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Elevated blood pressure in diabetes

In a person with diabetes, blood pressure can rise for the same reasons as in others. Elevated blood pressure is common in type 2 diabetes and in diabetic kidney disease. If blood pressure is consistently elevated, it is referred to as high blood pressure, or hypertension.

Blood pressure means the pressure in an artery caused by the heart contracting and pumping blood into the arteries. Blood pressure comprises of systolic blood pressure and diastolic blood pressure. Systolic pressure represents the working pressure resulting from the heart pumping. Diastolic pressure represents the resting phase of the heart.

Blood pressure varies depending on the time of the day. Temporary fluctuations are both common and normal. Blood pressure increases when you move or become stressed or angry. It decreases at rest. That is why the blood pressure level is determined on the basis of the average morning and evening results over a period of several days.

Your blood pressure is considered high if the systolic pressure is constantly 140 mmHg or higher and the diastolic pressure is 90 mmHg or higher.

Blood pressure is elevated by lifestyle factors such as using a lot of salt or alcohol, smoking, obesity. These may reveal a genetic predisposition for high blood pressure. Other contributing factors may include eating liquorice, anti-inflammatory drugs, hormone products, long-term stress and sleep apnoea, i.e. when your breathing stops temporarily during sleep. On rare occasions, the reason for high blood pressure can also be some other medical condition, for example, a kidney disease unrelated to diabetes or an adrenal gland disease.

In most cases, blood pressure is somewhat increased with age. Elderly persons in particular can have a high systolic blood pressure, even if the diastolic pressure is good. This is the result of blood vessels losing elasticity with age.

Type 1 diabetes as such does not elevate blood pressure. If your blood sugar is very high, it strains the kidneys, which may increase the blood pressure. Over a longer period of time, diabetes itself can also damage the kidneys even if the blood sugar balance is close to normal. This is signified by protein in the urine or the reduced ability of the glomeruli to filter. This often results in an increase in blood pressure.

Person with type 2 diabetes often has a wider metabolic disorder i.e. metabolic syndrome. Elevated and high blood pressure are characteristic of a metabolic syndrome. The reduced effect of insulin on tissues, called insulin resistance, affects the kidneys as well as the walls of blood vessels, increasing blood pressure.

In addition to a doctor’s interview and medical examination the investigation of high blood pressure (i.e. hypertension) includes blood and urine tests. The goal is to rule out other conditions that increase blood pressure, such as diseases of the adrenal gland or kidneys. However, such other treatable diseases are rare. 

The examination is also aimed at risk factors related to cardiovascular diseases.  The initial examinations aim to find out whether the elevated blood pressure has already had some potentially harmful effects on the body. In addition to the rhythm of the heart, electrocardiogram (ECG, in Finnish also called "sydänfilmi" i.e. "heart film") indicates whether blood pressure has damaged the muscle layer of heart (myocardium) and looks for signs of coronary heart disease.

The tests performed to check for kidney damage include a urine sample tested for a protein called albumin in urine using a sensitive method and a blood test to determine the kidney filtration rate.

The small blood vessels at the backs of the eyes are examined by photographing them or at an eye specialist’s appointment.

Breaks in breathing during sleep (sleep apnoea) may increase the blood pressure. It can be studied using polygraphy, which monitors breathing and the blood oxygen level while sleeping.

Updated 30.9.2023