CSN-CommunityPost-The Pressure Is On

If your Healthcare provider has informed you that you have hypertension or high blood pressure, you may have moaned at the thought of more dietary restrictions and another medicine to take. Or maybe you just tuned him out. Following all, you have enough to do with caring for your diabetes, and how severe could high blood pressure be since it has no symptoms?

High blood pressure is severe. However, by paying attention to it and you can save a lot of grief down the road.

Why it matters

High blood pressure is a critical risk factor for kidney failure, heart attack, and stroke in people with diabetes. While the connection between diabetes and high blood pressure is not fully understood, high blood pressure is two times most common in people with diabetes than in the population. More than half of bodies with Type 2 diabetes have high blood pressure at their diabetes diagnosis.

In a person experiencing diabetes, high blood pressure enhances the blood vessel damage caused by high blood sugar. High blood pressure response to more than two-thirds of the severe and life-threatening complexities of diabetes, containing stroke, kidney failure, and heart attack. However, numerous investigations have shown that treating high blood pressure aggressively reduces the risk of death from stroke and heart attack.

For people with diabetes, the goal of blood pressure control is to keep it below 140/90 mm Hg. This target was established based on large-scale research showing significant decreases in heart disease and stroke when blood pressure was managed at this level. Research also suggests that blood pressure goals are not being met: Only about half of people with diabetes consistently reach this goal.

Understanding blood pressure

The heart pumps blood by more than 93 miles of blood vessels, which work as a plumbing system, carrying blood to all the essential organs. A specific amount of pressure within this system is necessary to keep the blood moving, but too much stress can damage organs and vessels. If the heart pumps too tricky or the body's small blood vessels become narrow the pressure increases. If a person's blood pressure is persistently raised, a high blood pressure diagnosis is made.

Blood pressure is calculated in millimeters of mercury (mm Hg). The top, or "first," figure is the systolic pressure and measures the blood vessel walls' force as the heart contracts or squeezes. The lower, or "second," figure is the diastolic pressure, which is the force on the vessel walls as the heart relaxes. A person's blood pressure is categorized, as usual, hypertensive or prehypertensive (high-normal). The hypertensive group is additionally divided into stage 1 and stage 2, based on how high the measurements are above average. Stage 1 leads to blood pressure levels from 140/90 mm Hg to 159/99 mm Hg. Stage 2 relates to blood pressure levels of 160/100 mm Hg or above.

Blood pressure is dynamic, indicating that it can change instantaneously in reply to the external or internal environment. If you have an injury that leads to severe bleeding, your blood pressure decreases rapidly. But your body also reacts to that decreases within seconds by narrowing and squeezing the blood vessels and enhancing heart action to bring the pressure back up.

The body has many ways of adjusting blood pressure as needed to be sure its organs (primarily the brain) maintain an adequate supply of oxygen. This dynamic reply is part of the reason most people have what is known as white-coat hypertension. Being nervous in the medical room can result in a substantial rise in blood pressure that is not present at home. White-coat hypertension can make it tough to get the correct blood pressure measurement. When your blood pressure is calculated, your arm should be at your heart level, and the blood pressure cuff should be suitably sized for your component. If the cuff barely fits on your arm or pops off once it is in place, it may be too small, and you get a falsely high reading. Two readings are usually sufficient at a medical visit, but at times, a task taken at the end of the visit is most correct because you are more relaxed.

 It's a great idea to write down your blood pressure readings taken at the doctor's office, both for your information and to show any other healthcare providers you may see. This helps your healthcare providers coordinate their health and see whether the measures they're getting are typical for you. It's also necessary to discuss your blood pressure target with several members of your healthcare team to be assured you're all shooting for the aim established for people who have diabetes, less than 140/90 mm Hg. If you notice that different team members have other plans in mind, you may want to take the lead in letting them know what your goal is.

Calculating your blood pressure at home is also really valuable, particularly during periods of medicine adjustments. Home blood pressure monitors mostly cost approximately $40 to $60, and they are well worth the expenses. Wrist monitors may not be as good as those with a cuff that wraps around the upper arm. If you are using a home blood pressure monitor, you should bring it to your doctor's appointments periodically to be sure it is right. A great time to monitor at home is in the morning before you take any medications. Early morning is when blood pressure leads to be highest and when some medicines are wearing off. It is also an increased risk period for heart attack and stroke.

Another device that is often used to diagnose high blood pressure is the 24-hour ambulatory blood pressure monitor. This is a blood pressure monitor clipped onto a belt and connected to an arm cuff for 24 hours. Based on how it is programmed, the cuff impulsive inflates every 20–60 minutes to measure and log blood pressure throughout the day and night. It is a handy tool to assess people with white-coat hypertension, difficult-to-control high blood pressure, or low blood pressure (which may symbolize that a person's high blood pressure is being overtreated)—measuring blood pressure. At the same time, asleep is vital because blood pressure is expected to drop by about 10% to 20% at night. This is called a nocturnal dip. The absence of the nocturnal dip is associated with a higher risk of heart disease and stroke.

