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Hypertension as a risk for type 2?

G

Gardengnome

Well-Known Member
Messages
134
Location
uk
Type of diabetes
Don't have diabetes
Treatment type
Diet only
Dislikes
going to a gym
I feel this is rather a silly question but I'll ask it nonetheless. I realise high blood pressure is a risk for T2D but does this still apply if one takes medication and has it well controlled?
The fact is that if one completes the QRisk online you are asked if you take meds for hypertension and it will increase your risk if the answer is 'Yes' regardless of what your blood pressure actually is.
 
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I should think that the first question should be why would one have hypertension in the first place?
 
Guzzler said:
I should think that the first question should be why would one have hypertension in the first place?
Click to expand...

That's what I said to the HCA when she did an MOT 6 years ago and the bottom line was that it was genetic probably as there was no other obvious reason. But that's the way it often is I understand, you don't have to have a red face, be overweight or have steam coming out of your ears ! I reluctantly complied with the GP on the subject of meds and take just a moderate dose of Losartan. My feeling at the time was of feeling totally trapped by the NHS with their tick boxes. Pretty much like I think many people feel with a diagnosis of T2? It was only after I found I could get my health notes online that I discovered that the HbA1c taken at the same time was 41% and that has risen now to 43%. They never mentioned that at the time.
 
The good news is that a diet that is lower in carbs aids hypertension. Some people see a reduction in meds and some see the cessation of hp meds altogether. Kendrick reckons that saying 'Oh it's just genetic' is a bit of a cop out when what the experts really mean is 'we don't know but we're never admit to not knowing'.
 
Hypertension can be a result of insulin resistance and high insulin levels. Insilin prevents kidneys from excreting salt. Blood pressure rises as a consequence.
 
@Gardengnome Dr Malcolm Kendrick has just put up one of his excellent blogs, which might have been written specially for you! It analyses / demolishes the many risk calculators used by the medical profession to determine our futures. Find it here, https://drmalcolmkendrick.org/2019/01/02/what-causes-heart-disease-part-60-prediction/
Concerning hypertension, my understanding is that it is often caused by raised insulin levels, which happen long before T2 diabetes is actually diagnosed, but is part of the process of becoming T2. Many T2's can keep their insulin levels down by reducing carb consumption, which also keeps sugar levels down. Blood pressure drops quite quickly for some. If you haven't already done so, a good long read of the Diet Doctor site, https://www.dietdoctor.com/ could be helpful.
Sally
 
Gardengnome said:
That's what I said to the HCA when she did an MOT 6 years ago and the bottom line was that it was genetic probably as there was no other obvious reason. But that's the way it often is I understand, you don't have to have a red face, be overweight or have steam coming out of your ears ! I reluctantly complied with the GP on the subject of meds and take just a moderate dose of Losartan. My feeling at the time was of feeling totally trapped by the NHS with their tick boxes. Pretty much like I think many people feel with a diagnosis of T2? It was only after I found I could get my health notes online that I discovered that the HbA1c taken at the same time was 41% and that has risen now to 43%. They never mentioned that at the time.
Click to expand...

Garden gnome, I know what you mean. My blood pressure is always too high when taken at the surgery and I am not IR/overweight/red faced and so on, I follow a lowish carb diet, I run every day, I don't smoke or drink etc, etc...and still my blood pressure is high when taken by the Dr. Interestingly, I went private for this issue and was given a 24/7 ambulatory monitor. This showed that my blood pressure was normal to low over a 24hr period. If they had put me on tablets I probably would have been fainting every five minutes. They really are quick to throw pills at you and then before you know it, you've been on them for years and don't really know why. Sometimes there just doesn't seem to be an obvious reason so they say it's 'genetics', ie they don't know, it's flipping annoying though when it's automatically assumed it's because of 'life style'! :)
 
Gardengnome said:
I feel this is rather a silly question but I'll ask it nonetheless. I realise high blood pressure is a risk for T2D but does this still apply if one takes medication and has it well controlled?
The fact is that if one completes the QRisk online you are asked if you take meds for hypertension and it will increase your risk if the answer is 'Yes' regardless of what your blood pressure actually is.
Click to expand...

Do you know what your BP was when put on the tablets, and what is it now? How long have you been on the tablets?

