PREVALENCE OF HYPERTENSION AMONG PATIENTS

WITH DIABETES MELLITUS

Abstract
Type 2 Diabetes mellitus (DM) and Hypertension (HT) are most
common among the non communicable chronic diseases in developed
and developing countries around the world. This study reports the
prevalence of hypertension among diabetic patients.

Methods
Individuals of both sexes with diabetes were selected and asked for
history of hypertension and screened for hypertension.

Introduction
Diabetes mellitus and hypertension are common diseases that
coexist at a greater frequency than chance alone would predict.
Hypertension in the diabetic individual markedly increases the risk and
accelerates the course of cardiac disease, PVD, stroke, retinopathy,
nephropathy. Diabetic nephropathy is an important factor involved in
the development of hypertension in diabetics, particularly type 1
patients. However the etiology of HT in the majority of diabetic patients
cannot be explained by underlying renal disease and remains essential
in nature. The hallmark of hypertension in type 1 and type 2 diabetics
appears to be increased peripheral vascular resistance. There is
increasing evidence that insulin resistance / hyperinsulinemia may play
a key role in the pathogenesis of hypertension in both subtle and overt
abnormalities of carbohydrate metabolism. The goal of anti
hypertensive therapy in the patient with coexistent diabetes is to
reduce the cardiovascular risk as well as lowering blood pressure.

It has been estimated that 35-75% of diabetic complications can be

attributed to hypertension. In contrast, the absence of hypertension is
the usual finding in long term survivors of diabetes.

DM is a chronic disease increasing in explosive pattern in India. It

continues to increase in numbers and significance, as changing lifestyles
lead to reduced physical activity, and increased obesity.DM is a disease
of insidious onset and the symptoms ,when they eventually appear do
not warrant immediate attention and thus remain undiagnosed at
onset and even when diagnosed is often ignored by persons afflicted by
it. Anticipating an epidemic like increase in the number of diabetic
patients India has been christened as the ‘diabetic capital of the world’.
A patient who suffers from type 2 DM has a 2-4 times greater risk of
death from cardiovascular causes than the patient without DM. The
most common cause of death in the diabetic patient is heart disease. In
addition ,PVD, ESRD, blindness and amputation are common co-
morbidities in diabetic patients.
 Similarly, HT is considered to be one of the most common cause of
morbidity and mortality affecting mankind. The prevalence of HT
rapidly increasing in developing countries. Genetic and environmental
factors also play a key role in HT,90% of which are classified as
idiopathic.

Several studies conducted in different ethnic groups show a close

association between HT & DM, where the prevalence of Hypertension
is significantly higher in the patients with non insulin dependant DM.
Both systolic and diastolic HT has been reported, and conclusive
evidence indicates that the link between DM and essential HT is
hyperinsulinemia. The prevalence of HT is 1.5-2 times more in those
with DM than in those without DM, whereas almost one third of the
patients with HT develop DM later.

The presence of HT in diabetic patients substantially increases

the risks of coronary heart disease, stroke, nephropathy and
retinopathy. when HT coexists with DM, the risk of CVD is increased
by75%,which further contributes to the overall morbidity and mortality
of already high risk population. Generally HT in type 2 diabetic patients
clusters with other CVD risk factors such as micro albuminuria, central
obesity, insulin resistance, dyslipidemia, hypercoagulation, increased
inflammation and left ventricular hypertrophy.DM and HT are
interrelated diseases that strongly predispose people to atherosclerotic
cardiovascular disease, and hence have been referred to as the bad
companions.

RESULTS
 Total 30 patients with Dm were taken for this study. Among 30
patients 19 were male and 11 were female patients. Among 30 DM
patients 14 were hypertensive, this constitutes 46.6% of diabetic
patients. Among 19 male patients 9 were hypertensive this constitutes
47.36%.among 11 female patients 5 were hypertensive, this constitutes
45.45%

Several studies show close association between DM and HT. The

occurrence of HT in diabetic patients increases significantly the risk of
coronary artery disease, mortality and nephropathy. Its of significance
that BP is controlled in diabetic patients. High blood pressure in
diabetics hints at syndrome X or the metabolic syndrome which
includes HT, hyperglycemia, obesity and hyperlipidemia. Physiological
maneuvers such as calorie and salt restriction and regular physical
exercise, are shown to improve tissue sensitivity to insulin and hence
lower blood pressure both in normotensive and hypertensive diabetics.
Hence control of DM and HT by appropriate methods, particularly
dietary restriction of calories and sodium, and regular physical exercise,
must be highlighted in order to decrease both the prevalence of HT and
DM.

CONCLUSION
Increasing investigation should focus on identifying appropriate
antihypertensive agents that not only lower blood pressure but also
reduce cardiovascular risk and retard the rate of progression of diabetic
renal disease. In light of recent proposals that ACE inhibitors and
possibly calcium antagonists may be advantageous in conferring renal
protection in diabetic nephropathy.
 PREVALENCE OF HYPERTENSION AMONG PATIENTS
WITH TYPE 2 DIABETES MELLITUS

Submitted in partial fulfillment of IMACGP FCD course

December 2017.

Dr.N.RAJAKUMARI, MBBS.,MD.,
 BONAFIDE CERTIFICATE

I Dr.N.Rajakumari certify that the data submitted by me

is my original work generated from my patients.I am solely
responsible for any issue arising out of the work.

Signature of the candidate signature of the examiner

 ACKNOWLEDGEMENT

I am extremely thankful to Dr.Parthiban, M.Sc.,Ph.D.,

IMACGP Diabetology course coordinator for his constant
guidance throughout the program.

I am extremely grateful to all my teachers

Dr.R.Aruyerchelvan, M.D.,D.Diab,Erode, Dr.N.Bhavatharini,
MBBS.,D.Diab, Erode, Dr.R.Ramesh,MS(Gen Surgery), Lalgudi,
who have imparted the knowledge towards the better
understanding of this subject. This has enabled me in
completing this project.

My special thanks to my husband Dr.K.Krishnamoorthy,

MD., DM (Neurology)., and to my daughter K.R.Lakshana for
supporting me in this project.