The million dollar question in diabetes mellitus is how to prevent or at least minimize organ damage, even as blood sugar is controlled as meticulously as possible. While the intricacies of the forces that lead to organ damage in DM are being increasingly unravelled, there is no rule of the thumb to go by, so one is left to controlling as many parameters as physically possible and therein comes the role of tight BP control.
Extremely high blood pressure, not just diabetes, may be responsible for severe organ damage due to hypertensive emergencies in patients with diabetes, a new study suggests. The study, which was the largest of its kind, included 783 diabetic and 1,001 non-diabetic patients from a New Jersey hospital emergency department.
It is the first study to look at the risk factors and prevalence dramatic increases in blood pressure in a population largely affected by complications of high blood pressure. “Combined with the fact that diabetics with hypertensive emergency also had significantly higher levels of blood pressure, this suggests that the occurrence of severe damage to vital organs is not because of just diabetes but because of the accompanying severely elevated blood pressure,” she added. Benenson indicates that hypertensive emergencies are associated with life-threatening damage to the brain, heart, and kidneys. She says the risk of hypertensive emergencies in diabetics was significantly higher in those with cardiovascular conditions, kidney disease, and anemia.
Diabetic patients with hypertensive emergencies were compared with non-diabetic patients based on important demographic and clinical characteristics. In analyzing data, researchers found that patients with diabetes accounted for 52.27% of all hypertensive emergencies during the study period. There were 264 diabetic patients with hypertensive emergencies and 519 diabetic patients with hypertensive urgencies. The majority of patients were African Americans (88.6%).
Researchers found the odds of hypertensive emergencies were strikingly higher in diabetic patients with hyperlipidemia, coronary artery disease, congestive heart failure, renal insufficiency, and low hemoglobin. Acute or worsening heart failure was the most frequent acute target organ injury followed by myocardial infarction. Diabetic and non-diabetic patients had similar rates of target organ injuries.
The researchers conclude the development of hypertensive emergencies in patients with diabetes was not because of diabetes per se but because of coexisting highly elevated blood pressure. Tight blood pressure control may decrease the risk of hypertensive emergencies in this patient population.
“Given the fact that the presence of severely elevated blood pressure is the strongest driver of damage to vital organs in individuals with diabetes, the most important intervention for preventing hypertensive emergencies would be to better manage patients’ blood pressure,” said Benenson
(Clinical and Experimental Hypertension, 25 October 2018)