Diabetes, High Blood Pressure and Cholesterol: How One Condition Impacts the Other
I was diagnosed with Diabetes Type II in 1999. Prior to that date my blood pressure readings were averaging 147/91. In January of 2000 my doctor put me on Lipitor. Could my HBP be considered a secondary condition that is likely to be caused in part and/or aggravated by the diabetes mellitus?
Multiple readers have noted that they have one combination or another of hypertension, type 2 diabetes mellitus and hyperlipidemia (elevated cholesterol, or triglycerides, or low HDL cholesterol) and asked which came first and whether one is secondary to the other. The relationship is often complex as each can not only worsen the other but also increases the effect upon the adverse problems that can lead to heart disease.
In the question that I am answering, the blood pressures were already elevated and we would at least call them "pre hypertensive" before. The reason that we use the term "pre hypertensive" is that people who run high pressure early in life are more likely than others to run even higher pressures as they age. Indeed, the likelihood of having high blood pressure is quite low before age thirty but increases with each decade of life.
One of the reasons that blood pressure increases as we get older is arteriosclerosis. Our arteries are quite compliant and expand with each push of blood pumping from the heart. The arteries become a bit stiffer as we age (come to think of it, so are our joints), and no longer cushion the shock of blood coursing through under pressure from the heart. This stiffness causes the pressure within the blood vessels to rise, and this is what we actually measure. As we age, in a "Western" society our unhealthy diets lead us to deposit fat molecules (mostly forms of cholesterol) into the walls of the blood vessels building up "plaque" which can impede blood flow. As this impediment to blood flow increases, some of our organs can find themselves deprived of adequate blood supply. Everyone has heard of heart attacks, or strokes that occur as the result of plaque build up. Unfortunately, the problem is not limited to the heart and brain. Blockage of blood vessels to the bowel can cause major problems called mesenteric ischemia (the pain similar to angina of the heart occurs to the belly instead especially after heavy meals). Blockage of blood vessels to the legs causes pain upon walking which resolves quickly at rest. Blockage of the blood vessels to the kidneys however is quite silent, but causes loss of the ability to get rid of our own waste products, and an increase in a chemical that raises the blood pressure.
For diabetes, high blood pressure, and high lipid concentrations, isn't it interesting that each one can also be worsened by weight gain or weight above the ideal, and each one can be made better by weight loss? As weight and especially total body fat increases, the human being becomes more resistant to the effect of insulin. Insulin resistance is one of the known reasons for high blood pressure. This same resistance to insulin (the hormone that helps us metabolize sugar) causes what is now called "metabolic syndrome". Initially we have trouble breaking down the fat in our body and triglycerides increase, and eventually the diagnosis of type 2 diabetes is made when the pancreas (the organ that produces insulin) can no longer keep up with the demand for insulin.
I am often told in the office that someone can't lose weight and am asked about diets. In another column I will go over some of the recommendations. The reason however that there are so many diets available is that one size doesn't fit all. If you ask doctors about what to do for an episode of chest pain (angina), every one of them will pick nitroglycerine. Why? Because it has been proven effective for most patients (for many decades), and patients will take it as needed. This is not true of most diets.
Please keep in mind that this blog is for discussion purposes only and one should always discuss diagnoses and treatment with their individual provider.
Weight loss and maintaining a healthy weight are important ways to decrease your chances of developing high blood pressure, heart disease and diabetes.