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‍Hypertension and Diabetes mellitus are two conditions that are considered to be major risk factors for cardiovascular disease, including heart attacks, stroke and peripheral vascular disease. Hypertension is a condition associated with elevated blood pressures in the body while diabetes mellitus is characterized by uncontrolled blood glucose levels. Indeed, when found together they seem to act synergistically causing additional damage to the essential body organs including the brain, heart, kidneys and liver. The co-existence of diabetes mellitus and hypertension has been noted to confer a two to four times higher risk of cardiovascular disease, end-stage kidney disease and death, when compared to adults with normal blood pressure and no diabetes [1]. Hypertension is diagnosed based on multiple elevated blood pressure measurements taken over several visits, while diabetes mellitus can be checked for using blood tests including a random blood glucose level, fasting blood glucose level and HbA1c (glycated glucose).

Per the Centers for Disease Control and Prevention (CDC), nearly half of the adults in the United States have hypertension, and only 1 in 4 of those with hypertension have it under control [2]. Around 14.7% of US adults are thought to have diabetes, including diagnosed and undiagnosed [3]. One of the main reasons why some patients underestimate the importance of treatment compliance to control those diseases is that these diseases may not cause problems right away but the damage to the body manifests in the long run and may be irreversible. The longer the body is exposed to elevated blood pressure and high blood glucose levels, the harder it has to work to adapt to those abnormal conditions, which may eventually result in dysfunction and ultimately organ failure.

Thanks to the advancements in healthcare, we have come a long way in understanding those conditions and developing diagnostics and treatment modalities. Management often starts from making lifestyle modifications such as regular vigorous exercise, healthy eating which may include salt restriction in hypertension and carbohydrate restriction in diabetes, avoiding habits that further increase risk of cardiovascular disease such as smoking, as well as appropriate management of other comorbidities. It is important you discuss treatment options including different medications with your primary care physician, so you can collectively determine the best option for you in the context of your preferences and health profile.

Monitoring your health conditions will be important to assess treatment response and determine any adjustments necessary to your medication(s). Your hypertension can be monitored using a home blood pressure monitor, while your diabetes can be monitored using a glucometer, in addition to several new devices on the market that allow measuring your blood glucose with less poking. Your primary care physician will likely ask you to keep a log of your blood pressure and blood glucose readings for them to review when assessing treatment response and needed adjustments. SmartBP and Glucobyte are phone apps that assist you in tracking your progress and keeping logs for you to share with your provider. In the end, as tempting as it may be to skip the medication or not measure your blood pressure or blood glucose regularly, it is quite likely compliance with treatment will pay off in the long run when it comes to hypertension and diabetes and help reduce the risk of complications associated with those chronic conditions.

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References

1. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet. 2012;380(9841):601-610. doi:10.1016/S0140-6736(12)60987-8
2. Centers for Disease Control and Prevention. Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among U.S. Adults Aged 18 Years and Older Applying the Criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES  2015–2018 external icon. Atlanta, GA: U.S. Department of Health and Human Services; 2021.
3. Centers for Disease Control and Prevention. National Diabetes Statistics Report website. https://www.cdc.gov/diabetes/data/statistics-report/index.html.

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