Hypertension
Generally known as High Blood Pressure. This is important knowledge for diabetics as it is thought around 2 out of 3 diabetics have high blood pressure. If you are part of the '2' read on - if you are number 3 read on anyway, education is never wasted!
There is a lot of terminology associated with blood pressure that may be confusing so I thought it best to explain all that first, before going into dealing directly with it's effect on diabetics.
When they measure blood pressure they are measuring the pressure, or force, of the blood against the walls of your arteries.
You may well ask "if that is the case why am I told my blood pressure is (one number) over (another number), why not simple a single number?" That is because the blood pressure in your arteries varies depending on whether your heart is beating or at rest at that particular time.
So.............
The first, or top, number is the pressure in your arteries when your heart contracts, thus pumping the blood within it through the arteries and round the body. This is called systolic pressure. It is the highest pressure and therefore the highest number.
The second, or bottom, number is the pressure in your arteries when the heart is at rest and is filling with blood, between beats. This is called diastolic pressure. It is the lowest pressure and therefore the lowest number.
The pressure is measured in millimetres of mercury (mmHg) which was worked out by watching how high a column of mercury was raised by a particular pressure, prior to our digital age.
You will get a result that looks like this:- 130/80mmHg.
The 130 is your systolic pressure, the 80 your diastolic.
Blood pressure is measured by a Blood Pressure Monitor, or if you like long complicated words, a sphygmomanometer. Personally I get lost round about the second 'm'!
Usually the measurement is taken around the top of your arm and is actually measuring the pressure in your brachial artery, which is a blood vessel that goes from your shoulder to just below your elbow.
There are monitors that measure blood pressure at the wrist or on the finger but these are not nearly as accurate. (Your measured pressure varies depending on the hight of the measurement point in relation to your heart, and it should be taken at a point on the same level as your heart.
So, if you measure it on your wrist, it is prone to a lot of variation if you change your hand position with different readings. Your upper arm however, is not as likely to be in different positions, and it also has a stronger pulse, which is therefor easier to read accuratly.)
So, do you have high blood pressure?
Firstly remember blood pressure does change during the day, being at it's lowest when you are asleep. It rises when you get up but then stays pretty constant unless you get excited, are nervous, or active. Sometimes it can take a number of readings to determine whether you are actually hypertensive or not.
The norms for blood pressure have altered slightly through the years but that given by the National Heart, Lung, and Blood Institute (NHLBI) in around 2003 are as follows:-
Normal blood pressure 120/80
Systolic 120mmHg or less
Diastolic 80mmHg or less
Pre-hypertensive blood pressure 120/80 to 139/89 - need to take action to prevent high blood pressure.
Systolic 120mmHg - 139mmHg
Diastolic 80mmHg - 89mmHg
High blood pressure 140/90
Systolic 140mmHg or more.
Diastolic 90mmHg or more.
High blood pressure in diabetics.
Listed above are the pressures for normal people but as usual we diabetics have to be different and also as usual we are on the losing side.
130/80mmHg or more is considered high blood pressure for diabetics.
That is because even slightly high blood pressure can increase your risk of developing heart disease (it makes your poor heart work too hard), also stroke, nerve problems or eye problems.
For instance if you have maculopathy, (see retinopathy ), you should aim for a very low blood pressure so as to slow down or stop your sight getting worse.
If you already have any form of kidney disease even mildly high blood pressure increases your risk of making it worse. Kidneys, you see, play a part in controlling blood pressure (they control the fluid balance in the body).
It is a bit of a 'chicken and egg' situation. The less kidney function you have the higher your blood pressure will be but the higher the blood pressure the more your kidney function will decline. Lower your blood pressure and you slow down the progression of kidney disease.
Symptoms.
There aren't any! How's that for a short and sweet answer?
That is why you will have heard hypertension referred to as "the silent killer".
You may be totally unaware you have it but meanwhile it is going about it's dastardly deeds in the background, leading to all sorts of future complications.
The only way you can find out if you have high blood pressure is by getting it checked.
How to get your blood pressure down.
I'll give you all three guesses what you have to do - have you got it yet? You have, well done! You are right of course, it is our old friend, LIFESTYLE CHANGE . After all where does every control factor for diabetes seem to start!
1. Loose weight.
Diabetics, especially Type 2 diabetics, tend to be overweight and this is one of the prime reasons for high blood pressure.
I sort of see it as our poor hearts having to push that blood round a much larger area. Losing just 10% of your weight will cause a decided reduction in your blood pressure. Eating the correct foods can help achieve this loss.
