Dr Aidin Rawshani

High blood pressure (hypertension) and diabetes

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High blood pressure (hypertension) in diabetes mellitus

What is blood pressure?

Blood pressure is the pressure in the vessels of the body (arteries) and it is described by two values. The highest value — systolic pressure — is the maximum pressure in the vessels when the heart pumps. The lower value — diastolic pressure — indicates the pressure in the vessels between the heartbeats. A systolic pressure below 120 and a diastolic pressure below 80 is normal. When you enter the blood pressure, you first write the systolic pressure and then the diastolic, with a slash between. Thus, blood pressure 120/80 means systolic pressure of 120 and diastolic pressure of 80. In everyday language, most often say “overpressure” instead of systolic pressure and “suppression” instead of diastolic pressure. Blood pressure is measured in the unit mmHg, which is an abbreviation for millimeters of mercury.

What is hypertension (hypertension)?

High blood pressure and hypertension are the same things. You have high blood pressure if your blood pressure is higher than normal. Hypertension (high blood pressure) affects 10 -25% of all adults and is a major risk factor for coronary heart disease, heart attack, stroke, kidney disease and vascular disease of the legs. The fact is that hypertension is probably one of the most important causes of death in the world. This is very sad because it is quite easy to treat high blood pressure.

Why is it important to measure their blood pressure?

Hypertension is one of the absolutely most common and most important risk factors for cardiovascular disease. High blood pressure is the most common risk factor for heart attack, stroke, heart failure, atrial fibrillation and a number of other cardiovascular diseases. All people in the population should control their blood pressure and this should be done every year. If you have diabetes, it is especially important to be careful about blood pressure as high blood pressure increases the risk of diabetic complications.

Both people with type 1 diabetes and type 2 diabetes suffer from high blood pressure. Having both diabetes and high blood pressure significantly increases the risk of complications. Therefore, you who have diabetes should ensure that your blood pressure is controlled every year and that you receive treatment so that the pressure is below the target value. Target value means the blood pressure level you should stay below.

How to measure blood pressure?

You can measure blood pressure at the health center or where you have health contact. It is fast to measure blood pressure. The blood pressure measured in the medical center and the medical clinic is very high precision because the staff has experience measuring blood pressure. However, today you can buy automatic tonometers in trade. An example of such a tonometer is seen here below. They are very easy to use; you attach the cuff to the upper arm and press the start. It is important that the cuff is at the same height as the heart and one should ideally lie down and rest 5 minutes before the pressure is taken.

Automatic sphygmomanometer. These are available for purchase at pharmacies. Measurement precision is usually high. The diastolic pressure is shown as “DIA” and the systolic pressure is shown as “SYS”.

What are the symptoms of hypertension?

There are no symptoms of high blood pressure unless complications have arisen. It is important to detect high blood pressure in time to prevent the emergence of complications. People with hypertension are often other risk factors for cardiovascular disease. These include, for example, overweight/abdominal obesity, elevated blood lipids, and diabetes.

Where does the limit of hypertension go?

Optimal blood pressure: 120 systolic and 80 diastolic.Normal blood pressure: 120—129 systolic and 80—84 diastolic.High normal blood pressure: 130—139 systolic and 85—89 diastolic.Hypertension (abnormally high blood pressure) Grade 1:140—159 systolic, 90—99 diastolic.Hypertension (abnormally high blood pressure) Grade 2:160-179 systolic, 100-109 diastolic.Hypertensive crisis (requires emergency medical care): 180 systolic and 110 diastolic.

To get the diagnosis of hypertension

Blood pressure can vary greatly depending on what you do. When changing body position, straining or exercising, the blood pressure changes to adapt to the needs of the body. When properly conducted blood pressure measurement, blood pressure should be lower than 120 mm Hg systolic and lower than 80 mm Hg diastolic.

One has high blood pressure if systolic blood pressure is higher than 139 mm Hg or diastolic pressure is higher than 89 mm Hg. To be sure that you have high blood pressure, the pressure should be measured another 3 times within a month. If further measurements show that the pressure is 140/90 or higher, then most likely you have hypertension and then you should consult your doctor.

