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Quality Health Care and You - Diabetes

Diabetes and Blood Pressure

08/25/2009

Question:

Can diabetes affect abnormal blood pressure?

Answer:

Diabetes, and hypertension (high blood pressure) often exist together. Diabetic kidney disease is the leading cause of end stage kidney disease in the U.S. and is caused by long standing high blood sugars which cause structural and hormonal changes in the kidney. Over time, the kidney shows signs of strain by losing more and more protein. In the urine followed by reduced function and eventually in many patients, the kidneys may fail. During this time, the blood pressure may be normal but over time becomes more difficult to control. In this way, there is an indirect relationship between glucoses and blood pressure.

On the flip side, some speculate that when lipids (cholesterol and triglycerides) are controlled aggressively to current goals, the blood pressure is easier to control. This is thought to be related to improvement in vascular or blood vessel “health” or function. There may be a similar benefit to control of blood glucoses that is more direct at the artery responsiveness level or it may be, as above, indirectly related at the kidney level.

The answer to your question lies in the interconnectivity of the pathophysiology diabetes and its related complications. One can say that if blood pressure is already abnormal that persistently high glucoses likely will not help and may hasten the demise of the control of the blood pressure, either via direct blood vessel health or indirectly through its effects on the kidney.

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Response by:

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