Living with the chronic disease requires ongoing medical attention and is the leading cause of death and disability in the United States. Diabetes and hypertension are two of these chronic diseases that impact millions of people worldwide.
Hypertension, which is also known as high blood pressure, is when your average or resting blood pressure is higher than the normal range established by the American Heart Association. Your blood pressure is the amount of pressure that pushes against your artery walls which typically comes from the heart pumping blood. To have hypertension, your blood pressure should be at or higher than 130/80 mmHg per the CDC.
Common type of diabetes
There are two forms of diabetes, type 1 and type 2 diabetes, which both cause your blood glucose (or blood sugar) to be too high. Type 1 diabetes is usually diagnosed in children and young adults and is a result of your body being unable to make insulin (the hormone needed to allow blood glucose into cells for fuel). Type 2 diabetes is more common and typically diagnosed in middle-aged and older individuals. With type 2 diabetes, your body has the capability of producing insulin but it does not make or use it well.
The American Diabetes Association provides information about some common methods for diagnosis, including an A1C of greater or equal to 6.5% or a fasting blood sugar level at 126 mg/dl or higher.
If you’ve been diagnosed with or are worried about either of these conditions, in this blog we’re breaking down how they are connected and ways to prevent them.
How diabetes and blood pressure are connected
According to a 2012 review published in the Current Atherosclerosis Reports, hypertension occurs in about 30% of individuals who have type 1 diabetes and approximately 50% to 80% in those with type 2 diabetes. Studies have also indicated that only 42% of people with diabetes had normal blood pressure, and only 56% of those with hypertension had normal glucose tolerance (which indicates how your body processes sugar).
There are several reasons behind why these two conditions are often seen together. Researchers of a 2018 study published in Hypertension concluded that the “development of hypertension and diabetes mellitus track each other over time.” A common feature they notice in both prediabetes and prehypertension is insulin resistance. As we previously mentioned, insulin helps to keep the amount of sugar or glucose in the blood under control. When someone is insulin resistant, which occurs in type 2 diabetes, your body isn’t responding to or making enough insulin to allow glucose to enter the cells.
Insulin resistance often does not have any symptoms which leads to a gradual increase in blood sugar levels if it’s not being treated. This can cause damage to the blood vessels, eventually making them become thick and stiff (a condition called atherosclerosis). The hardening of these blood vessels increases the pressure that blood is being pumped through. , AKA high blood pressure. The combination of these effects left untreated can lead to serious conditions such as heart attack and stroke.
Diabetes and blood pressure share many risk factors. These include:
- Family history of these conditions
- Having excess weight and body fat
- An inactive lifestyle
- Stress and poor sleep
- Tobacco use
- Older age
Can one cause the other?
The short answer is yes, diabetes can cause hypertension and hypertension can cause diabetes.
There seem to be two factors that link these conditions together — genetics and environment. According to the same 2012 review, certain DNA sequences that can be used to predict the potential occurrence of diabetes were also linked with predicting the onset of hypertension. However, our lifestyle plays the biggest role in controlling environmental factors impacting our health, which includes diet and physical activity.
Factors such as inflammation and oxidative stress also occur in both hypertension and diabetes. A 2018 study published in the Journal of Inflammation Research states that as diabetes and hypertension progress, it decreases antioxidant and anti-inflammatory biomarkers which leads to an imbalance in oxidative stress and inflammation.
Prevention of high blood pressure and diabetes
Maintaining a healthy lifestyle is key to reducing the risk of chronic diseases, including diabetes and hypertension. High intakes of sodium, alcohol, and saturated fat combined with smoking, lack of physical activity, and mental stress, are all factors that can affect our overall health and longevity.
The American Heart Association recommends getting at least 150 minutes per week of moderate-intense aerobic activity or 75 minutes per week of vigorous aerobic activity. Moderate-intense activities include:
- Brisk walking (at least 2.5 miles per hour)
- Water aerobics
Along with aerobic activity, it’s recommended to add in 2 days of moderate- to high-intensity muscle-strengthening activity like resistance bands or weights.
When it comes to healthy eating, the Dietary Approaches to Stop Hypertension (DASH) diet, was created specifically to prevent and treat hypertension. An analysis published by the American Heart Association found that the DASH diet is also effective against diabetes. According to the article, the DASH diet significantly improved fasting insulin levels when followed for more than 16 weeks.
The DASH diet doesn’t require special foods, but it is geared towards a heart-healthy eating style. The plan recommends:
- Eating vegetables, fruits, and whole grains
- Choosing fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
- Limiting foods high in saturated fat including fatty meals, full-fat dairy products, and tropical oils (coconut and palm oils)
- Limiting sugar-sweetened beverages and foods
The diet highly recommends consuming no more than 2,300 milligrams of sodium per day, which is no more than 1 teaspoon. If sodium intake is cut back to 1,500 milligrams, blood pressure could be lowered even more.
Lifestyle changes are important, but some situations may call for the treatment of medication, as well. According to a 2017 article, published in the Journal of Hypertension, individuals that have a blood pressure that is 160/100 mmHg or higher, should be treated with medication along with lifestyle therapy. It’s also believed that the management of hypertension should be aggressive in those that have diabetes. The treatment for hypertension should include prescriptions that reduce cardiovascular events in those with diabetes. Medications might include:
- ACE inhibitors: relax blood vessels and decreasing blood volume
- Angiotensin receptor blockers: these block angiotensin, which is a chemical that narrows blood vessels
- Thiazide-like diuretics: reduce the fluid that accumulates in the body
- Dihydropyridine calcium channel blockers: reduce the entry of calcium into muscle cells
It’s also not uncommon to be prescribed multiple drugs simultaneously; however, if lifestyle therapy is consistent, in some cases, medications can eventually be discontinued.
Since diabetes and hypertension have many shared risk factors, those that are diagnosed with one will have a higher chance of developing the other. Prevention and management of these conditions come with lifestyle adjustments which include diet and exercise, but treatment will often include medication(s) based on the severity. If left untreated, the combination of diabetes and hypertension can lead to serious health complications including heart attack, or stroke.
Lauren Armstrong is a Registered Dietitian with several years of experience counseling and educating individuals seeking chronic disease prevention and a healthier lifestyle. She is a graduate of Western Michigan University and completed her dietetic internship at Michigan State University.