The Hypertension–Diabetes Continuum

Abstract

Hypertension and type 2 diabetes are both common chronic conditions that affect a major proportion of the general population. They tend to occur in the same individual, suggesting common predisposing factors, which can be genetic or environmental. Although the genes causing hypertension or diabetes await elucidation, the environmental causes of these diseases are well known. Obesity and physical activity are the 2 leading factors that predispose to both diseases. Individuals with abdominal obesity are likely to develop lipid abnormalities and elevation of blood pressure and glucose. In time, hypertension and diabetes ensue. Because of the shared etiology, there is substantial overlap between hypertension and diabetes. In the Hong Kong Cardiovascular Risk Factor Prevalence Study, 40% of the subjects in the community had either raised blood pressure or raised blood glucose. Only 42% of people with diabetes had normal blood pressure and only 56% of people with hypertension had normal glucose tolerance. The presence of hypertension or diabetes should alert the clinician to the possibility of the other condition. Obesity, lipid abnormalities, raised blood pressure, and glucose are all components of the metabolic syndrome. The syndrome therefore implies a pathologic process, which is potentially reversible in the early stages. Previous efforts targeting smoking, hypertension, and hypercholesterolemia have started to bear fruit. However, obesity is on the increase in developed and developing countries. It is now time to focus on obesity and the metabolic syndrome, which require more a public health than a pharmacologic approach.

High prevalence of hypertension among an ethnic group in Sudan: implications for prevention

“…The association obesity and high BP is well documented in the literature. 17,[25][26][27] Despite the well-documented association between diabetes and hypertension in literature, diabetes was not found to be associated with hypertension in this particular study. This may be attributed, in part, to the low prevalence of diabetes among participants; a fact that in turn be explained by the significant physical activity observed in individuals of this tribe.…”

Undiagnosed hypertension in a rural community in Sudan and association with some features of the metabolic syndrome: how serious is the situation?

“…This suggests either shared genetic or environmental factors in the etiology. 29,30 This implies that screening for hypertension needs to be targeted at diabetic patients.…”

Blood pressure monitoring in psychiatric inpatients with bipolar affective disorder

“…44,45 Diabetes and hypertension commonly co-occur and share aetiological factors such as obesity and physical inactivity, with the estimated prevalence of hypertension in diabetes being between 30-80%. [46][47][48] In hypertensive patients, the presence of the metabolic syndrome, a cluster of cardiovascular risk factors, exacerbates cardiovascular risk, further worsening prognosis. 49,50 The majority of our audited acute inpatient population was prescribed psychotropic medicines, often in combination.…”