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What Should A Diabetic's Blood Pressure Be?

Diabetes And High Blood Pressure

Diabetes And High Blood Pressure

If you have diabetes you should aim to keep your blood pressure well controlled. Having high blood pressure (hypertension) is one of several risk factors that can increase your chance of developing heart disease, a stroke and some other complications. Treatment includes a change in lifestyle risk factors where these can be improved. Many people with diabetes need to take medication to lower their blood pressure. How common is high blood pressure in people with diabetes? In the UK, about half of all people aged over 65, and about 1 in 4 of all middle-aged adults, have high blood pressure (hypertension). It is less common in younger adults. High blood pressure is more common in people with diabetes. Around 3 in 10 people with type 1 diabetes and around 8 in 10 people with type 2 diabetes develop high blood pressure at some stage. People with diabetes are more at risk of developing high blood pressure if they: Are of African-Caribbean origin. Are from the Indian sub-continent. Have a family history of high blood pressure. Have certain lifestyle factors - for example, those who: Are overweight. Eat a lot of salt. Do not eat much fruit and vegetables. Do not take much exercise. Drink a lot of alcohol. What is high blood pressure? This is not as simple to answer as it may seem. In general, the higher the blood pressure, the greater the risk to health. Depending on various factors, the level at which blood pressure is said to be high (hypertension) can vary from person to person. The cut-off point for blood pressure that is said to be high is 140/80 mm Hg or above for people with diabetes and 130/80 mm Hg for those with diabetes and complications (for example, kidney disease). These are lower than the cut-off point for people who do not have diabetes. Note: high blood pressure Continue reading >>

What’s Normal? Blood Pressure, Blood Glucose, Body Temperature

What’s Normal? Blood Pressure, Blood Glucose, Body Temperature

Have you ever wondered how 98.6° Fahrenheit or 37° centigrade became “normal” body temperature? In the 1850’s, a German physician named Carl Wunderlich collected data on 25,000 patients, taking their temperature multiple times. Wunderlich was the first to show how the body temperature fluctuates naturally throughout the day and night, and he was the first to set the threshold for fever (any temperature above 100.4 F.) But Wunderlich’s scientific method intrigued and challenged one very creative thinker. Philip Mackowiak, who is a medical doctor (internal medicine) and professor of medicine and medical historian at the University of Maryland, was interested in clinical thermometry, or the measurement of body temperature. He was able of obtain one of Wunderlich’s original thermometers. To make a fun story short (and you can listen to the entire podcast on Freakonomics here), Mackowiak describes the thermometer as unwieldy and non-registering, meaning it has to be read while it’s in place. In addition, Wunderlich only measured armpit (axillary) temperatures, and today we know that the most accurate measurements are by mouth or better, rectal temperature. Body temperature varies from one person to another. In women, it increases with ovulation and during the menstrual cycle. During vigorous exercise temperature increases. Wondering about the historical accuracy of “normal,” Mackowiak set up his own experiment. Mackowiak learned that a person’s temperature is “almost like a fingerprint” and is unique to the individual. In his modern study he found the actual “normal” temperature to be 98.2 degrees. My “normal” temperature is 96.8°. What’s yours? Blood Pressure There are many myths associated with high blood pressure (HTN), the most importan Continue reading >>

