High blood pressure in diabetes is a common problem faced by patients. According to statistics, hypertension is detected in 60% of diabetics. Pathology greatly worsens health, aggravates the course of the underlying disease. Against the background of high blood pressure increases the risk of severe complications (stroke, heart attack), the outcome of which is fatal.
For patients with diabetes type 1, 2, pressure is considered normal, not exceeding the indices of 130/85 mm Hg. Art. The appearance of hypertension is usually caused by severe damage to the blood vessels against the background of elevated glucose levels. Consider how to lower blood pressure in diabetes.
Pathogenesis, causes of pathology
In type 1 diabetes, the kidney is impaired due to microangiopathy (affection of small vessels) of the glomeruli. As a result, the protein is excreted in the urine. This condition is called proteinuria and is accompanied by an increase in blood pressure.
High pressure causes gradual dying off of the glomeruli. In the future, there is renal failure. In 10% of cases, hypertension is in no way associated with type 1 diabetes, but is a concomitant disease. In these patients, renal function is preserved.
In patients with type 2 diabetes, hypertension begins before diabetes or accompanies the disease. Kidney damage causes the development of pathology only in 15-20% of patients. In 30-35% of cases, the pressure rises before a breakdown in metabolism has occurred.
Pathology begins with the development of insulin resistance (lowering the sensitivity of tissues to the action of insulin). To compensate for this condition, insulin rises, causing an increase in blood pressure.
Pathogenesis of hypertension:
- The sympathetic nervous system is activated;
- Disrupted the normal process of excretion of sodium liquid;
- Inside the cells accumulates sodium, calcium;
- Walls of vessels thicken, their elasticity decreases.
Adverse factors that increase the likelihood of hypertension in type 1 and type 2 diabetes are the following:
- Elderly age;
- Deficiency of trace elements in the body;
- Chronic intoxication;
- Frequent stress;
- Other endocrine system pathologies.
High blood pressure in diabetes increases the likelihood of dangerous complications several times:
- Renal failure - 25 times;
- Non-healing ulcers, gangrene - 20 times;
- Heart attack - 5 times;
- Stroke - 4 times;
- A sharp deterioration in the function of vision - 15 times.
For many diabetics, high blood pressure is complicated by orthostatic hypotension. Pathology is characterized by a sharp drop in blood pressure when lifting from a prone position. It is manifested by darkening of the eyes, dizziness, fainting. The reason for the disturbed vascular tone is diabetic neuropathy.
In many patients, hypertension does not manifest itself, in other patients, an increase in pressure is accompanied by:
- Impaired vision;
- Increased fatigue.
There are 3 degrees of hypertension in diabetes, which are characterized by the following indicators:
- Soft The upper pressure is 140-159, the lower - 90-99 mm Hg. v .;
- Moderate. Upper BP - 160-179, lower - 100-109 mm Hg. v .;
- Heavy. The pressure exceeds 180/110 mm Hg. Art.
In order to avoid the rapid progression of vascular disorders and subsequent complications, patients with diabetes should try to keep the pressure at 130/85 mm Hg. Art. This will extend the life of 15-20 years.
With increased pressure, you need to consult a specialist, self-medication is unacceptable.. Therapeutic methods include:
- Drug treatment. Use drugs that lower blood pressure. The most frequently prescribed diuretics, ACE inhibitors, which reduce the risk of kidney damage.
- Diet. The body of the patient with diabetes is sensitive to sodium, therefore, with increased blood pressure, you need to reduce the salt in the diet. Often this measure has a good effect.
- Weight loss. This will improve the overall condition.
- Compliance with the daily routine, maintaining a healthy lifestyle. Motor activity, sports have a positive effect on blood vessels, reduce the concentration of glucose in the blood.
Drugs and doses are selected so that the pressure decreases gradually. The optimal period to reach the norm is about 8 weeks from the start of taking the drugs. Too rapid decrease in blood pressure causes deterioration of blood circulation, the functions of organs and systems are disturbed.
Altered carbohydrate metabolism in diabetics makes selection of drugs difficult. Medicines are prescribed taking into account the state of the patient and the severity of the pathology.
To lower blood pressure in type 1 and type 2 diabetes, drugs of the following groups are commonly used:
- Diuretics (Furosemide, Diacarb);
- ACE inhibitors (Captopril, Enalapril);
- Beta-blockers (Nebilet, Trandat, Dilatrend);
- Alpha-blockers (Doxazosin, Prazozin, Terazosin);
- Calcium antagonists (Diltiazem, Verapamil);
- Agonists (stimulants) of the imidazoline receptor (Albarel, Physiotens).
