Type 2 Diabetes and Hypertension

Hypertension is extremely common in people with type 2 diabetes, affecting approximately 20-60% of all patients, depending on age, ethnicity, and body weight. The causes of this type of high-blood pressure are unknown, but are likely to be a complex combination of genetic, environmental, and other factors. A number of genetic factors or interactions between genes play a major role in essential hypertension and many experts believe that specific chromosomes house the genes responsible for blood pressure regulation. Whereas kidney damage is generally the cause of high blood pressure in type 1 diabetes, obesity and insulin resistance are the factors associated with hypertension in type 2 diabetes. Obesity is common in both type 2 diabetes and hypertension and clinical testing indicates that obesity is the one common element linking insulin, type 2 diabetes, and high blood pressure. However, studies have found a stronger association between hypertension and insulin resistance in thin patients as well as overweight people with type 2 diabetes. The development of hypertension in patients with diabetes is particularly harmful, as it is responsible for up to 75% of diabetic cardiovascular complications, including coronary artery disease, peripheral vascular disease, and stroke. Hypertension is also thought to play a significant role in the development of retinopathy (eye damage), nephropathy (kidney disease), and possibly neuropathy (nerve damage). The gas nitric oxide also plays a predominant role in hypertension. It can be produced in the body, affecting the smooth muscle cells that line blood vessels by keeping them relaxed and flexible. It may also help prevent blood clotting. Low levels of nitric oxide have been observed in people with high blood pressure (particularly in African Americans) and may be a significant factor in essential hypertension. Clinical testing and research has explored the benefits of lowering blood pressure in individuals with diabetes, such as a reduction in cardiovascular disease, stroke, or nephropathy events. In older individuals with type 2 diabetes, females in particular, the incidence of heart failure is rapidly increasing, and hypertension is often the primary cause. Additionally, aside from diabetes, hypertension is the leading cause of end-stage renal disease (ESRD). Coexisting hypertension and diabetes is a common clinical scenario that can ignite a vicious cycle of rising blood pressure, increasing renal damage, and increased cardiovascular morbidity. Treatment of hypertension often requires multiple drugs to effectively minimize and prevent complications of diabetes. In patients with type 2 diabetes mellitus, the impact of blood pressure control on micro vascular and macro vascular health may be equal to or even greater than that of strict glycemic control. Those who have type 2 diabetes must also be aware of secondary hypertension, which has recognizable causes that are usually treatable or reversible. There are a number of medical conditions that can cause secondary high blood pressure. The most common of which is kidney disease, although it occurs more often in older diabetics. Sleep apnea, a disorder in which breathing briefly ceases repeatedly during sleep, is also highly associated with hypertension. A weak but still higher than normal association with high blood pressure has even been observed in those who snore or have mild sleep apnea. The link between sleep apnea and hypertension is thought to be largely due to obesity, but major studies are finding a higher rate of hypertension in people with sleep apnea regardless of their weight. Treating sleep apnea with a device known as nasal continuous positive airway pressure (CPAP) may have modest benefits on blood pressure as well. Additionally, some medical conditions may contribute to temporary hypertension such as cirrhosis, pregnancy, and Cushing's disease. To help temporarily aid blood-pressure, people with type 2 diabetes can attain certain prescription and over-the-counter medication. This includes cough medicines that contain pseudo ephedrine, oral contraceptives, corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Other causes of secondary hypertension in type 2 diabetics include stress and vigorous exercise, as well as caffeine, cigarettes, and alcohol, all of which could increase the risk of stroke if not limited.