Blood Pressure Medications Have Extra Health Benefits For Diabetes

Blood Pressure Medications Have Extra Health Benefits For Diabetes

Blood Pressure Medication Information Two classes of medications--angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)--often are used to treat high blood pressure, also called hypertension. They also help reduce the risk of stroke and heart attack in high-risk people, including those with diabetes. ACE inhibitors and ARBs also help decrease diabetes-related kidney and heart complications. They also have little adverse effect on glucose levels and cholesterol. "They are the go-to class of antihypertensives in patients with diabetes, as cardiac [heart] and renal [kidney] protective drugs," says endocrinologist Bob Busch, M.D., of Albany, New York. Complications Protection In addition to their positive effect on blood pressure, ACE inhibitors and ARBs have been shown to: Reduce the progression of some diabetes complications that affect the kidneys and eyes. A recent study called the ADVANCE trial demonstrated that blood pressure-lowering therapy with an ACE inhibitor and a water pill reduced the number of kidney events experienced by people with type 2 diabetes by 21 percent, compared with those on a placebo. Protect the heart. The ADVANCE study showed that the relative risk of death from cardiovascular diseases decreased by 18 percent and death from any cause decreased by 14 percent for people with type 2 diabetes taking an ACE inhibitor and water pill. How Blood Pressure Medications Work Here's how ACE inhibitors and ARBs work to lower blood pressure and provide other health benefits. ACE inhibitors: These meds work to widen blood vessels and increase the amount of blood pumped by the heart. They also improve the flow of blood so the heart has less work to do. ARBs: Drugs in this family block a hormone that causes blood vessels to narr Continue reading >>

Blood Pressure Management In Patients With Diabetes

Blood Pressure Management In Patients With Diabetes

Patients with diabetes who also have hypertension are at increased risk of morbidity and mortality from cardiovascular events. However, blood pressure control is frequently suboptimal in the primary care setting. Large clinical trials support the use of antihypertensive medications in these patients to reduce the risk of cardiovascular disease and death. Hypertension is the most common diagnosis in primary care patients. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as a systolic blood pressure (BP) ≥ 140 mmHg or diastolic BP ≥ 90 mmHg for adults ≥ 18 years of age. These thresholds are reduced to systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg for individuals with diabetes or renal disease.1 More than 74 million adults were estimated to have elevated BP from U.S. population-based surveys in 2006,2 with equal prevalence among men and women.2 African Americans have the highest disease burden, with > 40% of adults being affected.2 Furthermore, the prevalence of hypertension increases with age, approaching 75% in individuals ≥ 80 years of age.3 People with diabetes are at greater risk to develop elevated BP. This review offers a summary of recent literature regarding hypertension prevalence and management in adults and children with diabetes and a discussion of the clinical implications and practice recommendations relevant to primary care providers. Epidemiology of Hypertension Among Those With Diabetes The estimated prevalence of hypertension in adults with diabetes is 20–60%, which is 1.5–3 times higher than that in age-matched individuals without diabetes.4,5 The onset of hypertension differs for people with type 1 versus those with type 2 diabetes. Indi Continue reading >>

Diabetes And High Blood Pressure

Diabetes And High Blood Pressure

Diabetes is a condition in which the amount of glucose (sugar) in your blood is too high because your body cannot use it properly. This happens because your body either cannot use or make a hormone called insulin, which is responsible for turning sugar into food for your body's cells. There are two main types of diabetes: Type 1, where your body is unable to produce any insulin Type 2, where your body either does not produce enough insulin, or cannot use it. Symptoms of diabetes The main symptoms of diabetes are: Increased thirst Frequently needing to go to the toilet, especially at night Extreme tiredness Weight loss Blurred vision Genital itching Thrush If diabetes is not controlled, it can cause serious damage to your kidneys, eyes, nervous system, heart and blood vessels. Treatment for diabetes aims to avoid this by keeping blood sugar levels as near to normal as possible. Type 1 diabetes is usually treated by insulin injections, as well as healthy eating and being active. Type 2 diabetes is usually treated by healthy eating and being active alone, but sometimes tablets or insulin injections are also needed. Diabetes and high blood pressure About 25% of people with Type 1 diabetes and 80% of people with Type 2 diabetes have high blood pressure. Having diabetes raises your risk of heart disease, stroke, kidney disease and other health problems. Having high blood pressure also raises this risk. If you have diabetes and high blood pressure together, this raises your risk of health problems even more. If you have diabetes, your doctor will want to be sure that your blood pressure is very well controlled. This means that they will probably want your blood pressure to be below 130 over 80. People with diabetes and high blood pressure are sometimes given the blood pressure Continue reading >>

Specific Blood Pressure Targets For Patients With Diabetic Nephropathy?