Types of high blood pressure

As stated earlier, the goal of blood pressure for those with diabetes is lower than 140/90 mm Hg consistently. That indicates the highest reading you should notice is 139/89 mm Hg. Persistent readings over this target should prompt a focused evaluation of your blood pressure by you and your healthcare team. The initial assessment covers three significant issues: identifying the reason for high blood pressure, looking for proof of organ damage that may have already taken place, and discussing lifestyle issues affecting blood pressure.

The reason for having high blood pressure are classified into two broad groups. The first group is known as primary or essential hypertension. This is a common form of high blood pressure, and the exact reason is not clearly understood. But, it is considered to be due in part to a combination of environmental and genetic factors. Having diabetes may magnify some of these factors. In people who have Type 1 diabetes, kidney disease is also believed to play a central role in high blood pressure progression. For those who have Type 2 diabetes, insulin resistance and obesity may be important factors. But, it should be observed that some researches show a stronger relationship between diabetes and high blood pressure in those experiencing type 2 diabetes who are thin.

The second type of high blood pressure is adequately called secondary hypertension. While it is limited to typical, it is curable without the requirement for long-term drug treatment. There is a long list of situations and medication that can cause secondary hypertension. Kidney disease is the most common form of secondary hypertension. Two main kidney arteries supply the kidneys, and when a kidney artery grows, a narrowing, the kidney "your blood pressure is too low. It then sends signals to increase your blood pressure inappropriately. This is known as renal (kidney) artery hypertension. An open blocked artery with a balloon and stent (a kind of medical scaffolding) can cure this high blood pressure in many cases.

Thyroid disease, sleep apnea, and certain hormone-producing tumors can cause high blood pressure as well. Some over-the-counter drugs and prescriptions can also raise blood pressure. Steroids, non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen), and specific cold medication (including those including pseudoephedrine) are a few of the more well-known culprits. Oral contraceptives are also related to high blood pressure in women, incredibly obese, or smoke women.

High blood pressure is generally called "the silent killer" because even while it harms your organs, it usually does not cause any symptoms. That's why an essential part of the primary evaluation of high blood pressure is knowing any damage that has been caused by it. Pumping against a high pressure can strain the heart and make it to become enlarged or hypertrophied. An enlarged heart is connected with an enhanced heart attack risk, sudden death, stroke, and heart failure. An echocardiogram (heart ultrasound) or electrocardiogram can identify this complication. Regularly filtering under high pressure can cause kidney damage, resulting in abnormal kidney function and protein leakage into the urine. These high blood pressure complications are called end-organ damage, but they can improve with aggressive treatment of high blood pressure.

Essential hypertension generally progresses very slowly over the years. This is in clear contrast to secondary hypertension, which more frequently moves quickly over months, weeks, or even days, leading to a rapid increase in blood pressure. This is named accelerated hypertension and can be associated with headaches, nausea, visual problems, drowsiness, or confusion. The one with immediately worsening blood pressure and notable symptoms should be evaluated rapidly by their physician. The pace of the blood pressure increase can be an essential clue to the cause.

Treating high blood pressure

Once the high blood pressure is diagnosed, a treatment program should begin immediately. In cases where the blood pressure is significantly raised (as in stage 2 hypertension, with systolic blood pressure high than 160 mm Hg), drug therapy is often initiated right away. At the same time, lab tests and x-ray research are obtained. When an individual is found to have secondary hypertension, treatment is directed at the cause. If an individual is found to have a kidney artery blockage causing hypertension, he will be considered a method to open the blocked kidney artery.

If a curable type of hypertension is found and treated, long-term medication therapy may be avoided. In most cases, treatment of the cause does not lead to complete blood pressure resolution, and some blood pressure medicine is still needed to keep the blood pressure at the goal level (below 140/90 mm Hg).

As per a national committee on hypertension, two of the most critical aspects of successfully treating high blood pressure are trusting your doctor and the urge to succeed. Setting a target is the next step, and when hypertension and diabetes coexist, the aim is to consistently maintain a blood pressure level below 140/90 mm Hg. Lifestyle changes are central to maintaining blood pressure control to avoid or reduce the need for medicines. A heart-healthy lifestyle also enhances the effectiveness of medications when they are needed.

 For a person who doesn't have diabetes but diagnosed with blood pressures higher than 140/90 mm Hg, treatment duration with lifestyle changes can is considered. For those with diabetes, the risk of heart disease, stroke, and kidney failure is so much higher than current guidelines recommend initiating drug therapy simultaneously as lifestyle changes.

Lifestyle changes

There is an enormous overlap between the lifestyle measures that are beneficial for high blood pressure and those that help control diabetes. Performing regular exercise, losing excess weight, keeping it off, and getting adequate sleep are starting. Research suggests that your blood pressure may lower 3–5 mm Hg for every 10 pounds of extra weight loss.

