In the article, we will consider the most effective drugs for pressure in diabetes mellitus.
Hypertension is an increase in blood pressure, in which medical manipulations will bring the patient much more benefit than unwanted side effects. Blood pressure readings of 140/90 or more should be treated because hypertension greatly increases the risk of blindness, kidney failure, stroke, and heart attack. In type 1 and type 2 diabetes, the acceptable blood pressure limit is reduced to 130/85 mm Hg. Art. If the pressure is higher, you need to make every effort to lower it.
Hypertension is very dangerous in both types of diabetes. This is due to the fact that the combination of diabetes with high blood pressure increases the likelihood of heart attack, blindness, stroke, kidney failure, leg amputation.and gangrene. High blood pressure at the same time is not so difficult to normalize, unless the kidney pathology has gone too far.
Diabetes blood pressure pills are commercially available in large quantities.
Why does diabetes develop hypertension
In both types of pathology, the causes of arterial hypertension may differ. Type 1 - in 80% of cases, hypertension develops due to kidney damage (diabetic nephropathy). In the second type of diabetes, hypertension most often develops in a patient much earlier compared to disorders of carbohydrate metabolism and diabetes itself. One element of the metabolic syndrome (a precursor to type 2 diabetes) is hypertension or high blood pressure.
Type 1 diabetes - the causes of hypertension are as follows (sorted by frequency): diabetic nephropathy (kidney pathology); primary (essential) hypertension; systolic isolated hypertension, other endocrine diseases.
Type 2 diabetes - primary (essential) hypertension; systolic isolated hypertension; diabetic nephropathy, hypertension due to defects in the patency of the renal vessels; other endocrine disease.
Notes. Systolic isolated hypertension is a specific pathology of the elderly. Other endocrine diseases may include Cushing's syndrome, pheochromocytoma, primary hyperaldosteronism, or other rare diseases. Essential hypertension is a condition where the doctor cannot determine whyblood pressure rises. When hypertension is combined with obesity, the cause is most likely the patient's intolerance to dietary carbohydrates, as well as a large amount of insulin in the blood. This is called "metabolic syndrome", which is well treated. In addition, there may be chronic psychological stress, lack of magnesium in the body, intoxication with cadmium, lead or mercury, narrowing of a large artery due to atherosclerosis.
High blood pressure in type 1 diabetes
The main and very dangerous cause of high blood pressure in type 1 diabetes is kidney dysfunction, which includes diabetic nephropathy. This complication occurs in 35-40% of patients with diabetes mellitus and has several stages: microalbuminuria (small molecules of a protein such as albumin appear in urine); proteinuria (kidney filtration is getting worse, large proteins appear in the urine; chronic kidney failure.
Among type 1 diabetic patients without kidney disease, ten percent are affected. In patients with microalbuminuria, this value rises to twenty percent, with proteinuria - up to 50-70%, with chronic kidney failure - up to 70-100%. Blood pressure also depends on the amount of protein excreted in the urine: the more it is, the higher the patient's performance.
When the kidneys are affected, hypertension occurs due to poor excretion of sodium in the urine by the kidneys. There is more sodium in the blood, fluid accumulates,to dilute it. Excessive circulating blood makes blood pressure higher. If glucose levels rise in the blood due to diabetes, then it attracts even more fluid so that the blood does not thicken too much. The volume of circulating blood is thus further increased.
Kidney disease and hypertension thus form a vicious circle that is dangerous for the patient. The body tries to compensate for the insufficient functioning of the kidneys, and blood pressure therefore rises. It, in turn, increases intraglomerular pressure. This is the name of the filter elements in the kidneys. As a result, the glomeruli gradually die off, the kidneys function worse and worse. This process ends in kidney failure. However, in the early stages of diabetic nephropathy, this vicious circle can be broken if the patient is treated in a timely manner. It is important to know which blood pressure pills to take for diabetes.
The main thing is to bring the sugar content to the norm. Drugs such as diuretics, angiotensin receptor blockers, and ACE inhibitors also help.
Hypertension in type 2 diabetes
Long before the appearance of true diabetes, that is, the second type, the pathological process originates with insulin resistance, which means reduced tissue sensitivity to the effects of insulin. To compensate for insulin resistance, a very large amount of insulin circulates in the blood, and therefore blood pressure rises. With timethe lumen of the vessels decreases due to atherosclerosis, which becomes another significant contribution to the appearance of hypertension. At the same time, the patient has increased abdominal obesity (near the waist). It has been established that adipose tissue secretes substances into the blood that additionally increase blood pressure. Pills for pressure in type 2 diabetes should be selected by a doctor.
