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Article by Dr. Sheri Colberg, Phd, FACSM

 

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TYPE 2 DIABETES AND HIGH BLOOD PRESSURE (HYPERTENSION)


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Type 2 diabetes and high blood pressure (hypertension) are strongly linked with each other. High blood pressure can increase the chance of cardiovascular disease, leading to a heart attack or stroke, as well raising the risk of kidney disease, blindness and the need for amputation.

Persons with diabetes are especially at risk.

Research has shown that at least 40% of people suffering from diabetes in its various forms have high blood pressure. But losing weight via a balanced, nutritious diet and carefully-planned regular exercise can greatly improve the efficient management of diabetes by reducing high blood pressure.

In people without diabetes, the endothelial cells that line blood vessels contain nitric oxide (NO), which helps to maintain blood pressure at a normal level. Unfortunately, people with diabetes experience a reduction of NO in endothelial cells caused by attacks by cell-damaging "renegade" molecules called free radicals.

Gentleman in hospital bed being cared for by a nurse.This process leads to endothelial dysfunction, which is frequently a harbinger of cardiovascular disease leading to a heart attack or stroke. High levels of fatty acids and triglycerides in the blood stream - common in persons with diabetes - may also damage the heart, leading to cardiomyopathy, which occurs when the heart muscle becomes inflamed and doesn't work properly. If neglected, this condition can eventually lead to heart failure.

Researchers in Finland set out to measure how diabetes and high blood pressure affect the chances of having a stroke, particularly if the person has both conditions. They also wanted to discover whether strokes are more likely to be deadly in people with diabetes.

The study focused on 49,582 Fins aged between 25 and 74. At the start of their survey, none of the participants had a history of stroke or coronary heart disease (disease of the heart's blood vessels). (1)

The researchers performed detailed surveys over 19 years, with participants initially required to complete a questionnaire that asked in-depth information about their health. High blood pressure and diabetes status was determined by asking about the type of medical care they received and the medications they took.

Gentleman having his blood pressure checked.The health of the participants was checked at regular intervals. Information about stroke and stroke-related deaths of any deceased participants was gathered from national information sources and computerized databases.

The end results were dramatic. Data showed that both high blood pressure and diabetes raised the chance of a person having a stroke. But the effect of having both conditions greatly increased the risk of stroke and a fatal outcome.

Participants with high blood pressure and diabetes were found to be 4.5 times more likely to have a stroke. If they did have a stroke, they were more than 9 times more likely to die from it than somebody with neither disease.

The blood pressure and diabetes status of each participant was determined by whether or not they were prescribed drugs to treat the conditions. Researchers cautioned, however, that this information may not have been completely accurate since it was self-reported by the participants. Some cases of high blood pressure and diabetes may have been missed and researchers had no way of knowing whether people took their medications as prescribed.

High blood pressure can be a major cause of inflammation - the body's defensive response to harmful stimuli.

In the case of diabetes, the harmful stimuli are thought to elevated levels of insulin - a classic symptom of Insulin Resistance.

If neglected over the years, inflammation can lead to serious damage to the arteries. The medical profession is still studying and evaluating the role of inflammation in a wide variety of disorders that can be inter-connected with diabetes. These disorders include the cluster of increased risks for cardiovascular disease called Metabolic Syndrome (Syndrome X) and Polycystic Ovarian Syndrome (PCOS), a leading cause of menstrual irregularity and female infertility as well as skin conditions, excess facial and body hair and female baldness. To learn more, please click on Inflammation, Insulin Resistance and Diabetes.

(1) The impact of history of hypertension and Type 2 diabetes at baseline on the incidence of stroke and stroke mortality, by G. Hu and colleagues. Stroke 36:2538–2543, 2005.

 

 

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