Why Patients With Hypertension Should Be Screened for Type 2 Diabetes

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People with High Blood Pressure Should Be Screened for Diabetes

The United States Preventive Services Task Force recommends that people who have sustained blood pressure greater than 135/80 mm Hg, whether or not they have been treated for hypertension, should undergo screening for type 2 diabetes mellitus, which is sometimes known as “adult-onset diabetes.” The rationale for this recommendation is evidence that shows people with hypertension who do not yet have symptoms of diabetes benefit from the initiation of measures to prevent coronary heart disease if they are discovered to have diabetes.

High blood pressure, which is defined as blood pressure greater than or equal to 140/90 mm Hg, is a very common condition in people who have diabetes. Between 20 and 60 percent of patients with diabetes will also have high blood pressure. High blood pressure is often part of a syndrome known as “metabolic syndrome,” which includes resistance to insulin, cholesterol disorders, and central obesity.  

The available evidence suggests that all adults with high blood pressure readings that are consistently greater than 135/80 mm Hg benefit from tighter control of risk factors associated with diabetes for prevention of coronary heart disease.

People who have diabetes are at greater risk of bad outcomes from coronary heart disease, and people with diabetes benefit from strict management of other risk factors. The American Diabetes Association and many experts recommend that people who have diabetes should try to maintain lower blood pressure targets to reduce their risk of heart attacks and strokes.  

Studies show that people with diabetes who have blood pressures greater than 120/70 mm Hg have a higher rate of cardiovascular events, like heart attack and stroke. Blood pressures greater than 120/70 mm Hg in people with diabetes is also associated with increased mortality. Most experts recommend that people with diabetes try to keep their blood pressure lower than 130/80 mm Hg.

Experts recommend that lifestyle changes should be added to medication therapy when people with diabetes try to reduce their blood pressure. These changes include reduction of salt intake, weight loss, and moderately intense physical activity, like brisk walking for 30 to 45 minutes most days of the week. 

A study in 2002 found that 19.3 million American adults had diabetes, and it is estimated that a third of these adults are undiagnosed. Risk factors for diabetes include advancing age, obesity or being overweight, a family history of type 2 diabetes, and being a member of a minority population at increased risk. African-Americans, Hispanics, Pacific Islanders, American Indians, Alaska natives, and Asians are at higher risk for type 2 diabetes. 

It is estimated that an additional 26% of the US adult population has “pre-diabetes,” and modification of some risk factors, like weight or sedentary lifestyle, may help these adults avoid development of diabetes. The American Diabetes Association recommends that people have a fasting plasma glucose test for an initial screening test. A positive test is determined by a level of blood glucose of greater than 126 mg/dL. If you have a positive fasting glucose test, your doctor may want to confirm it on a separate day with a repeat test. If your test results are “borderline,” you may also want to have the test repeated on a separate occasion.

There are several different screening tests to determine if you are at risk of diabetes or if you have diabetes. Each test has different advantages and disadvantages. 

If you have hypertension, your doctor should screen you for glucose intolerance or type 2 diabetes. There is adequate evidence that people with blood pressure above 135/80 mm Hg who have diabetes discovered through a screening program will benefit from the strict blood pressure control strategies indicated for diabetic patients to reduce coronary heart disease.

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