2. Exercise.
This ties in with diet as a means to reduce weight and it also strengthens the heart.
3. Eat less salt.
4. Drink less alcohol.
Only 1 unit per day.
5. Give up smoking.
Smoking raises blood pressure.
6. Medications.
If diet and exercise do not get your blood pressure down soon your doctor will probably want you to go on medication.
This makes sense because high blood pressure is almost worse for a diabetic than high blood sugars.
So what medications are there?
(You may be put on one of these or a combination. Your health practitioners will work with you to find out what works best for you. )
1. The ACE inhibitors.
ACE stands for 'angiotensin converting enzyme' and these drugs work by preventing the production of a hormone, Angiotensin II.
This is the hormone that causes blood vessels to contract, thus making it harder for the blood to flow through them and so blood pressure increases.
Once the blood vessels relax the blood pressure drops. They appear to have the added benefits of protecting the kidneys.
Side effects.
A persistent dry cough - a common problem. Low blood pressure with symptoms of headache & dizziness. Altered taste sensation.Nausea & diarrhoea.
2. Angiotensin Receptor Blockers/Antagonists (ARBs).
These work in much the same way as the ACE inhibitors, the difference being that instead of preventing the production of the hormone the stop the effect of the hormone.
The end result is still a relaxed blood vessel and reduced blood pressure. They are often used when a patient cannot tolerate an ACE inhibitor.
Side effects.
Cough - rare, unlike in ACE inhibitors. Elevated potassium levels Low blood pressure therefore dizziness & headache Drowsiness Diarrhoea and heartburn Metallic or salty taste in mouth, Rash.
3. Calcium channel blocker.
These stop calcium from entering the cells of the heart and blood vessels.
When calcium enters into these cells the heart contracts and arteries narrow. Blocking it causes blood vessels to relax, the heart does not have to work so hard and the blood pressure drops.
Side effects.
Oedema - swelling of the legs with fluid Constipation, Nausea, Low blood pressure along with headache, drowsiness, and dizziness. Rash.
4. Diuretics.
Often known as 'water pills' these help the body get rid of excess water. The more water in the body, the higher the volume of blood. The more blood the harder the heart has to pump so the blood pressure rises.
There are a number of different types of diuretics.
Thiazides are the only type of diuretic that dilates the blood vessels, which also helps to lower blood pressure.
Potassium-sparing diuretics do not cause your body to lose potassium like other diuretics do.
Loop-acting diuretics cause the kidneys to increase the flow of urine so reducing amount of water in your body.
Side effects.
Can elevate blood glucose levels.
Elevated potassium levels in all except Potassium-sparing diuretics.
Increased sensitivity to sunlight (with thiazide diuretics)
Dizziness or light-headedness
Diarrhoea
Joint pain & cramps.
Rash.
5. Beta-blockers.
These work by blocking the action of adrenaline and thus reducing the nerve impulses that travel through the heart, causing the heart to beat slower and with less force. Blood pressure is reduced and the heart works less hard.
Side effects.
Fatigue Cold hands and cold feet Nightmares (with some preparations) Wheezing Impotence Breathlessness Dry eyes Very slow pulse Dizziness Depression Digestive tract problems
6. Alpha-blockers.
These medications prevent the hormone noradrenaline from stimulating the muscles in the walls of smaller arteries and veins, which is what causing them to constrict. Blocking that causes the vessels to relaxed and dilate. This means better blood flow and lower blood pressure.
Side effects.
Much lower blood pressure - can cause dizziness, light-headedness, heart palpitations, and fainting. Headache Nausea, Weakness, Weight gain Small decreases in LDL cholesterol. AND, of major importance............ Can cause heart failure with long-term use.
7. Alpha-beta-blockers.
These work like alpha-blockers do but also slow the heartbeat as beta-blockers do. This causes less blood to be pumped through the vessels and blood pressure to drop.
Side effects.
Dizziness Postural hypotension (blood pressure falls when standing up)
8. Nervous system inhibitors.
Electrical impulses from the brain are carried to all parts of the body by sympathetic nerves. There are some of these that tell the blood vessels to constrict. Sympathetic nerve inhibitors prevent these messages getting through. The vessels stay wide and blood pressures drop.
Side effects.
Dry mouth Drowsiness Dizziness
9. Vasodilators.
These medications relax the muscle in the blood vessel walls, causing the vessels to widen and the blood pressure to drop.
Side effects.
Fluid retention Rapid heart rate
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