Understanding your blood pressure for diabetes

Myth “You know if you have high blood pressure because it gives you headaches”

Truth High blood pressure does not always give you symptoms, and it is often found by chance during routine health checkups. Having your blood pressure checked at your annual diabetes reviews, and more frequently if your health professional suggest it, will be a more reliable indicator of whether your blood pressure is high.

My doctor tested me for Type 2 diabetes because I am having treatment for high blood pressure. Why is that?

Type 2 diabetes and high blood pressure are both linked to insulin resistance, so if you have one of these conditions it is common to have the other, too. If you keep both your blood pressure and your blood glucose level under control, your chances of developing long-term complications, especially heart disease, are greatly reduced.

What is high blood pressure?

If your larger blood vessels become more rigid and your smaller blood vessels start to constrict, your blood has to flow through a narrower space than before. The result is greater pressure on your blood vessel walls, which is known as high blood pressure or, medically, as hypertension. Having high blood pressure is common when you have Type 2 diabetes.

I have high blood pressure but I don’t feel sick. Why does it need to be treated?

Having high blood pressure makes you much more prone to cardiovascular disease (CVD) – a serious condition that develops over many years as your blood vessels gradually become narrower and less flexible. You may have high blood pressure without knowing it and, if it remains untreated, you may develop angina (severe chest pain) or have a heart attack or a stroke. Taking your blood pressure treatment as prescribed and having regular checkups can help prevent these serious conditions.

What should my blood pressure be?

If you have Type 2 diabetes your blood pressure should be below 130/80 millimeters of mercury (mmHg). In some situations, for example if you have already developed kidney damage (nephropathy), you may need to keep your blood pressure lower, for example, 125/75 millimeters of mercury (mmHg) to prevent further damage. Discussing your ideal blood pressure level, and ways to achieve it, with your health professional will give you the level that is right for you.

Why are there two figures in my blood pressure measurement?

The top figure refers to the level of pressure in your blood vessels as your heart contracts and pumps blood around your body. This is known as the systolic blood pressure. The second figure is the lowest pressure as your heart relaxes between beats. This is known as the diastolic blood pressure.

What can I do to lower my blood pressure?

Stop smoking and lose weight if you need to, eating more fresh fruit and vegetables and less saturated fat and salt (for example, less processed or commercially prepared meals) to help reduce your blood pressure. Physical activity will also lower your blood pressure. Take any blood pressure pills that you have been prescribed, even if they do not affect the way you feel, to help keep your blood pressure in the recommended range.

How low can my blood pressure go?

It would be unusual for your blood pressure to be under 100/60 mmHg if you are otherwise healthy. For every 10 mmHg drop in your systolic blood pressure (the first figure) toward this level, you benefit by reducing your risk of heart attack or stroke.

Genes to re-grow heart

Doctors may finally be successful in growing new heart cells. Research reported in the Circulation journal details the results of a new study to understand more about the treatment of a common heart problem called angina.

Angina occurs when blood vessels cannot get enough oxygen-rich blood to the heart to meet the demand, particularly during physical exertion. The most common side effect is chest pain. In the past, doctors have treated the condition either with medication to slow the heart’s beating, or surgery to bypass or correct the affected areas.

Doctors have been studying the use of therapy to inject genes that help re-grow heart cells. This research, conducted at eight medical centers, looked at the effects of gene therapy in 79 patients. Doctors injected an inactive virus, called Ad5 (containing the human FGF4 gene) into 60 patients. The human FGF4 gene can stimulate blood vessel growth.

Doctors compared each person’s exercise treadmill time (ETT) before and after therapy. Treated patients improved more in their treadmill time than untreated patients. While the doctors are pleased with their initial results, they are cautious. They say further research will need to be conducted.

Several of the co-authors of the study are founders and consultants of the company who makes the virus-gene combination. This study was partly funded by that company, Collateral Therapeutics, Inc.

SOURCE: Circulation, 2002;105:1291-1297

Type 2 diabetes and heart disease

What is the link between Type 2 diabetes and heart disease?

