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Quality Health Care and You - Diabetes

High Blood Pressure and Type 2 Diabetes

05/22/2008

Question:

I have been taking glyburide for Type 2 diabetes for 15 years. Now they say my kidneys are failing and my blood pressure is high. It was 160/82 so the kidney doctor gave me Diovan 160mg once a day and Norvase 10mg once a day.  I cut down on salt as well as sugar.  It`s hard to find some thing to eat as he said not to eat potassium as that hurts my kidneys. Well now my blood pressure is up to 178/100.  Why is this? I had it lower with no medicine some days it was 140/80. Now it never comes down. What`s wrong? I take 4 Gliburide a day -- two morning two dinner time.

Answer:

It is unfortunate that you are having to go through this but it is not out of the ordinary or unusual. Diabetes often has hypertension and abnormal lipids (fats and Cholesterol) associated with it, especially if you have had diabetes for a number of years.

Over the last fifteen years, there have been changes in your blood vessels as a result of the diabetes, especially if your control has been suboptimal, which together with lipid abnormalities and advancing age have lead to a stiffening of your arteries which is recorded as high blood pressure. Current recommendations are a blood pressure goal of <130/80 is safe for diabetics, and even lower if there is a great deal of leaking protein in your kidneys which reflects damage to the small arteries and nerves in your kidneys.

Your doctor was right in starting medication and encouraging lifestyle changes such as low salt, moderation of protein intake, DASH diet which encourages fiber, fruits and vegetables (these need to be discussed with a dietitian to avoid increased potassium levels, however).

I must add, however, that optimal control of glucose requires an individual approach and I am not certain that you are at a goal of HbA1c<7-7.5% which is what I would work toward. This might rerquire diabetes education and additional medications including insulin if necessary. Optimal control of lipids and glucose likely make it easier to control blood pressure.

The only aspect of your care that I would inquire about is the use of diuretics.  Drugs like hydrochlorothiazide or, in advanced cases or difficult blood pressure situations, loop diuretics, can be very effective in people with diabetes and hypertension patients who are among the most difficult types of populations to treat. I would start with a diabetes education program, a solid nephrologist and an endocrinologist to get you started on the right path to control.  It is important for you to understand that controlling these factors can make a difference and slow the progression and possibly prevent the most severe kidney damage but there are no guarantees.

For more information:

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Response by:

Laurie   Sadler, MD Laurie Sadler, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University