High systolic blood pressure is probably the strongest risk factor

Diastolic blood pressure rises during the course of life until the age of 55, after which it gradually drops. Systolic blood pressure constantly rises throughout life. Therefore, elderly people may have normal diastolic blood pressure but high systolic blood pressure. Therefore, systolic blood pressure is considered the most useful risk marker.

Who should examine their blood pressure?

Blood pressure can be examined starting from the age of 20 years. Even healthy individuals should be controlled their blood pressure because high blood pressure is very common and usually does not cause any symptoms.

What to consider when measuring blood pressure

You should refrain from caffeine and smoking as well as snuff no later than 30 minutes before measuring your blood pressure. You shall sit in a comfortable chair with your arms hanging down. After 5 minutes of rest in the chair, the pressure can be measured. The blood pressure cuff should be placed at the level of the heart (i.e. at chest level). Blood pressure is calculated as the average of two measurements made every 1 minute.

How can I lower my blood pressure?

A healthier diet, increased exercise, better lifestyles and weight loss are the cornerstones of the treatment of hypertension. Even minor reductions in blood pressure (reduction of 3-5 mm Hg) result in significant health benefits through a reduced risk of cardiovascular disease. Drug treatment can be recommended to everyone with hypertension unless lifestyle changes lead to normalized blood pressure.

  • Increased physical activity: exercise 30 min 3-7 times per week can lower blood pressure by the order of 4 mm Hg systolic and 3 mm Hg diastolic. Exercise also has other beneficial effects on health.
  • Weight loss (if overweight): If you reduce your body weight by 3 -9%, it may lower your blood pressure by about 3 mmHg systolic and 3 mmHg diastolic. In addition, weight loss has a very good effect on other risk factors such as blood lipids, blood sugar, and vascular function.
  • Diet: There are studies that suggest that increased amounts of fruits, vegetables, and low-fat products can lower blood pressure in the same order of magnitude as exercise. People who consume a lot of salt should reduce their salt intake as this can have a significant effect on blood pressure. Try to eat less than 400 mg of salt per serving.
  • Reduction of alcohol consumption: Reducing alcohol intake among high consumers is associated with a dose-dependent reduction in blood pressure.
  • Stress management: High-stress level is likely to lead to higher blood pressure.
  • Drugs: For diabetic patients, preference should be given to drugs that are ACE inhibitors or ARBs, as these have been shown to be particularly beneficial if you have diabetes. Talk to your caregiver if you have high blood pressure but lack drug treatment.
  • Quit smoking: Smoking gives higher blood pressure. In addition, smoking leads to a plethora of other diseases and problems.

What to consider when measuring blood pressure

The wide blood pressure cuff needs to be adjusted to your arm’s range. A small cuff can give falsely high value and too large cuff can give too low value. Equipment should be calibrated annually so that they do not show error values. The cuff must be at heart height. The arm must be at heart height. Too low levels of the arm can result in too high pressure. Irregular heart rhythm makes it more difficult to measure the pressure because the pulse varies from stroke to blow. The arm must be completely relaxed and the person must sit in a resting position. A tense arm muscle gives false high value. Many especially elderly patients and many years of diabetes have stiff blood vessels (this is called Mönkeberg sclerosis) which gives false high blood pressure and can cause very different blood pressure in their arms. If the person is stressed, has pain, freezes, freshly smoked or drunk coffee This gives this a falsely high value. Blood pressure should not be taken in conjunction with blood sampling (tends to give high value due to stress) Some people get false high values if they visit a healthcare facility and more often pressure when the doctor takes it than when a nurse does it (this is called white coat hypertonia).

Automated/electronic meters are of varying quality and place great demands on technology. They also give incorrect values if blood pressure is very low, very high if the pulse is low or high and in case of irregular heart rhythm. Health care requires that blood pressure be measured manually in order for the value to be used as a basis for treatment or changes in treatment. This means that if you measured high blood pressure with an automatic blood pressure cuff at home, it will be checked manually at the medical center.

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