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The yin and yang of cardiovascular problems

The yin and yang of cardiovascular problems

Controlling high blood sugar and blood pressure is vital for cardiac and metabolic health
 Diabetes and High blood pressure compliment each other and proper management of both is vital for heart health.
Photo by Goutham V

Hypertension and diabetes complement each other, and experts point out a higher risk of developing blood pressure variations and their eventual comorbidities if optimum blood sugar levels are not maintained and managed at the earliest.

“My mother, Sudesh Kashyap (69), was diagnosed with diabetes after a series of blood tests done around four years ago while she was being treated for chikungunya,” Meenakshi Sharma, 43, a project manager with a leading company in Gurugram, Haryana, tells Happiest Health. “I never realised it till the doctor pointed out that she was hypertensive, and her blood pressure was constantly high. This was also the reason why she was consistently feeling very low and dizzy even after sleeping. Her blood pressure was around 200/120mmHg and pulse was 130 beats per minute.”

But various personal reasons and pandemic-related stress caused Kashyap to her ignore her health. Later, it was found that she also developed high cholesterol, including blockages in her heart that required an angioplasty in 2021.

The twins: blood pressure and blood sugar

“Blood pressure and blood sugar are called twins — either both come together or one after the other,” says Dr Ashwin Karuppan, consultant, internal medicine & infectious disease, Gleneagles Global Health City, Chennai.

In order to highlight the link between blood pressure and blood sugar levels in diabetics, the American Diabetes Association published a position statement in its journal Diabetes (Ian H de Boer et al. 2017) stating that hypertension was common among diabetics and its prevalence depended on multiple conditions including the type and duration of diabetes. Hypertension was also listed as a strong modifiable factor for both micro and macrovascular complications of diabetes.

An article published in the Current Atherosclerosis Reports journal by Bernard MY Cheung and Chao Li in 2012 points out that diabetes and hypertension share common physiological pathways, including insulin resistance, oxidative stress and adipokines (cell signalling molecules of body fat tissues) that constantly interact and influence each other. Hypertension and diabetes are both end results of a condition called metabolic syndrome. Central obesity was pointed out as the main cause of metabolic syndrome.

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The triad: Blood sugar, blood pressure and cholesterol

People with high blood sugar, dyslipidaemia (high cholesterol) and high blood pressure are more likely to develop each of these conditions without proper health management.

“Diabetes is basically a metabolic disease, which means it could affect everything in the body,” says Dr Karuppan. “It will increase your weight, which will lead to high cholesterol that will be deposited in all your arteries, which in turn will thicken the blood vessels. As a result, the heart has to pump harder than usual to ensure blood flows through these narrowed arteries, leading to a significant increase in blood pressure.” He says if high blood sugar is left unmanaged, it will eventually lead to high cholesterol and high blood pressure.

“Because of high cholesterol, arterial stiffness increases, and this is responsible for high blood pressure,” says Dr Bikash Majumdar, senior cardiologist, Apollo Hospitals, Kolkata. “Arterial stiffness usually increases with age, but it comes earlier if one is diabetic and has high cholesterol.”

Dr Swami Kannu, senior consultant and clinical lead, internal medicine and allied sciences, MGM Healthcare, Chennai, says that when blood pressure levels go beyond the ideal numbers (120/80mmHg), it requires intervention — initially by lifestyle changes or by medical help if required. He recommends the same for diabetics with elevated blood sugar levels.

Risks of hypertension and diabetes

According to Dr Majumdar, some of the complications that can arise when both diabetes and hypertension co-exist include:

  • Heart attack
  • Ventricular hypertrophy (thickening of the heart muscle)
  • Brain stroke
  • Kidney problems
  • Eye-related complications
  • Heart artery blockages.

Precautions for diabetics

Being at a higher risk of heart attack and of developing kidney diseases in the future, individuals with diabetes who are trying to avoid hypertension should follow these tips:

Dietary and lifestyle changes

  • Have fatty, oily and sugary food in moderation
  • Consume fresh vegetables and fruits (especially non-tropical: oranges, apples, guavas, etc.)
  • Have more green leafy vegetables and proteins, less carbohydrates
  • Avoid smoking, excessive salt and junk food
  • Avoid refined wheat flour (maida) and rice. Instead opt for whole wheat and parboiled rice (which is reddish and husky).

Dr Swami Kannu recommends the DASH diet as being beneficial for both hypertension and diabetes. He also says that high blood pressure does not develop because of a one-time event of uncontrolled diabetes, rather it happens over a period.

Regular exercise

People should do brisk walking for at least 30 minutes. To be effective, the walk should make them sweat and feel their own breathing – it should not be the usual strolling.

Sharma, the primary caretaker of Kashyap, says that despite being overweight and overstressed, her mother neglected the signs of diminishing health (like extreme fatigue and giddiness) that pointed to severe cardiac conditions. However, Kashyap has been following the doctor’s instructions ever since her angioplasty.

Timely follow-up

Dr Swami Kannu says regular follow-ups with the doctor and screening at home (with the help of BP and sugar-level monitors) are highly recommended. While one-time screening at the clinic helps the doctor to make an elaborate diagnosis, home screening gives additional information about a person’s condition.

“Blood pressure readings taken in the morning just after one gets out of the bed and fasting sugar levels are excellent indicators of hypertension and diabetes level,” says Dr Swami Kannu.


Experts say there is a higher risk of developing blood pressure and its comorbidities if optimum blood sugar levels are not maintained and managed at the earliest. Diabetes and hypertension are closely linked to each other and people with diabetes have a higher risk of developing hypertension. The co-existence of both blood sugar and blood pressure could also lead to multiple cardiovascular complications, including heart attacks, strokes and kidney complications if left untreated. However, both conditions can be managed and kept well under control through a healthy diet and physical activity.


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