Type 2 diabetes is more than simply a raised blood glucose level. You are also likely to develop various problems related to your heart and blood vessels – for example, high blood pressure and high cholesterol levels. Although the link between high blood pressure and diabetes is not yet fully understood, it is thought that it may result from high levels of insulin circulation in your blood as a result of insulin resistance (which is usual in Type 2 diabetes). As a result, your blood vessels become scarred and hard plaques form – this causes narrowing of your blood vessels, which makes it more difficult for your blood to flow. The risk of blockages in your blood vessels also increases; these can cause angina (severe chest pain) or a heart attack.

What is cardiovascular disease?

“Cardio” means heart and “vascular” means blood vessels. If you have Type 2 diabetes, you are prone to a range of cardiovascular problems including high blood pressure, hyperlipidemia (a high level of fat in your blood), angina (severe chest pain), heart attack, stroke, peripheral vascular disease (pain in yoru legs when walking or resting due to reduced circulation), and heat failure. You are also two to four times more likely to develop cardiovascular disease (CVD) than someone without diabetes. CVD is one of the major problems associated with Type 2 diabetes.

How would I know if I have CVD?

CVD does not necessarily cause any symptoms and may only become apparent when you have a heart attack or a stroke. But it is possible for your health professional to look for signs of CVD, such as high blood pressure and high levels of cholesterol in your blood. If tests are positive, you can have treatment for these conditions even though they do not make you feel ill. This is why you need to have your blood pressure and blood cholesterol levels checked regularly.

Can I take drugs to prevent CVD?

Taking regular low doses of aspirin (or other blood-thinning tablets if you can’t take aspirin) can help reduce your risk. You may also be prescribed pills to reduce your cholesterol level if you need them. Even if you need pills, eating healthily and becoming or staying active will play an important role in lowering your risk of CVD.

What exactly are “raised blood lipids”?

When you have Type 2 diabetes, your levels of cholesterol and triglycerides – two types of lipids (fats) in the blood – are likely to be raised, a condition known as hyperlipidemia. Both of these fats are essential in small amounts, but when their levels are raised they can damage your arteries. There are two types of cholesterol in your blood: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). In a healthy person, the proportion of HDL to LDL is higher than it is in a person with Type 2 diabetes. Elevated levels of lipids in the blood are treated in order to lower your blood fats and to correct the ratio of HDL to LDL. This in turn prevents your arteries from narrowing.

How can losing weight prevent CVD?

If you are overweight, losing even a few pounds is one of the most important things you can do if you have Type 2 diabetes. Losing weight and becoming more active will help to lower your blood cholesterol levels and blood pressure. Your body will also become more responsive to the insulin you produce, and your heart will be under less strain.

Will physical activity help me prevent CVD?

Yes, just 30 minutes of moderate activity five times a week will help you control your blood pressure and reduce your cholesterol level, which in turn reduces your risk of CVD. Physical activity helps you lose weight because you not only burn more calories while you are active but you also speed up your metabolic rate so that your body uses up more calories even when you are less active.

How important is it to stop smoking now I have Type 2 diabetes?

Very important; if you smoke, you have a far higher risk of CVD, heart attack, and stroke. Having Type 2 diabetes further increases the risk. Going to smoking cessation clinics and using nicotine replacement therapy such as patches or chewing gum can help you give up.

My Type 2 diabetes was diagnosed after a heart attack. How can I prevent another?

Taking any medication you have been prescribed to reduce your blood pressure and cholesterol level, increase your blood flow, and control your blood glucose level will make a big difference. Relaxation therapy and attending your cardiac rehabilitation meetings will help to reduce your risk. Stopping smoking and being active – for example, walking every day – are also important.

Coronary heart disease

Coronary heart disease includes angina, heart attacks, and cardiac arrest. Many nutrients have been shown to reduce these, including vitamin E, alpha-linolenic acid, folic acid, vitamins C, B6 and B12, unsaturated fats, fruit and vegetables, dietary fiber, whole grains, nuts, alcohol, fish oils and magnesium.

