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Hypertension is commonly diagnosed in people with diabetes.
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Approximately one-third of American adults have hypertension, or high blood pressure, and the vast majority are said to have "essential" hypertension, meaning that there is no direct identifiable cause for their high blood pressure. Although some people with diabetes have "secondary" hypertension -- for example, hypertension directly related to the kidney damage caused by their diabetes -- essential hypertension is frequently diagnosed in people who have diabetes.
A Delicate Balance
In a healthy cardiovascular system, the arteries are elastic and flexible, which allows them to expand and contract in response to your heartbeat. Healthy arteries are also highly responsive to internally produced вЂњvasodilatorsвЂќ -- substance, such as nitric oxide, that make your blood vessels open wider. Finally, your kidneys regulate blood pressure by producing artery-constricting hormones and by regulating the amount of sodium and water in your circulation. These factors help maintain the delicate balance that keeps your blood pressure at an optimal level. Whether or not you have diabetes, any factor that increases arterial stiffness, reduces your arteries' response to vasodilators or increases the amount of sodium and water in your blood vessels can trigger high blood pressure.
A report in the December 2011 issue of the International Journal of Angiology describes essential hypertension in terms of interactions between genetic factors, acquired metabolic disorders and environmental factors, such as diet and lifestyle. In particular, the report's authors point to insulin resistance - an acquired metabolic disorder seen in type 2 diabetes - as one of the primary triggers for hypertension. Insulin is a hormone that stimulates your cells to absorb and metabolize glucose from your bloodstream. If your cells are resistant to insulin, they don't absorb glucose efficiently, and your blood glucose rises too high. As your blood glucose rises, your pancreas secretes more insulin in an effort to drive your glucose level downward. Consequently, people who are insulin resistant tend to have more insulin in their bloodstream. In addition to its glucose-regulating properties, insulin stimulates your kidneys to retain sodium and water, which pushes your blood pressure upward. The higher your insulin level climbs, the higher your blood pressure is likely to be.
If your blood glucose level is higher than it should be - a situation that characterizes all forms of diabetes - your body converts the excess to highly reactive molecules called aldehydes. Aldehydes react with the proteins in your tissues, including the walls of your arteries, to form advanced glycation end products, or AGEs. AGEs interfere with the enzymes that produce nitric oxide, so your arteries become tighter. Further, your immune system is very sensitive to AGEs and tries to destroy them, which triggers an inflammatory response. Inflammation in the walls of your arteries causes them to stiffen and encourages formation of cholesterol and fatty plaques, a process called atherosclerosis. All of these changes set the stage for hypertension and cardiovascular disease.
In people with diabetes, treatment of high blood pressure can be difficult unless elevated blood glucose, insulin resistance and arterial inflammation are also addressed. Your doctor may recommend lifestyle changes - weight loss, regular exercise and dietary modifications - as well as medications to control your blood pressure and reduce your blood glucose level. If you have type 2 diabetes, your doctor may recommend metformin (Glucophage). This medication makes your cells more responsive to insulin and, according to a 2006 study published in Arteriosclerosis, Thrombosis, and Vascular Biology, may reduce some of the arterial inflammation seen in people with diabetes.