Specific Blood Pressure Targets For Patients With Diabetic Nephropathy?

Diabetic nephropathy represents a condition frequently detected in current clinical practice characterized by a very high cardiovascular risk profile. Blood pressure reduction via antihypertension drug treatment represents a therapeutic approach capable of exerting favorable effects on renal and cardiovascular outcomes. The purpose of this article is to review the current literature and results of key clinical trials pertaining to blood pressure goals of antihypertension treatment in these patients. The pros and cons of a less or a more intensive blood pressure goal in diabetic nephropathy will be discussed, with particular emphasis on the cardiovascular and renal effects of each therapeutic strategy. Introduction In patients with diabetes, nephropathy, with or without an increased urinary protein excretion, is accompanied by a much greater risk of progression toward end-stage renal disease (1) as well as of the occurrence of myocardial infarction, heart failure, or stroke (2). A number of randomized controlled trials have documented that in these patients, both progression to renal events and fatal or nonfatal cardiovascular outcomes can be favorably affected by antihypertension drug treatment (3–6). There is no agreement, however, on how low blood pressure should be brought in order to maximize the renal and cardiovascular protective effects of the blood pressure–lowering intervention under this circumstance—namely, whether the target should be similar to the one recommended for the general hypertensive population, i.e., 140/90 mmHg, or lower blood pressure values should be pursued. This article will examine the evidence in favor or against the less and the more intensive blood pressure–lowering treatment strategy in patients with diabetic nephropathy. The eff Continue reading >>

Diabetes And High Blood Pressure: How To Manage Both

Diabetes And High Blood Pressure: How To Manage Both

Type 2 diabetes and high blood pressure (hypertension) are a dangerous combination, putting your health in jeopardy in a number of ways. That means it's crucial to take steps to control high blood pressure when you have diabetes. To start, having type 2 diabetes increases your risk for developing high blood pressure. High blood pressure is a heart disease risk factor on its own, and when you also have diabetes, having high blood pressure puts you at even greater risk. For example, for people who have diabetes, the risk of heart disease increases twofold in men and fourfold in women compared to people without diabetes. If you have diabetes and high blood pressure, your risk of heart disease doubles over that of a person who has high blood pressure alone. “There’s no doubt that diabetes and high blood pressure are a dangerous duo. They’re both very common and are linked by obesity, which is also very common. Nearly half of all people diagnosed with type 2 diabetes have high blood pressure at the time of their diagnosis,” says Betul Hatipoglu, MD, an endocrinologist at the Cleveland Clinic in Ohio. How Diabetes Increase Your Risk of High Blood Pressure Type 2 diabetes is caused by resistance to insulin, the hormone your body needs to use blood sugar for energy. When you have type 2 diabetes, since your body resists insulin, sugar builds up in your blood. “That means your body makes even more insulin, and insulin causes your body to retain salt and fluids, which is one way diabetes increases your risk for high blood pressure,” Dr. Hatipoglu says. For this reason, it’s important to check your blood pressure regularly, just like it is for you to check your blood sugar. Follow your doctor’s recommendations for how often to do both. Blood pressure is measured by Continue reading >>

