems to be fertile soil for both," says Dr. Srinivasan Beddhu, a professor of internal medicine at the University of Utah School of Medicine.
Also, the sheer commonness of hypertension all but ensures that most people with Type 2 diabetes will end up with both diseases. Roughly half of all U.S. adults have hypertension, and that percentage goes up with age. "It can develop as early as [ages] 30 to 42, but in most cases, by the time you're in your 50s, it's there," says Dr. George Bakris, a professor of medicine at the University of Chicago. Although hypertension often precedes Type 2 diabetes, Bakris says, diabetes is increasingly common in young adults and even children. It's more important than ever to keep an eye out for both conditions, perhaps especially if you're overweight or obese.
Here, experts explain how high blood pressure and Type 2 diabetes cause trouble in combination, as well as how to manage the conditions and reduce their associated risks.
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Understanding the connection
Every time a heart beats, it sends blood out into the body via the circulatory system. In between beats, the heart fills with blood. A person's blood pressure refers to two different but related measurements of this cycle. The first, known as systolic blood pressure, is the pressure inside the arteries when the heart beats and pumps out blood. The second measurement, known as diastolic blood pressure, is the pressure inside the arteries when the heart is resting and filling with blood. These two numbers are usually presented together, and they almost always rise and fall in unison. In the U.S., blood-pressure scores higher than 130/80 mm Hg are considered hypertensive.
Bakris says hypertension is often called a "silent killer" because it may cause no symptoms. Even when a person's blood pressure is dangerously high, the symptoms that develop are so common and nonspecific—meaning they turn up for all sorts of reasons—that you may not connect them with high blood pressure. Dizziness, headaches, and blurry vision are among these nonspecific symptoms. By the time they set in, a person's blood pressure may have been elevated—and doing damage—for several years. What sort of damage? High blood pressure can stretch or injure your arteries in ways that raise your risk for heart disease, arterial disease, stroke, and other cardiovascular complications. High blood pressure also increases stress on the kidneys and some other organs.
Type 2 diabetes is a medical condition defined by high blood-sugar levels. These high levels are caused by problems related to insulin, which is a hormone that signals to the body's cells that they need to absorb blood sugar. In people with Type 2 diabetes, the cells become "resistant" to insulin, meaning they do not properly absorb blood sugar. As with hypertension, the early symptoms of Type 2 diabetes—frequent urination, blurry vision, dramatic hunger spikes—may not raise immediate red flags. If someone isn't staying on top of their doctor's appointments, they may not be aware that one or both of these conditions is present.
How do these conditions combine in ways that contribute to health problems? "Both affect the small blood vessels," says Dr. Mattias Brunstrom, a hypertension specialist and physician researcher at Umea University in Sweden. "Diabetes affects the vessels in ways that make them stiffer, and high blood pressure impairs their function." This stacking of arterial damage helps explain why the combination of the two conditions is associated with cardiovascular problems, including higher rates of heart disease and stroke.
At the same time, both hypertension and Type 2 diabetes may also promote higher-than-normal levels of blood sugar. Elevated blood sugar can damage the cells of the kidneys (as well as the heart and blood vessels). Kidney disease—and ultimately kidney failure—is a common complication among people with both of these conditions. "If you have [systolic] blood pressure consistently above 180, within 12 to 15 years, you will be on dialysis," Bakris says, referring to a medical procedure that removes, filters, and returns the blood to someone whose kidneys are no longer up to it. Elevated blood sugar caused by Type 2 diabetes further damages kidney cells, and increases the odds that the kidneys will struggle or fail to perform their job.
Although cardiovascular and renal problems are two of the most common complications, hypertension and Type 2 diabetes can cause or contribute to a wide range of health problems—from dementia to blindness. "Both affect the vasculature, which can impair the health of any organ system," Brunstrom says.
Fortunately, there are effective ways to manage both conditions and therefore reduce all of these health risks.
