Causes Of Low Blood Pressure In Diabetics:
Many patients with type 2 diabetes have high blood pressure. Dr. Asako Sato, Tokyo Women's Medical University Clinical Laboratory Department, Diabetes Center (concurrent post), will explain the blood pressure reduction goals and attention to daily life of patients with both diabetes and hypertension.
According to the 2014 survey by the Ministry of Health, Labor and Welfare, the number of diabetic patients in Japan was 3,166,000 and the number of hypertensive patients was 10,108,000, both of which are on the rise. And it is said that 40-60% of diabetic patients also have high blood pressure.
So why are people with diabetes more likely to have high blood pressure? Diabetes and high blood pressure are diseases that are often caused by lifestyle habits such as eating habits and exercise habits. When you have obesity or metabolic syndrome, your sympathetic nervous system becomes tense and many hormones that raise blood pressure are secreted. Also, because insulin becomes less effective, a large amount of insulin is secreted from the pancreas, but insulin reduces sodium excretion from the kidneys, resulting in high blood pressure. Thus, diabetes and hypertension are interrelated. There are also genetic predispositions and endocrine disorders that cause both.
Hypertension is one of the major risk factors for myocardial infarction and stroke. Stroke was the leading cause of death in the Japanese until the late 1970s. One of the causes was the high intake of salt. Too much salt causes high blood pressure. Recently, awareness of salt reduction has increased and stroke deaths have decreased. However, compared to the West, the Japanese still have more strokes.
Diabetes and hypertension are diseases that promote arteriosclerosis. People with diabetes are 2-3 times more likely to have myocardial infarction and stroke than people without diabetes. It is said that the addition of high blood pressure to diabetes is 6 to 7 times higher than that of people without diabetes or hypertension. In a study of Japanese people with type 2 diabetes, hypertension was mentioned above as a risk factor that causes stroke, but an increase in systolic blood pressure has been pointed out.
And overseas reports, diabetic patients have a higher mortality rate from cardiovascular disorders such as myocardial infarction and stroke than those without diabetes. Moreover, the higher the blood pressure, the higher the mortality rate (Fig. 1).
It is also known that hypertension is an important factor that exacerbates diabetic nephropathy, which is a diabetic complication.
Of course, people with diabetes should aim for good blood sugar control. In addition, good blood pressure control has been shown to reduce the risk of diabetes-related complications and death along with stroke and myocardial infarction (Figure 2).
So how much blood pressure should you target? The “Hypertension Treatment Guidelines 2014” of the Japanese Society for Hypertension sets the blood pressure reduction target for diabetic patients to less than 130/80 mmHg. However, in older people, strict blood pressure control is set slightly higher because it can cause dizziness and orthostatic hypotension (Table). In the elderly, blood pressure will be carefully controlled according to the disease state of each patient.
● Blood pressure measurement
First of all, try to measure your blood pressure at home to know your blood pressure. In a relaxed mood, in a sitting position, measure with the arm or wrist wrapped around the armband at the level of the heart. If possible, we recommend using the upper arm type rather than the fingertip type. Make a note of the time taken and report it to your doctor at the time of your visit.
● Low salt
Low salt is most effective in lowering blood pressure. Foods with high salt content, such as soy sauce, pickles, boiled plums, dried plums, and miso soup, require caution. Please refer to the packaging of some foods, which contains the amount of sodium and salt equivalent. It is also recommended to use vinegar (without seasoning) or lemon juice instead of salt as a method of reducing salt.
● Weight management
Obesity and metabolic syndrome can increase blood pressure. Also, eating a lot means that you are also eating salt. Proper calorie restriction to improve obesity can also lead to salt loss.
● Smoking and drinking
Smoking not only raises blood pressure, but smoking itself is a risk factor for stroke and myocardial infarction. It is also a risk factor for cancer, so quit smoking. Drinking alcohol also affects the control of diabetes, so let's use it appropriately.
● Daily life
Try to exercise moderately and get enough sleep without stress.
● Antihypertensive drug
Antihypertensive drugs prescribed by your doctor are needed to control your blood pressure. Be sure to take it.
Asako Sato
Tokyo Women's Medical University Laboratory and Diabetes Center
In diabetes, you can prevent complications by keeping good blood glucose control and actively lowering blood pressure. Try to improve your lifestyle and treat blood pressure as well as blood pressure.
Next time, we plan to have diabetes in the elderly.
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