High Blood Pressure (bp) And Diabetes

High Blood Pressure (bp) And Diabetes

The risks of cardiovascular disease is greatly increased in the patient with both diabetes and hypertension. NICE guidance with respect to type 2 diabetes states (1): frequency of blood pressure measurement measure blood pressure at least annually in a person without previously diagnosed hypertension or renal disease. Offer and reinforce preventive lifestyle advice for a person on antihypertensive therapy at diagnosis of diabetes, review control of blood pressure and medications used, and make changes only where there is poor control or where current medications are not appropriate because of microvascular complications or metabolic problems repeat blood pressure (BP) measurements within: 1 month if BP is higher than 150/90 mmHg 2 months if BP is higher than 140/80 mmHg 2 months if BP is higher than 130/80 mmHg and there is kidney, eye or cerebrovascular damage. Offer lifestyle advice (diet and exercise) at the same time add medications if lifestyle advice does not reduce blood pressure to below 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage) monitor blood pressure 1-2-monthly, and intensify therapy if on medications until blood pressure is consistently below 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular disease) first-line therapy in hypertension in a diabetic first-line blood-pressure-lowering therapy should be a once-daily, generic angiotensin-converting enzyme (ACE) inhibitor. Exceptions to this are people of African-Caribbean descent or women for whom there is a possibility of becoming pregnant first-line blood-pressure-lowering therapy for a person of African-Caribbean descent should be an ACE inhibitor plus either a diuretic or a generic calcium-channel antagonist (calcium-channel blocker) a calcium-ch Continue reading >>

Symptoms, Diagnosis & Monitoring Of Diabetes

Symptoms, Diagnosis & Monitoring Of Diabetes

According to the latest American Heart Association's Heart Disease and Stroke Statistics, about 8 million people 18 years and older in the United States have type 2 diabetes and do not know it. Often type 1 diabetes remains undiagnosed until symptoms become severe and hospitalization is required. Left untreated, diabetes can cause a number of health complications. That's why it's so important to both know what warning signs to look for and to see a health care provider regularly for routine wellness screenings. Symptoms In incidences of prediabetes, there are no symptoms. People may not be aware that they have type 1 or type 2 diabetes because they have no symptoms or because the symptoms are so mild that they go unnoticed for quite some time. However, some individuals do experience warning signs, so it's important to be familiar with them. Prediabetes Type 1 Diabetes Type 2 Diabetes No symptoms Increased or extreme thirst Increased thirst Increased appetite Increased appetite Increased fatigue Fatigue Increased or frequent urination Increased urination, especially at night Unusual weight loss Weight loss Blurred vision Blurred vision Fruity odor or breath Sores that do not heal In some cases, no symptoms In some cases, no symptoms If you have any of these symptoms, see your health care provider right away. Diabetes can only be diagnosed by your healthcare provider. Who should be tested for prediabetes and diabetes? The U.S. Department of Health and Human Services recommends that you should be tested if you are: If your blood glucose levels are in normal range, testing should be done about every three years. If you have prediabetes, you should be checked for diabetes every one to two years after diagnosis. Tests for Diagnosing Prediabetes and Diabetes There are three ty Continue reading >>

What Is The Ideal Blood Pressure Goal For Patients With Diabetes Mellitus And Nephropathy?

What Is The Ideal Blood Pressure Goal For Patients With Diabetes Mellitus And Nephropathy?

Abstract There appears to be a broad consensus among professional health organizations that a blood pressure (BP) of 130/80 mm Hg or less is the recommended therapeutic BP target for subjects with diabetes mellitus. This review focuses on key studies that have examined the relationship between BP reduction and its impact on diabetic complications. An attempt is being made to identify the BP level at which maximum protection against diabetic complications is conferred, and below which further reduction no longer delivers a benefit that exceeds risk. Specific attention has been accorded to data contributing to establishing ideal BP goals in diabetic patients with nephropathy. On the basis of recent studies, it would appear that a BP below 140/90 mm Hg should be recommended for all diabetic individuals, and around 135/85 mm Hg for most. BP should be closer to, but not below, 130/80 mm Hg for those subjects at the highest cardiovascular risk. For those diabetic subjects at highest risk for stroke, lower BP may provide greater protection against stroke as shown in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. In younger individuals with diabetes and hypertension of shorter duration, it may be possible to lower BP below 130/80 mm Hg without untoward side effects and in fact with cardiovascular benefit, but this remains to be demonstrated. The ideal BP goal in diabetic patients with nephropathy remains questionable, and for now, the recommended target must be considered the same as that for the general diabetic population. Continue reading >>