Let us consider in more detail each group of drugs.
There are 4 diuretic groups:
Thiazide-like diuretics, which do not affect glucose concentration, have a good effect. In cases of diabetes of the 1st and 2nd type, thiazide diuretics are used in an amount not exceeding 12.5 mg. Both groups of diuretics prevent the appearance of complications in the kidneys, myocardium, but such drugs cannot be used in case of renal failure.
Loop diuretics are rarely used, because the body loses potassium as a result. However, they are indicated for renal failure, in which case potassium supplements are also prescribed.
They block the enzyme that is involved in the synthesis of active angiotensin, which causes an increase in blood pressure. Medications prevent the development of complications in the kidneys, heart. Sugar concentration does not increase during the period of administration.
The drugs have a mild hypotensive effect, persistent lowering of blood pressure is achieved after 2 weeks. In type 1 and type 2 diabetes, such drugs are contraindicated if hyperkalemia and renal artery stenosis are detected. In some patients, they cause a cough. It should be borne in mind that if hypertension is severe, ACE inhibitors will not have a therapeutic effect.
There are 2 groups:
- Selective. They act only on the receptors of the cardiovascular system;
- Nonselective. Affect all body tissues.
Nonselective beta blockers are contraindicated for diabetics because they increase sugar. Selectives are prescribed if diabetes and elevated blood pressure are combined with other pathologies:
- Heart attack;
- Heart failure.
Such drugs are often used simultaneously with diuretics. Blockers are not used to treat high blood pressure in patients with asthma.
The processes of calcium intake into cells are slowed down, which leads to vasodilation and decrease in blood pressure. There are 2 groups:
- Dihydropyridine. Increase heart rate, reduce the likelihood of a heart attack.
- Non-dihydropyridine. Reduce heart rate, suitable for the treatment of hypertension, appeared on the background of nephropathy. Help avoid kidney damage in diabetes.
And those and others can be used simultaneously with diuretic, ACE inhibitors. Do not use them for heart failure, unstable angina.
Agonists (stimulators) of imidazoline receptors
Medications weaken the function of the sympathetic nervous system, resulting in reduced heart rate, blood pressure decreases. Long reception improves work of cardiovascular system.
Contraindications for appointment:
- Heart failure;
- Syndrome of the sinus node;
- Liver disease.
They block postsynaptic alpha-adrenoreceptors, providing a steady decrease in pressure without increasing the heart rate. In diabetes, these drugs reduce the concentration of sugar, increase insulin sensitivity.
For hypertension that has developed on the background of type 1 or type 2 diabetes, pay special attention to nutrition. Low-carb diet effectively lowers sugar, helps to normalize blood pressure.
Observe the following rules:
- The diet should contain vitamins, trace elements in sufficient quantities;
- Reduce salt intake. Daily rate - no more than 1 tea. l;
- Avoid foods rich in sodium;
- Eat more often - at least 5 p. / Day, in small portions;
- Do not eat before bedtime. The last meal should be no later than 2 hours before bedtime;
- Eat low-fat foods, give preference to complex carbohydrates;
- Eat potassium rich foods. Macroelement dilates the walls of blood vessels and helps reduce pressure.
Include vegetables, fruits allowed for diabetics in the daily menu. Other approved products:
- Wholemeal bread;
- Lean meat, fish;
- Fat-free dairy, fermented milk products;
- Vegetable broths;
- Dried fruits;
- Vegetable oils.
To improve the taste of dishes, use seasonings, aromatic herbs, lemon juice.
- Products from wheat flour;
- Smoked meat;
- Fat varieties of fish, meat;
- Saturated broths;
- Caffeinated beverages;
- Alcoholic drinks.
Being overweight greatly increases the likelihood of hypertension in diabetics. To lose weight, it is recommended to reduce the daily caloric intake, increase physical activity.
Maintaining a healthy lifestyle contributes to lowering pressure in type 1 and type 2 diabetes. Required:
- Full rest;
- Avoiding alcohol or minimizing the use of alcoholic beverages;
- The exclusion of smoking. Nicotine increases the likelihood of complications on the cardiovascular system;
- Avoiding stressful situations.
Important regular physical activity (charging, walking at an active pace, etc.). Massage has a good effect. Normalization of pressure with the help of drugs, diet, increase motor activity helps to alleviate the course of hypertension in diabetes and significantly improves well-being.