I can't answer your question about the Q-Risk calculation, but it is a one size fits all calculation, and has a lot of ridiculous anomalies. The same question could be asked about diabetes. You tick yes if you are diabetic. T1 and T2 are the only choices and there is no option for entering the HbA1c or any other option. Even though my GP has removed me from the register she still includes T2 in the calculation, which more or less doubles the risk factor. If I were you I wouldn't be worried in the least about the risk score.
 
Totally agree with the above; syndrome X is the clustering of hypertension, Type 2 diabetes, dyslipidaemia and several other things which are probably linked by insulin resistance.
Blood pressure reduction itself probably does not alter risk of future diabetes, but some BP treatments eg thiazides and beta blockers increase diabetes risk, and others eg calcium channel blockers and alpha blockers are probably neutral and some drugs eg ACE inhibitors and sartans might be a bit protective against future diabetes.
How the insulin resistance and associated hyperinsulinaemia cause hypertension is not exactly known - as above, it increases salt retention via the kidneys, and increases the resistance of blood vessles, but there are probably other factors.
So tricks to reduce insulin resistance eg weight loss and exercise help both blood pressure and diabetes risk.
best wishes
 
Guzzler said:
The good news is that a diet that is lower in carbs aids hypertension. Some people see a reduction in meds and some see the cessation of hp meds altogether. Kendrick reckons that saying 'Oh it's just genetic' is a bit of a cop out when what the experts really mean is 'we don't know but we're never admit to not knowing'.
Click to expand...

I'm a great fan of Kendrick and what he says re. cholesterol etc but admit I haven't actually heard that one, I'm sure he's right though. It was Kendrick who taught me to question just about everything the nannying NHS dishes out.
[Cue a big argument with my newly qualified junior dr granddaughter who slammed out of the room when I said recently that statins are offered according to what number on the Qrisk you had and that the risk had been lowered from 20% to 10% overnight with no explanation. "Why would they do that Granny": I didn't get the chance to mention Big Pharma before she'd gone!!
However I did comply with the hypertension thing though, I think I allowed myself to be scared by threats of Dementia, stroke,heart attack, etc dished out by the HCA when first I had the MOT.
I waited 3 months before going on meds and seeing another GP who was not so dismissive as the first. In the meantime I got my weight better controlled [BMI was 23], raised my exercise level by buying another dog to walk, cutting out salt etc.There was a lot of white coat syndrome I'm sure, but it was only after the second dr said that she would be jumping up and down and insisting on meds if I was her mother that I thought perhaps I should take notice. I've never been able to come off the things unfortunately but on the other hand I've never increased them either.
 
Bluetit1802 said:
Do you know what your BP was when put on the tablets, and what is it now? How long have you been on the tablets?

I can't answer your question about the Q-Risk calculation, but it is a one size fits all calculation, and has a lot of ridiculous anomalies. The same question could be asked about diabetes. You tick yes if you are diabetic. T1 and T2 are the only choices and there is no option for entering the HbA1c or any other option. Even though my GP has removed me from the register she still includes T2 in the calculation, which more or less doubles the risk factor. If I were you I wouldn't be worried in the least about the risk score.
Click to expand...

It was 160/90 originally but these days hovers around the 120/70 mark, but in the surgery can rise to 170! So definitely a White Coat patient! Trouble is they say medication is for life and I've never dared to test it.
I felt so angry and frustrated at the diagnosis at the time, wishing all along that I'd never bothered to turn up for the MOT; prior to that I'd never been near a dr unless there was a good reason and here I was being called in for checks for this and tests for that and frankly feeling like a cash cow for the NHS. It was only later when I found they hadn't bothered to mention the HbA1c of 41 [OK I know it wasn't yet 42] but I did query it and the GP just said the numbers would rise and he'd have Metformin ready for me when they did. Quite certain he was. Thanks but no thanks!
 
sally and james said:
@Gardengnome Dr Malcolm Kendrick has just put up one of his excellent blogs, which might have been written specially for you! It analyses / demolishes the many risk calculators used by the medical profession to determine our futures. Find it here, https://drmalcolmkendrick.org/2019/01/02/what-causes-heart-disease-part-60-prediction/
Concerning hypertension, my understanding is that it is often caused by raised insulin levels, which happen long before T2 diabetes is actually diagnosed, but is part of the process of becoming T2. Many T2's can keep their insulin levels down by reducing carb consumption, which also keeps sugar levels down. Blood pressure drops quite quickly for some. If you haven't already done so, a good long read of the Diet Doctor site, https://www.dietdoctor.com/ could be helpful.
Sally
Click to expand...

