Hypertension Greater Risk in IHS with High Prevalence of Type 2 Diabetes

WASHINGTON, DC—About 60 million people in the US have high blood pressure according to the CDC. High blood pressure is a major risk factor for heart disease, the leading cause of death in the US. Often referred to as the “silent killer,” hypertension usually has no noticeable warning signs or symptoms until other serious problems arise.

For someone with diabetes who is already at risk for heart attack and stroke, hypertension can be particularly problematic because it can increase that risk. In the IHS, where there is a high volume of patients with type 2 diabetes, physicians are particularly mindful of the importance of controlling hypertension in diabetic patients. “People with diabetes are two to four more times likely to die of cardiovascular disease than the general population, and so obviously with our huge rates of diabetes, it’s especially important to control hypertension,” said Dr Ann Bullock, a clinical consultant in the IHS Division of Diabetes Treatment and Prevention.

Addressing Hypertension

High blood pressure tends to be more common in African-Americans than Caucasians. Family history, smoking, obesity, and diabetes are all risk factors for hypertension. Many times, however, no cause for hypertension is identified, according to the NIH.

One of the problems with hypertension is that since it seldom has any symptoms, many people do not realize they have it until a serious problem develops. “People seldom have any symptoms that would bring them to a clinic for treatment. It’s totally something you don’t know until you throw a blood pressure cuff on someone,” said Bullock.

The unadjusted prevalence rate of hypertension for the entire adult (>20 yr old) American-Indian and Alaska-Native population is 22 per 100. The unadjusted figure for hypertension in adults with diabetes is 83 per 100.

In the IHS, it is a standard of care to do a blood pressure check on a diabetic patient for every visit.

The IHS standard of care for diabetes is that the target blood pressure for a diabetic is less than 130/80mm. “Thirty-six percent of our patients are in that ideal range. That is pretty high. Another 26 percent are in 140/90mm [range],” said Capt Kelly Acton, USPHS, who is director of the IHS Division of Diabetes Treatment and Prevention.

Within American-Indian and Alaska-Native communities, many opportunities are available for patients to get their blood pressure checked. “We have public health nurses, community health representatives, health fairs, and lots of awareness in our communities about health screening. So, it’s hard to go somewhere for long without getting your blood pressure checked,” Acton said.

Controlling Hypertension

Losing weight if necessary, exercising regularly, and eating a healthy diet are among the actions that can be taken to decrease blood pressure. However, medications may still be necessary to control blood pressure. While there are many effective medications to control blood pressure, sometimes patients think they have failed if they have to use a medication to control their blood pressure, according to Acton. “One of the messages that the whole diabetes community is trying to get out now is that the failure is not for taking the medications, the failure is if you fail to take them or fail to control that risk factor so you end up with a complication,” she said.

It is important for physicians to stress that the patient may need medications to control their hypertension, and that this is not a failure on their part. “The research shows that patients listen to us a lot more than we think they do, so our opinion matters,” she said.

Controlling hypertension in diabetic patients, as well as other risk factors, does pay off. A March 23, 2007 CDC Morbidity and Mortality Weekly Report that looked at the racial differences in the incidence of end-stage renal disease found that among American-Indians and Alaska-Natives, the incidence of ESRD attributable to diabetes, hypertension, or glomerulonephritis decreased from the period spanning 1999 to2004.

The report stated that the decline in diabetes-related ESRD incidence among AI/ANs—despite the increasing diabetes prevalence in this population—suggests that diabetes management has improved and the prevalence of other risk factors has decreased. “What CDC attributed it to is our efforts to address risk factors. So, while there are other factors, blood pressure is always going to be one of those factors,” said Acton.

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