Dr Jitendra Singh
The primary focus of Diabetes management in 21st century is the protection of target organs is like heart, kidney and eyes. While strict control of Blood sugar is the basic prerequisite for success of any preventive strategy, the importance of simultaneous aggressive treatment of co-morbidities or co-afflictions like hypertension or high blood pressure is being increasingly realized.
High blood sugar and high blood pressure together constitute a double assault and, therefore, strict control of blood pressure in a diabetic individual reduces the risk of diabetic damage to heart, eyes and kidneys.
Lower Blood Pressure Targets
That the hypertension or high blood pressure increases the risk for developing microvascular as well as macrovascular disease affecting various organs has been well documented over the years by a number of widely published studies from authentic sources across the globe. There is also enough evidence that both the prevalence and severity of effect on organs is markedly reduced by medical interventions aimed at lowering the blood pressure.
The recommended target levels of blood pressure to be achieved in a Diabetic are much lower than those in case of a non-diabetic. This means that in case of Diabetic, the lower the blood pressure the better it is for the overall long-term outcomes. In other words, if, for example, the treatment of hypertension in a non-diabetic aims at bringing down the levels below 140/90 or 135/85 mm Hg, in case of a Diabetic the aim should be to bring down the level to the range of 130/80 mm Hg or preferably 120/80 mm Hg. A treatment strategy that targets a blood pressure level of 120/80 mm Hg is found to significantly reduce the incidence and progression of diabetic retinopathy affecting the eye, diabetic nephropathy affecting the kidney and the Diabetes related heart disease.
Early Antihypertensive Treatment Recommended
High blood pressure is detrimental to each aspect of diabetic retinopathy and therefore a tight BP control policy helps reduce the risk of clinical complications of diabetic eye disease. Same is true also in the context of diabetic nephropathy and other diabetic vascular complications. Antihypertensive treatment beginning early in the course of Diabetes Mellitus is recommended by a number of documented reports including the worldwide acknowledged UKPDS data.
Hypertension or high BP in the presence of Diabetes constitutes a double assault on target organs in human body. Tight control of blood pressure right from the beginning is recommended preferably using drugs like ACEIs and ARBs which also have an additional preventive effect against diabetic complications.
It is finally the responsibility of medical professionals particularly Diabetologists and physicians to educate the diabetes affected individuals under their care about the benefits of blood pressure control in reducing the chances of loss of vision or kidney failure or heart attack. Also, the diabetic individuals need to be emphatically counselled regarding the importance of routine monitoring of blood pressure in addition to periodic screening for the status of eyes, heart and kidneys.
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