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What you can do
As is the case with most common health conditions, experts say that a combination of lifestyle changes and prescription drugs are often an effective one-two punch for people with both hypertension and Type 2 diabetes.
"First, I would say that lifestyle changes are the basics of all disease management," Brunstrom says. He re-emphasizes the strong associations linking hypertension and Type 2 diabetes to obesity, and the role excess weight plays in exacerbating many health complications. "Obesity or overweight is a huge driver of both these conditions, so weight management would be very crucial," he says. "Diet, exercise—any way you can get your weight down is good."
Even if you're not losing weight, exercise is still beneficial. "It increases circulation around the body and improves function of the small vessels, which might get [blood] pressure down," he says. "It might also improve the sensitivity to insulin and reduce glucose." That's all good stuff. Even short of sweaty exercise sessions, spending less time sitting or in a sedentary position—walking, for example, or doing chores around the house on your feet—may be helpful.
When it comes to eating, Brunstrom highlights the DASH diet, which is endorsed by the National Heart, Lung, and Blood Institute for the management of hypertension. (DASH stands for "dietary approaches to stop hypertension.") The DASH diet involves limiting your intake of saturated fats, which are common in red meat and fatty dairy products, and also cutting down on your intake of salt and sugary foods and drinks. Meanwhile, the DASH diet recommends eating lots of fruits and vegetables. Other experts endorse these eating habits. "I always tell my patients to eat healthy, which means more fruits and vegetables, less red meat, fewer high-carbohydrate foods," says the University of Utah's Beddhu.
Recently, some researchers have examined the benefits of intermittent fasting plans for the management of Type 2 diabetes. These approaches involve limiting or eliminating all caloric intake for an extended period of time—usually 16 hours or longer. There's evidence that they may be beneficial. They also appear to be safe for people with early or mild disease. "But if you have diabetes and are on medications, these diets can wreak havoc," Bakris says. "If you want to try that, you need the help of a physician or accredited diabetes dietitian."
Weight-loss surgery may be a treatment option worth considering. Recent research shows that bariatric surgery has helped both young people and adults get better control of their diabetes and hypertension. In some cases, especially those involving teenagers, weight-loss surgery has removed the need for medications or even eliminated the diseases entirely.
Apart from surgery and lifestyle interventions, experts agree that prescription medications are almost always necessary to manage these diseases. "You can reduce your pill burden if you're really good on the lifestyle side—so eating right, reducing sodium intake, exercising regularly," Bakris says. "But even on the low end, most people with diabetes and hypertension are going to require four to six medications."
Others agree that pills are pretty much unavoidable. "I always compare [taking] them to doing your taxes or brushing your teeth," says Dr. Tom Brouwer, a cardiology resident and researcher at Amsterdam University Medical Centres in the Netherlands. "It's not fun, but you need to do it."
In the U.S., medical guidelines recommend that doctors aim to get people with both hypertension and diabetes down to blood-pressure scores below 130/80 mm Hg. There's some ongoing debate about whether targeting even lower numbers would be beneficial. Brouwer has conducted research in this area, and he says that in many cases he's a proponent of aiming for a systolic BP of 120. "If a patient tolerates it, I tend to try to lower their blood pressure all the way to 120," he says.
There are many different drugs used to treat people with both hypertension and Type 2 diabetes. But two of the most popular options are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, both of which help relax the arteries and so assist blood flow. Apart from being effective for hypertension, these drugs also help protect the kidneys. Diuretics (drugs that increase urination), as well as beta blockers and calcium channel blockers, are all common treatments.
"With these three drugs, an overwhelming majority of patients get to the target blood pressure," Brouwer says.
For those at risk for hypertension, diabetes, or both, experts say that all the lifestyle measures above—a good diet, exercise, and maintaining a healthy weight—are among the best ways to lower your risks. By following your doctors' drug recommendations and trying to live a healthier life, you can protect yourself from serious complications. "I tell patients: you can help yourself," Bakris says. "But you have to put in the effort."
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