This complex is called the metabolic syndrome. Thus, hypertension occurs much earlier than type 2 diabetes. It is often found in the patient immediately after the diagnosis is made. However, a low-carbohydrate diet is good for controlling both disease and hypertension. Elevated levels of insulin in the blood is called hyperinsulinism. It occurs as a reaction to insulin resistance.
Prescriptions for blood pressure in type 2 diabetes are quite expensive.
When the pancreas is forced to produce an excessive amount of insulin, it wears out a lot. Over time, she can no longer cope, and there is an increase in blood sugar, the patient develops type 2 diabetes. How does blood pressure rise due to hyperinsulinism? It first activates the sympathetic nervous system; because of the kidneys, liquid and sodium are worse excreted with urine; calcium and sodium accumulate in cells, an excessive amount of insulin thickens the vascular walls, and for this reason their elasticity decreases. Treatment of pressure in diabetes should be comprehensive.
Specificity of hypertensive manifestations in diabetes
The natural rhythm of pressure fluctuations during the day is disturbed in diabetes mellitus. In a normal person, in the morning and at night, during sleep, blood pressure decreases from 10 to 20% compared to daytime levels. Diabetes becomes the reason that at night the pressure in many hypertensive patients does not decrease. Moreover, when diabetes and hypertension are combined, the pressure at night is often higher than during the day. The defect is also thought to be due to diabetic neuropathy.
Excessive blood sugar disrupts the autonomic nervous system that regulates the life of the human body. Because of this, the ability of blood vessels to regulate their tone worsens, that is, relaxation and narrowing, depending on the load. Thus, with simultaneous diabetes and hypertension, not only one-time measurements of pressure indicators are needed, but also daily monitoring. It is carried out using a special device. The result of this study is to adjust the dosage of tablets that reduce blood pressure in diabetes and the time of administration.
In practice, it is seen that in patients of the first and second type, increased sensitivity to s alt is most often noted compared to hypertensive patients without diabetes, which means that a strong therapeutic effect can be provided by limiting s alt in their diet. To treat high blood pressure in diabetes, you need to try to eat less s alt and evaluate the result in a month. All this is complicated by orthostatic hypotension. This means that the patient's blood pressuredecreases sharply when he changes position.
Orthostatic hypotension is observed after a person stood up abruptly, in the form of darkening in the eyes, dizziness or fainting. This problem, like a defect in the circadian rhythm of pressure, appears due to the occurrence of diabetic neuropathy. The human nervous system gradually loses the ability to control vascular tone. If the patient gets up quickly, then there is a sudden increase in load. However, the body does not have time to increase blood flow, and the state of he alth worsens because of this. Orthostatic hypotension complicates the diagnosis and treatment of high blood pressure. With diabetes, blood pressure should be measured in two positions - both lying and standing. If the patient has such a complication, he needs to get up all the time "by feeling", slowly. In this case, blood pressure pills for diabetes can also help.
Description of antihypertensive drugs
The drug must meet the following criteria:
- It's good to relieve pressure. In this case, complications occur at a minimum.
- Implementation to protect the kidneys and heart from the negative effects of high blood pressure.
- Should not affect lipid and carbohydrate metabolism.
How to choose the right pills for high blood pressure in diabetes?
Hypertension drugs
There are several types of drugs that reduce high blood pressure and are successfully used inhypertension therapy: calcium blockers, ACE inhibitors, diuretics, beta-blockers, vasodilators, selective alpha-blockers, angiotensin receptor antagonists.
It should be noted that the specialist prescribes an individual treatment course for each patient. Incorrect combination of drugs can cause death. It is strictly forbidden to self-medicate.
Use of ACE inhibitors
The most effective blood pressure pills for diabetes and hypertension are angiotensin-converting enzyme blockers. The pharmacological effect is aimed at reducing pressure indicators, eliminating the development of heart failure, reducing the tension of cardiac muscle tissue.
Reception is contraindicated in the following conditions:
- lung disease or asthma;
- when a history of kidney failure is established, the drug should be taken with caution, as well as monitor pressure, monitor calcium and creatinine levels in the blood;
- breastfeeding and pregnancy.
This category of drugs causes the development of arterial narrowing in the kidneys, and therefore they should be prescribed with caution in patients with a history of atherosclerosis.
It is important to know that when using ACE inhibitors, it is desirable to limit s alt intake. Dosage during the day - no more than three grams.
Most commonpressure tablets for diabetes are the following: "Berlipril"; "Enalapril"; "Captopril". The last medication in pill form is an emergency for emergencies when blood pressure suddenly rises.