Thanks Sally and James, I will read both these as you suggest. A new year and I'm realising that I've been messing about for far too long without lowering my carb intake. It's a whole new learning curve as it isn't just about losing weight, which I don't need to do. I'm currently trying to greatly reduce my fruit intake starting with grapefruit for breakfast. I shall miss it enormously and am not sure that blueberries and Greek yogurt quite fill the void.
 
Gardengnome said:
and am not sure that blueberries and Greek yogurt quite fill the void.
Click to expand...

Swap the yogurt for double cream on alternate days. That could help fill the void, and try strawberries and cream or better still raspberries and cream/yogurt. Have a bit of variety.
 
Bluetit1802 said:
Swap the yogurt for double cream on alternate days. That could help fill the void, and try strawberries and cream or better still raspberries and cream/yogurt. Have a bit of variety.
Click to expand...
Will try that, I actually have vast quantities of raspberries and blackcurrants in the freezer so this is a way to use them up. I would never have guessed there were so many carbs in fruit. I actually really like Greek yogurt eaten any way.
 
Gardengnome said:
Will try that, I actually have vast quantities of raspberries and blackcurrants in the freezer so this is a way to use them up. I would never have guessed there were so many carbs in fruit. I actually really like Greek yogurt eaten any way.
Click to expand...
 
SimonCrox said:
Totally agree with the above; syndrome X is the clustering of hypertension, Type 2 diabetes, dyslipidaemia and several other things which are probably linked by insulin resistance.
Blood pressure reduction itself probably does not alter risk of future diabetes, but some BP treatments eg thiazides and beta blockers increase diabetes risk, and others eg calcium channel blockers and alpha blockers are probably neutral and some drugs eg ACE inhibitors and sartans might be a bit protective against future diabetes.
How the insulin resistance and associated hyperinsulinaemia cause hypertension is not exactly known - as above, it increases salt retention via the kidneys, and increases the resistance of blood vessles, but there are probably other factors.
So tricks to reduce insulin resistance eg weight loss and exercise help both blood pressure and diabetes risk.
best wishes
Click to expand...

Insulin is believed to over-ride the RAS feedback system restricting sodium loss by putting up aldosterone. Hence all type 2's should probably be on an angiotensin 2 blocker or one of the 'prils that works earlier in the chain on angiotensin 1, (but the prils cause some patients to have a cough).

There are papers on this subject, it is not unexplored how insulin hacks the feedback system with positive feedback on bp.
Derek
 
sally and james said:
@Gardengnome Dr Malcolm Kendrick has just put up one of his excellent blogs, which might have been written specially for you! It analyses / demolishes the many risk calculators used by the medical profession to determine our futures. Find it here, https://drmalcolmkendrick.org/2019/01/02/what-causes-heart-disease-part-60-prediction/
Concerning hypertension, my understanding is that it is often caused by raised insulin levels, which happen long before T2 diabetes is actually diagnosed, but is part of the process of becoming T2. Many T2's can keep their insulin levels down by reducing carb consumption, which also keeps sugar levels down. Blood pressure drops quite quickly for some. If you haven't already done so, a good long read of the Diet Doctor site, https://www.dietdoctor.com/ could be helpful.
Sally
Click to expand...
@sally and james thanks for the link to Kendrick
 
Bluetit1802 said:
Not all T2s! My blood pressure has never been high. I struggle to reach 120.
Click to expand...
You may not have high insulin Blue tit?
That why I said probably? One can be a black swan!
There are so many variables, even some individuals with very high aldosterone have normal blood pressure, as some who have a very high input of carbs do not have T2D.
Some of us are inevitably outliers, not many are my height!?
regards
Deeek
 
lindisfel said:
You may not have high insulin Blue tit?
Click to expand...

I suspect I have not had very high insulin resistance. My triglycerides have always been low, before and after diagnosis. My blood pressure has always been normal (except when on a particular cancer treatment but even then it wasn't outrageous). My fasting levels were rarely above 6 and dropped to low to mid 5's quite quickly. The only metabolic syndrome I had was being overweight especially round the middle, but my liver functions have always been good with the ALT in the teens and 20's, similarly the Gamma GT. I guess I am a black swan!
 
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