Hypertension increases the risk for end-organ damage in people with diabetes.
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More than 1 in 10 American adults have diabetes, according to the Centers for Disease Control and Prevention. Many people with diabetes also have hypertension, or high blood pressure. A March 2006 review in "Diabetes Care" referred to these two conditions as concordant, because the biological processes that cause diabetes also contribute to hypertension. Diabetes or hypertension alone magnify your risk for end-organ damage to your eyes, heart, brain, kidneys and other organs. When you have both conditions, the risk for end-organ damage sharply increases. Only by treating both disorders can you minimize end-organ damage.
Damage Starts Early
The tissue injury inflicted by diabetes and hypertension begins in the early stages of these diseases, long before any signs or symptoms of end-organ damage appear. When a stroke, heart attack, kidney failure or blindness has already occurred, treatment is of limited value. So, doctors begin treatment to prevent or delay end-organ damage as soon as you are diagnosed with diabetes. Even if your blood pressure is normal, the processes that lead to hypertension, such as inflammation in the walls of your arteries, are already in motion.
Control Blood Glucose
Hyperglycemia, or high blood glucose, is the hallmark of diabetes and contributes to the complications of diabetes in a variety of ways. A study performed at Mayo Clinic College of Medicine and published in the April 2011 issue of "Journal of Investigative Medicine" demonstrated that high blood glucose accelerates the inflammatory process that damages the blood vessels of people with diabetes. This triggers a cascade of events that lead to atherosclerosis, or stiffening of your arterial walls, and progressively higher blood pressure. So, blood pressure control could be difficult if your blood glucose is not under control. Your doctor may recommend daily exercise, weight loss, dietary changes, and oral or injectable medications to lower your blood sugar level.
Lower Blood Pressure
Approximately 70 percent of people with hypertension need at least 2 medications to control their blood pressure, whether or not they have diabetes. Angiotensin converting enzyme inhibitors, such as lisinopril (Zestril, Prinivil) or quinapril (Accupril), are typically the first line of treatment for people with diabetes and hypertension. In addition to lowering your blood pressure, ACE inhibitors reduce the kidney damage that so often develops in people with diabetes.
If ACE inhibitors are not tolerated, angiotensin receptor blockers, such as losartan (Cozaar) or telmisartan (Micardis), are usually the next choice. If blood pressure control is not sufficient with 1 medication, addition of a calcium channel blocker, such as nicardipine (Cardene) or amlodipine (Norvasc), or a diuretic, such as hydrochlorothiazide, may be necessary.
A Multifaceted Problem
End-organ damage due to diabetes is typically classified as microvascular -- damage due to small blood vessel disease -- and macrovascular -- damage due to large blood vessel disease. Microvascular complications of diabetes include vision loss, kidney failure and nerve damage. Heart attacks and strokes are manifestations of macrovascular damage. To prevent these complications, you must manage your blood glucose, cholesterol levels and blood pressure. Your doctor will work with you to develop a treatment program that addresses all of these issues.