Foods To Eat With High Blood Pressure & Diabetes

Foods To Eat With High Blood Pressure & Diabetes

High blood pressure increases your risk for heart attack, stroke and cardiovascular disease. Blood pressure management is critical if you have diabetes since it also increases your risk for diabetes complications. In addition to maintaining a healthy weight and limiting alcohol intake, a healthy diet can improve your blood pressure levels and your overall health, according to the American Heart Association. For best results, seek specified guidance from a qualified health care professional. Video of the Day Fruits and vegetables provide rich amounts of vitamins, minerals, antioxidants and fiber. Fruits and vegetables also have a mellowing effect on blood sugar levels and can help lower blood pressure, according to the Harvard School of Public Health. Consume a variety of fresh, colorful fruits and vegetable regularly for broadest dietary benefits. Since fruit and starchy vegetables contain carbohydrates, consume appropriate portion sizes and daily amounts, as recommended by your doctor or diabetes specialist. Examples of nutrient-rich fruits and vegetables include citrus fruits, berries, apples, pears, plums, kiwi, cantaloupe, tomatoes, avocado, spinach, kale, broccoli, cauliflower, cabbage, Brussels sprouts, red and green bell peppers, carrots and peas. Nutritious starchy vegetables include squash, sweet potatoes, baked potatoes and pumpkin. Whole grains also provide rich amounts of nutrients and fiber. As low-glycemic carbohydrate sources, whole grains can support healthy blood sugar levels and keep you fuller longer between meals. Consume a variety of whole grain foods as part of a balanced, healthy diet for best results. Foods rich in whole grain nutrition include whole grain breads, tortillas, pasta and cereals, brown rice, quinoa, wild rice, air-popped popcorn and Continue reading >>

High Blood Pressure

High Blood Pressure

Blood pressure is a measurement of the force of your blood against the blood vessel walls. There are often no signs of high blood pressure. This means that you may have high blood pressure and not know it. The recommended target for people with diabetes is less than 130/80 mm Hg. The top number is the pressure when your heart contracts and pushes blood out (systolic). The bottom number is the pressure when the heart relaxes between beats (diastolic). Why is controlling blood pressure important for people with diabetes? When blood pressure is high, it puts stress on the body. This can cause damage to the heart, brain, kidneys, and eyes. High blood glucose levels are a risk factor for hypertension (high blood pressure) as it can lead to hardening of the arteries. Compared to people without diabetes, people with diabetes are much more likely to develop heart disease and/or experience a stroke at an earlier age. If you have diabetes, get your blood pressure checked every time you visit your health-care team. Am I doing all that I can to control my blood pressure? Do I have my blood pressure checked every time I visit my health-care team? Am I at a healthy weight? Do I follow a healthy diet that includes vegetables, fruits, low-fat dairy products, and is low in sodium and saturated and trans fats? Am I physically active on a regular basis? Am I a non-smoker? Do I manage stress in a healthy way? Do I limit my alcohol intake? Do I take my medication as prescribed? Strategies to lower blood pressure Try these healthy eating tips: Choose vegetables and fruits more often (fresh or frozen without added salt). Choose low-fat (one per cent or skim) dairy products. Choose legumes (dried beans, peas and lentils) more often. Rinse canned beans with water. Choose whole grains such as wh Continue reading >>