Even today in the twenty-first century, heart disease statistics are frightening: In a study performed in the UK in 1991, 48% of everyone who had a heart attack died within 30 days. Half of those who died had NO prior symptoms – the first warning that they had heart disease was the last! Sadly, this is especially the case when young people have a heart attack. If half of heart attacks are fatal, then waiting until one develops symptoms is much too late for many people. Prevention, therefore, is essential, and good nutrition is a very powerful part of prevention.

Some of the reductions are truly remarkable. These results suggest that relatively simple and inexpensive changes in nutrient intake can dramatically reduce the risk of coronary heart disease, which continues to kill almost one third of the populations of most Western countries.

Sudden unexpected death (cardiac arrest) is very common with heart disease. Many of us have friends, colleagues and even family members who simply dropped dead and who never had the opportunity to reach the high-tech facilities in our hospitals which may have saved them. Because of these horrifying figures prevention is far more effective than waiting until symptoms appear and then starting treatment.

Here are some of the studies showing how coronary heart disease can be affected by nutrition and supplementation:

Vitamin E

• Women in the Nurses Study who took vitamin E for short periods shoed almost no benefits; however, when they took it for more than 2 years, the risk of coronary disease was reduced by 41%.
• The USA Male Health Professional Study: 44,000 male doctors and other health professionals were followed for 4 years. Those men who took at least 100iu of vitamin E per day for more than 2 years had 37% less coronary artery disease.
• A study of 11,000 older people aged 67-105 years: taking vitamin E supplements reduced coronary heart disease deaths by 47%, and taking both vitamin C and E by 53%.
• Despite the negative attitude of the medical press, many doctors recommend antioxidant vitamins. USANA Vitamins Proflavanol® C100 is using innovative Nutritional Hybrid Technology to combine two of USANA’s most popular Nutritionals, Proflavanol® and Poly C®, Proflavanol® C100 packs the best of both worlds into a single, powerful pill.
• In a survey of cardiologists in the USA, 44% personally used antioxidant supplements and 37% recommended them to their patients.
• A smaller survey was taken of members of the Royal Australasian College of Physicians: 15% consumed antioxidants and 20% recommended them to their patients. However, when they developed heart disease themselves, 34% of Australasian physicians took antioxidant supplements.

Alpha-linolenic acid

This is one of the few fats our bodies cannot manufacture. This is an omega 3 fatty acid found in oily fish and flax seed oils which seems to be beneficial for the optimal function of blood vessels, nerves, skin, hormones and joints.

Women in the Nurse Study who had a high intake of alpha-linolenic acid had 45% fewer heart attacks than those taking only a little or none.

Folic acid and vitamins B6 and B12

These B vitamins help lower the blood homocysteine. High blood homocysteine level is an important risk factor for heart disease. Women in the Nurses Study who took higher doses of folic acid (greater than 700ug/day) had 31% less coronary heart disease. Those who took vitamin B6 (more than 4 mg/day) had a 33% reduction.

Dietary fat intake

We eat four types of fat – saturated fats (animal fats), polyunsaturated fats (vegetable and fish oils), monounsaturated (olive oil) and trans fats (mostly man-made fats). It appears that the trans fats are by far the worst, although most medical authorities recommend also reducing the amount of saturated fat eaten as well.

• Women in the Nurses Study who had high overall fat intakes did not have more heart disease. But looking at the types of fat, there was a difference. Trans fats were the worst – doubling the risk of heart disease to 200%, while saturated fat increased heart disease by 17%. Monounsaturated fat reduced heart disease by 19% and eating more polyunsaturated fat reduced it by 38%.
• Trans fat intake: the partial hydrogenation of vegetable oils to produce margarine and shortening produces trans-fatty acids. Women in the Nurses Study who had higher intakes of trans fats had more coronary heart disease. Regular users of margarines for 10 or more years had a 67% increase.

Refined sugars

Sugars which are rapidly absorbed into the blood stream cause peaks in blood glucose and insulin. These are called high glycaemic sugars, and have been blamed for obesity, diabetes, and also can aggravate heart disease. Many processed carbohydrates fall into this category: e.g. bread, white rice, sweets, cakes and cookies.

• Women in the Nurses Study who ate high glycaemic foods had more than 2 ½ times the risk of developing coronary heart disease.