A woman patient of mine reported her blood sugar was under control and her HbA1c (average sugar counts over three months) was 6.8 per cent. I was seeing her for only the second time but her blood sugar had improved considerably, she had lost weight and her cholesterol was in check. The blood pressure (BP) recorded that day was, however, 145/96. The BP recording on her last visit was 140/90. I sensed she had an undiagnosed hypertension, which could have caused her insulin resistance and diabetes. Both are closely interlinked and stem from poor lifestyle markers and worse, fuel each other.
She denied any history of high BP but on probing confessed that it sometimes shot up to 160/100. “I take a pill then, SOS!” She protested strongly when I said this means she has high BP and needs treatment on a regular basis. It took a good 15 minutes to convince her to start medication. I am still not certain if she will actually comply with my advice and keep her diabetes in check.
HYPERTENSION AND DIABETES
Hypertension (the medical word for high blood pressure), can lead to numerous complications if left unattended in those with diabetes. Uncontrolled, it can rupture blood vessels in the brain, trigger heart attacks, kidney failure and poor vision, apart from headaches and irritability. The recently published INDIAB Study (2023) showed that in people with diabetes, the reported prevalence of hypertension is of the order of 70 per cent!
The combination of uncontrolled diabetes and hypertension is particularly injurious for the heart, kidney and eyes. Like with diabetes, the challenge with hypertension is that most often it produces no symptoms till organ damage has occurred. Since most people hate taking medication when they are feeling fine, hypertension often goes uncontrolled.
ARE YOU CHECKING YOUR BP RIGHTLY?
Digital sphygmomanometers (BP measurement devices) are accurate, if used correctly. Make sure you haven’t had tea/ coffee/caffeinated drinks/smoked or exercised in the last 30 minutes before checking, and you’re sitting comfortably in a quiet room with your feet flat on the floor for at least five minutes. Avoid talking while the BP is being measured.
Wear the cuff on a bare arm resting at the level of the heart, the lower edge of the cuff 2 cm above your elbow crease. Take two readings at a one minute interval and calculate the average. If you are a known patient of hypertension, check your blood pressure at least twice a week, and see a doctor if persistently elevated.
An Ambulatory Blood Pressure Monitoring (ABPM) system, which measures BP every 20 minutes, for 24 hours, is the best bet. If high readings are recorded, such a patient requires treatment.
WHEN SHOULD YOU TAKE MEDICATION?
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If your BP is <150/95 with no organ damage or diabetes, your doctor may suggest lifestyle measures for a few weeks before starting medication. You have to make sure that these weeks don’t stretch into months or years! Most people with hypertension require regular medication. If your BP is well controlled on treatment, it is NOT a signal to stop your medicines! It is well controlled because of the tablets.
Like with all medications, some side effects are seen with antihypertensives too. For example, ACEi (angiotensin converting enzyme inhibitors, or -sartans) can cause a chronic cough, or CCBs (calcium channel blockers, or -dipines) can cause your feet to swell up. However, these side effects are rare, and there are alternatives which may be used if a certain ill effect is bothersome. Most medications at the right doses are tolerated well, and have the benefit of protecting the heart and kidneys. Medications do not damage your organs, hypertension and diabetes do! If your BP is high despite three types of medications, please contact your doctor. You could be having resistant hypertension, or a secondary cause. Seeing a specialist is necessary.
Dealing with diabetes, therefore, is not just about managing blood sugar. It also means managing co-morbidities.
