Hypertension (high blood pressure) and diabetes are common chronic diseases and both are risk factors for coronary artery disease.
This article first appeared in the medical column “Ask-the-Doc” in the World Journal.
Family practice physician, Dr. Edward Yu stresses the importance of good medication management in the treatment of hypertension and other chronic disorders.
Many people have both diseases. While there is no causational relationship between hypertension and diabetes, the two are closely related. For example, the risk of complications is noticeably higher when both diseases are present. Additionally, the risk of hypertension in diabetic patients is twice that of non-diabetic patients. “Often times, people neglect the importance of blood pressure control in diabetic patients,” said Dr. Edward Yu, a family medicine physician.
While most people understand the risk factors for hypertension and diabetes individually, most do not recognize the added risk of having both diseases. With diabetes alone, there is increased risk for coronary artery disease, stroke, kidney, and vision damage. However, if someone has both diabetes and hypertension, there is added risk of damage to eyes and kidneys.
Dr. Yu noted that the mechanisms by which diabetes and hypertension damage the body are different. For instance, the way in which hypertension injures kidney cells differs from that of diabetes. With the two diseases combined, damage to the kidneys is compounded. “The point is not to tease out the differences and determine how to treat diabetes or hypertension individually,” notes Dr. Yu. “One must deal with both concurrently to reduce the burden of hypertension and diabetes.”
Dr. Yu went on to say that patients with diabetes also frequently suffer from hyperlipidemia (high cholesterol), resulting in a trio of metabolic diseases— high cholesterol, high blood pressure, and diabetes—where each condition requires separate medication. “Blood pressure control is of most importance if one has all three diseases, because hypertension is extremely dangerous and can lead to increased risk of stroke and coronary artery disease,” stressed Dr. Yu. “Elevated blood sugar, blood pressure, and blood cholesterol all damage internal organs in different ways, but good blood pressure control can help reduce the negative impacts of diabetes and hyperlipidemia.”
Many people believe that medications hurt the liver and kidneys, or believe that because they are already taking blood pressure medication, they shouldn’t also be taking medication for diabetes. “Medication for hypertension and diabetes are two separate things; both medications should be taken over the long term,” Dr. Yu said. If there is concern over safety or side effects, patients should work closely with their physicians to find the most suitable combination. “Sometimes you just have to try it. It’s like buying Christmas presents. If you don’t like it, you can return it.”
Dr. Yu also noted that hypertension can damage kidney cells and lead to kidney function deterioration. Therefore, patients should pay attention to medications for hypertension and diabetes when they have kidney injury. Some medications warrant extra caution. Physicians and patients should also pay close attention to side effects and responses to medications.
Doctor’s Profile: Dr. Edward M. Yu is a family practice specialist. He was born in Seattle and moved to Hong Kong with his father at the age of six. He holds a bachelor’s degree in Genetics from UC Davis, and medical degree from UCLA. He completed his internship and family medicine residency at UCLA. He joined El Camino Health in 1997. Languages spoken: Mandarin Chinese, Cantonese, English.
This article first appeared in the World Journal and the Fall 2019 issue of Chinese Health Initiative Wellness eNewsletter.
Learn more about the Chinese Health Initiative.
- Having hypertension puts you at risk for heart disease and stroke, which are leading causes of death in the United States.2
- In 2020, more than 670,000 deaths in the United States had hypertension as a primary or contributing cause.2
- Nearly half of adults in the United States (47%, or 116 million) have hypertension, defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg or are taking medication for hypertension.3
- Only about 1 in 4 adults (24%) with hypertension have their condition under control.3
- About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mmHg or higher. This includes 37 million U.S. adults. 3
- About 34 million adults who are recommended to take medication may need it to be prescribed and to start taking it. Almost two out of three of this group (19 million) have a blood pressure of 140/90 mmHg or higher.3
- High blood pressure costs the United States about $131 billion each year, averaged over 12 years from 2003 to 2014.4
Rates of High Blood Pressure Control Vary by Sex and Race
Uncontrolled high blood pressure is common; however, certain groups of people are more likely to have control over their high blood pressure than others.
- A greater percentage of men (50%) have high blood pressure than women (44%).3
- High blood pressure is more common in non-Hispanic black adults (56%) than in non-Hispanic white adults (48%), non-Hispanic Asian adults (46%), or Hispanic adults (39%).3
- Among those recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic white adults (32%) than in non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic adults (25%).3
Rates of High Blood Pressure Vary by Geography
High blood pressure is more common in some areas of the United States than in others. Below is a map showing the self-reported rate of hypertension by state in 2011 (using a definition of hypertension as a blood pressure ≥140/≥90 mmHg). However, this map likely underreports the true effect of hypertension in each state, because about 1 in 5 adults with high blood pressure is unaware of it and would not report having it.5
The map shows that concentrations of counties with the highest hypertension prevalence – meaning the top quintile – are located primarily in Mississippi, Louisiana, Arkansas, Oklahoma, Texas, Kentucky, Tennessee, Alabama, Georgia, South Carolina, North Carolina, Virginia, Maine, and Michigan. Pockets of high-rate counties also were found in Florida, New Mexico, Arizona, Nevada, and Missouri.
Source: Interactive Atlas of Heart Disease and Stroke
CDC’s Public Health Efforts Related to High Blood Pressure
- Diabetes, Heart Disease, and Stroke – State Programs (State Public Health Actions to Prevent and Control Chronic Diseases)
- Million Hearts®
- WISEWOMAN
Learn More About Hypertension
For more information about high blood pressure, visit the following websites:
- Medline Plus
- National Heart, Lung, and Blood Institute
- American Heart Association
References
- Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018;71(19):e13–115.
- Centers for Disease Control and Prevention, National Center for Health Statistics. About Multiple Cause of Death, 1999–2020. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention; 2022. Accessed February 21, 2022.
- Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among U.S. Adults Aged 18 Years and Older Applying the Criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2015–2018. Atlanta, GA: U.S. Department of Health and Human Services; 2021. Accessed March 12, 2021.
- Kirkland EB, Heincelman M, Bishu KG, et. al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003-2014. J Am Heart Assoc. 2018;7:e008731.
- Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38(6):600–609.