Calcium antagonists in diabetic patients
Calcium channel blockers are long-term effective, may affect hypertension, but there are a number of contraindications. Subdivided into these types: non-dihydropyridines and dihydropyridines.
The most important pathology is the change in calcium metabolism due to magnesium deficiency. The mechanism of action of the drug is aimed at reducing the penetration of calcium into the muscle heart cells, vascular walls, thus preventing the occurrence of spasms. Better blood flow to important organs.
Contraindications for these drugs are as follows: development of heart failure; the presence of angina pectoris in the history of the disease; stroke in the acute phase; hyperkalemia.
The following medicines of this series are prescribed: Diltiazem, Verapamil, Felodipine, Nifedipine. Patients with diabetic nephropathy are prescribed "Verapamil", which protects the kidneys from the negative effects of high sugar content. It is necessary to drink in a complex, along with ACE inhibitors.
What other pills for high blood pressure in diabetes can help?
Indispensable helpers - diuretics
Increase in the amount of sodium, as well as the accumulation of water in the body, causes an increase in the volume of circulating blood, and this becomes an important factor that provokesarterial pressure. Patients with elevated sugar levels are sensitive to s alt, which worsens the situation significantly. Diuretics are a good way to combat this problem.
There is the following classification of diuretics:
- thiazide - they have such side effects as a negative effect on cholesterol and sugar levels, inhibition of renal activity;
- osmotic - can provoke hyperosmolar coma;
- potassium sparing - cannot be used in kidney failure;
- loop - if these pills are taken irresponsibly, cardiac arrhythmia and hypokalemia can occur;
- carbonic anhydrase inhibitors - the negative feature is a small targeted effect, due to which the desired result will not be obtained.
Among all diuretics, taking into account side effects, it is advised to take loop drugs that reduce blood pressure in diabetes. Their action is concentrated on enhancing the quality of renal activity. They are prescribed to eliminate edema, they perfectly combine with ACE inhibitors. Since the negative point is the excretion of potassium from the body, it is necessary, along with the use, to replenish the content of this element through additional medicines.
The best loop drugs are as follows: Bufenox, Torasemide, Furosemide.
Treatment with diuretics alone is ineffective, other antihypertensive medications are required.
There are other effective pillsfrom high blood pressure in diabetes.
Using beta-blockers
In ischemic and hypertensive heart disease and arrhythmia, beta-blockers are indispensable drugs, which distinguish these drugs into three groups:
- Non-selective and selective - affect pancreatic cells, reducing the rate of insulin production. Good effect on the activity of the heart, increasing the risk of type 2 diabetes.
- Hydrophilic and lipophilic - cannot be used in diabetes, as they stimulate liver pathologies and disrupt lipid metabolism.
- Dilating vessels - have a positive effect on lipid-carbohydrate metabolism, but they have many side effects.
Safe remedies for hypertension in type 2 diabetes are allocated: Corvitol, Bisoprolol, Nebivolol.
Pharmacological influence is aimed at increasing tissue susceptibility to the hormone, as well as the progress of metabolic processes.
It is important to know that beta-blockers mask the symptoms of potassium deficiency, which is why they are prescribed under the supervision of a specialist.
Which drugs for pressure in diabetes, it is quite difficult to decide on your own.
Selective alpha-blockers
The advantage of these drugs lies in the direction of influence on the reduction of lesions of the endings of the nerves and their fibers. They are characterized by a combined effect: they are antispasmodic, vasodilator and hypotensive agents. Besides,tissue vulnerability to insulin is stimulated, sugar levels are suppressed, and this is necessary for type 2 diabetes.
The disadvantage of these remedies for pressure in diabetes is the possibility of the following conditions:
- puffiness;
- orthostatic hypotension - may occur in a patient with diabetes mellitus;
- appearance of persistent tachycardia.
It is very important to know that the use of alpha-blockers in heart failure is strictly prohibited.
For long-term therapy, the following drugs are used: Terazosin, Doxazosin and Prazosin.
Angiotensin receptor antagonists as a replacement for ACE inhibitors
These are drugs to reduce blood pressure in diabetes with minimal side effects and a beneficial effect on the body. Eliminate left ventricular hypertrophy, prevent myocardial infarction, kidney failure, and reduce the likelihood of stroke.
The best funds from this group: Losartan, Telmisartan, Candesartan.
During treatment, blood pressure, potassium and creatinine levels should be monitored.
There are quite a lot of drugs for pressure in diabetes on the pharmaceutical market. However, self-medication is not necessary to avoid negative consequences. Only qualified diagnostics and individually selected treatment will help to achieve the desired effect.