Losing weight is very challenging, but the health benefits of doing it are substantial. A moderate reduction in calorie intake, along with a regular exercise program, is the best way to reduce your weight gradually. Moderate-intensity exercise, like brisk walking, is felt to be safer than very vigorous exercise. Intense workouts such as heavy lifting or snow shoveling can briefly raise blood pressure and stress the heart too much. On the other hand of the spectrum, passive movements such as those done in yoga or tai chi may lower blood pressure.

Reducing sodium intake can be useful in lowering blood pressure. Many people are more sensitive to salt than others, meaning that their blood pressure has a more exaggerated salt response—people with diabetes and obesity lead to salt sensitivity. A low-salt diet has been linked with a reduced risk of cardiovascular disease. Decreasing sodium intake to below 2400 milligrams daily has significant benefits for blood pressure. Still, avoiding table salt can't be done since most sodium in American diets comes from processed foods. Viewing food package labels to choose low-sodium foods is therefore also necessary. Other dietary changes that are helpful mod contain eating intake of caffeine and alcohol.

It is not clear why, but a vegetarian diet has been proved to benefit blood pressure. This is probably related to an increased intake of fruits and vegetables and lower saturated and total fat intake. The DASH diet is rich in fruits, low-fat dairy products, and vegetables while avoiding saturated fats. It gives plenty of calcium, potassium, and magnesium, which are essential for lowering blood pressure. Combining the DASH diet and salt restriction diet is an excellent start to managing your blood pressure. 

Just like sleep disorders are known to increase blood pressure, good sleep habits benefit blood pressure. In people without hypertension, blood pressure is higher in the morning after a poor night's sleep. Psychological stress is also responsible for hypertension, and stress-reduction and relaxation techniques are beneficial and essential parts of a full treatment program.

Drug therapy

In people who have diabetes diagnosed with high blood pressure, medication is initiated along with lifestyle changes. Improvements have been caused in the understanding of what causes hypertension. This has resulted in developing several different types, or classes, of drugs that lower blood pressure. The major categories for blood-pressure-lowering medicines include diuretics (usually called water pills),  angiotensin receptor blockers (ARBs), beta-blockers, alpha-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors.

These forms are commonly used to treat high blood pressure in people with diabetes, but ACE inhibitors and ARBs should be considered first-line treatments. Over the previous few decades, numerous research has shown that these medications have protective effects independent of their capacity to lower your blood pressure: They also decrease the complications of diabetes, containing heart disease, kidney disease, and stroke. Further research is looking into whether using ARBs and ACE inhibitors together would give even better kidney and cardiovascular protection. These medications have become the cornerstone of blood pressure treatment, and there is even some proof that they may delay or prevent the onset of diabetes.

Calcium channel blockers work by relaxing blood vessels, pointing to lower blood pressure. They come in two types, non-dihydropyridine (n/OMination with ACE inhibitor and ARB therapy to amplify heart and kidney protection).

Diuretics continue to be an essential class of blood pressure medication. They decrease a person's water and salt content by stimulating urination. They work great when a person has a salt-restricted diet. Beta-blockers slow the heart rate and lowers blood pressure. They have been found to have critical heart-protective qualities, decreasing the risk of death after a heart attack, and improving heart failure treatment. But, both diuretics and beta-blockers are less desirable as first-line treatments in people with diabetes. These medicines may have adverse effects on weight and blood glucose control. But, they are often needed ultimately if the blood pressure is challenging to control.

Numerous other blood pressure medications are available and work in a various method. As a person is treated for higher blood pressure, his drugs are continuously increased and "stacked" one on top of another until blood pressure is achieved. It usually takes three or more blood pressure medicines to control high blood pressure in people with diabetes. While some drugs are more beneficial for diabetes than others, achieving the aim of blood pressure of lesser 140/90 mm Hg without any side effects is the target. This target must be completed using other medicines if a person cannot tolerate therapy with ACE inhibitors or ARBs. The price of many of these medicines is high, and for some people, the price may play a role in drug choice.

Coming up with a plan

It can take various weeks to several months to find the right dose of a medicine or combination of the drug and lifestyle changes to reach constant blood pressure measurements lesser 140/90 mm Hg. If your blood pressure is high, to begin with, it may initially be necessary to see your healthcare provider as usual as once a week to coordinate your treatment plan. When your blood pressure is under control, it should be examined every four to six months at your everyday diabetes checkups. Your physician may also recommend more frequent home monitoring. It's not uncommon to eventually need changes to your blood-pressure-lowering regimen moreover. Many people can manage control for many years with the same regimen, while others cannot. If blood pressure worsens quickly, it may be essential to look for a secondary cause not chosen during the first evaluation.

Continuing blood pressure control with the same vigor as blood glucose control will improve your chances of a long and healthy life. The need for multiple medicines and a physically and financially tolerable drug regimen controls hypertension in people with diabetes complications. Success demands patience and perseverance by you and your healthcare team, along with personal motivation and the belief that you can succeed.