Diabetes And High Blood Pressure

Diabetes And High Blood Pressure

High blood pressure (hypertension) can lead to many complications of diabetes, including diabetic eye disease and kidney disease, or make them worse. Most people with diabetes will eventually have high blood pressure, along with other heart and circulation problems. Diabetes damages arteries and makes them targets for hardening, called atherosclerosis. That can cause high blood pressure, which if not treated, can lead to trouble including blood vessel damage, heart attack, and kidney failure. Compared to those with normal blood pressure readings, people with hypertension more often have: Peripheral vascular disease, hardening of the arteries in the legs and feet Even blood pressure that's at the higher end of normal (120/80 to 129/80), called elevated, impacts your health. Studies show that you have a two to three times greater chance of getting heart disease over 10 years. Readings vary, but most people with diabetes should have a blood pressure of no more than 130/80. The first, or top, number is the "systolic pressure," or the pressure in your arteries when your heart squeezes and fills the vessels with blood. The second, or bottom, number is the "diastolic pressure," or the pressure in your arteries when your heart rests between beats, filling itself with blood for the next contraction. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels. Usually, high blood pressure has no symptoms. That's why you need to check your blood pressure regularly. Your doctor will probably measure it at every visit, and you may need to check it at home, too. Many of the things you do for your diabetes will also help with high blood pressure: Control your blood sugar. Don't drink a lot of alcohol. Limit how m Continue reading >>

Type 2 Diabetes And Hypertension

Type 2 Diabetes And Hypertension

High blood pressure, or hypertension, is a condition that’s often present in people with type 2 diabetes. It’s unknown why there’s such a significant correlation between the two diseases. It’s believed that obesity, a diet high in fat and sodium, and inactivity contribute to both conditions. Hypertension is known as a “silent killer” because it has no obvious symptoms and many people are unaware that they have it. A 2013 survey by the American Diabetes Association (ADA) found that fewer than half of people at risk for heart disease or type 2 diabetes reported discussing biomarkers, including blood pressure, with their care providers. If you have hypertension, it means that your blood is pumping through your heart and blood vessels with too much force. Over time, consistently high blood pressure tires the heart muscle and can enlarge it. In 2008, 67 percent of adults aged 20 and over with self-reported diabetes had blood pressure rates of greater than 140/90. In the general population and in people with diabetes, a blood pressure reading of less than or equal to 140/90 is considered normal. What does this mean? The first number (140) is called the systolic pressure. It indicates the highest pressure exerted as blood pushes through your heart. The second number (90) is called the diastolic pressure. This is the pressure maintained by the arteries when the vessels are relaxed between heartbeats. Healthy people should get their blood pressure checked several times a year. People with diabetes need to be even more vigilant. If you have diabetes, you should have your pressure checked at least four times each year. If you have diabetes and high blood pressure, the ADA recommends that you self-monitor at home, record the readings, and share them with your doctor. Ac Continue reading >>

Managing Diabetes: New Evidence On Targets For Blood Pressure And Blood Glucose

Managing Diabetes: New Evidence On Targets For Blood Pressure And Blood Glucose

Key messages: 1. Current evidence does not support blood pressure targets lower than the standard targets for people with raised blood pressure and diabetes 2. Better evidence is needed to guide the choice between targeting intensive or conventional glycaemic control in people with type 2 diabetes but intensive control increases the risk of both mild and severe low blood sugar Today is World Diabetes Day and there’s a big emphasis on knowing the complications of diabetes and trying to avoid them. Maintaining healthy blood pressure levels and blood sugar levels are important ways to reduce the risk of damage to the heart and blood vessels, kidneys, nerves and eyes. We have new evidence from Cochrane systematic reviews which helps shed some light on which approaches might be best when it comes to setting targets for blood pressure and blood glucose levels. Blood pressure targets: how low should you go? When treating high blood pressure (BP), doctors and patients will want to know what levels they’re aiming for. For some time the advice has been that a target of 140/90 mmHg is right for the general population being treated for high blood pressure. The first number, 140 here, is the systolic blood pressure (SBP) and the second, 90, the diastolic blood pressure (DBP) and these are generally considered separately in clinical practice. The National Institute for Health and Care Excellence recommends 140/90 mmHg as the target BP levels for those aged under eighty in their Hypertension Guideline, with no alternative recommendation for people with diabetes. Other guidelines have recommended lower BP targets for diabetics, including recent European guidelines which recommend a target lower than 140/85mmHg. There was no consistent evidence to recommend a target SBP of below 130 Continue reading >>

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