Living with hypertension & diabetes

Like most people, you probably know at least one person who’s living with high blood pressure or diabetes. Despite greater public awareness and increased media attention, these two chronic diseases have grown
into major global health threats.

Every minute, someone in Thailand is diagnosed with a major chronic disease – hypertension, diabetes, chronic kidney disease, stroke or heart disease. That’s the sobering reality from a report released this year by Thailand’s Ministry of Public Health.

This issue of Better Health takes an in-depth look at hypertension and diabetes – two of the most serious chronic diseases affecting millions of people in Thailand and around the world – that can wreak havoc with one’s health and cause numerous life-threatening conditions.

Living with hypertension & diabetes

Like most people, you probably know at least one person who’s living with high blood pressure or diabetes. Despite greater public awareness and increased media attention, these two chronic diseases have grown into major global health threats.

Every minute, someone in Thailand is diagnosed with a major chronic disease – hypertension, diabetes, chronic kidney disease, stroke or heart disease. That’s the sobering reality from a report released this year by Thailand’s Ministry of Public Health.
This issue of Better Health takes an in-depth look at hypertension and diabetes – two of the most serious
chronic diseases affecting millions of people in Thailand and around the world – that can wreak havoc with one’s health and cause numerous life-threatening conditions.

Hypertension

Proper pressure in the circulatory system is critical to life, ensuring healthy bloodflow from the heart to every part of the body via blood vessels and arteries. The term blood pressure describes the force that moves blood through arteries and vessels. With every heartbeat, blood pressure increases as blood is pumped out from the heart; then, after the beat, the heart relaxes and blood pressure drops.

Hypertension – the medical term for high blood pressure – is one of the most prevalent and growing health threats around the world. In Thailand, statistics from 2008 revealed that an estimated two million adults aged 40 or older had been diagnosed with high blood pressure; the actual number is believed to be much higher due to the significant number of undiagnosed cases and the growing number of cases being diagnosed in adults younger than 40. In 1999, the World Health Organization (WHO) emphasized the growing threat of hypertension by issuing a directive that more broadly defined hypertension as a blood pressure level above 140/90.

The dangers of high blood pressure

High blood pressure describes the condition whereby the heart relaxes but the pressure in arteries and blood vessels doesn’t experience a normal drop. Dr. Prapaporn Phimphilai, a board-certified physician with many years of experience treating hypertension patients, explains: “High blood pressure can inflict a wide range of damage to the circulatory system, including hardening of the arteries, narrowing of the arteries, an aortic aneurysm, and weakening of arterial walls – a dangerous condition that can lead to an artery rupture and other serious conditions.”

It is critical for hypertension patients to keep their blood pressure under control to help prevent damage to the body’s other organs. High blood pressure is a key risk factor for a number of life-threatening diseases, including stroke, heart disease and kidney disease.

Causes and symptoms explained

In the vast majority of cases, it’s not possible to pinpoint a precise cause of a patient’s high blood pressure. This type of high blood pressure, called primary hypertension or essential hypertension, accounts for about 85 percent of hypertension cases. “While there’s no cure for essential hypertension, adopting healthier lifestyle changes can help keep blood pressure within a healthy range,” says Dr. Prapaporn.

“The other type of high blood pressure, secondary hypertension, affects a small number of patients; typically, their high blood pressure is caused by another medical condition such as chronic kidney disease or an endocrinal disease. Secondary hypertension can be a side effect of certain medications, particularly birth control pills, steroids, and NSAIDs. This type of hypertension is curable once the root cause has been diagnosed and successfully treated.”

High blood pressure is particularly dangerous because it can progress for a long time without producing any warning signs or symptoms. It’s known as a “silent killer” and typically goes unnoticed until a patient has his blood pressure checked. “Most people are completely unaware they have high blood pressure until it’s discovered ‘accidentally’ during a doctor visit for some other health reason,” Dr. Prapaporn explains. “A local study conducted several years ago found that 20 to 30 percent of adults with high blood pressure believed they had almost no hypertension risk.”

Some patients only learn they have high blood pressure when they visit their doctor for everyday problems like headaches, dizziness or blurred vision. “When high blood pressure is discovered,” says Dr. Prapaporn, “it’s important to initiate a treatment plan as soon as possible to help prevent, or at least delay, the onset of potential complications that can prove life-threatening.”

Making lifestyle modifications

While high blood pressure may be a serious chronic disease that’s usually not curable, it can be successfully managed and kept in check if the patient makes a conscious decision to live a healthier lifestyle and follows his or her doctor’s advice for taking medication that helps keep blood pressure under control.

“In healthy people, blood pressure is usually around 120/80 or a bit lower,” says Dr. Prapaporn. “Slightly elevated pressure – ranging from 120/80 to 139/89 – is classified as pre-hypertension, as there is a high probability the patient will eventually develop full hypertension. It’s very important that patients adopt a healthier lifestyle as a means of keeping their blood pressure under control. If you haven’t yet acted on your doctor’s advice for getting regular exercise and eating a healthy diet, now is the time to get started – the sooner, the better.”

It’s not always possible to keep within the target blood pressure range (below 140/90) through lifestyle modifications alone. In these cases, doctors typically prescribe one or more blood pressure medications depending on each patient’s individual circumstances – particularly if the patient also is diabetic or suffers from kidney disease. The overall treatment objective is to reduce the patient’s risk of suffering any of the complications that can seriously damage a patient’s health and quality of life.

“Successfully managing hypertension depends on a patient’s ability to make lifestyle modifications such as following a healthy diet, limiting salt consumption, and getting regular exercise,” Dr. Prapaporn adds. “These healthy changes not only reduce the long-term harmful effects of high blood pressure; they also help limit the potential harm that can eventually result from a patient’s other life-threatening conditions. Hypertension patients should have their blood pressure monitored regularly as a means of assessing the impact that lifestyle changes and medication are having in helping keep their condition under control.”

Though hypertension holds the potential to cause a number of serious conditions, its diagnosis doesn’t automatically mean one’s future health is doomed. Managing hypertension is possible through a combination of high quality medical care and healthier living – potent weapons in the battle to live a full and fulfilling life of good health and happiness.

Normal	< 120	< 80	Eat a healthy, high-fiber diet and exercise regularly.
Pre-hypertension	120 - 139	80 - 89	Have blood pressure checked periodically. Eat more high-fiber foods such as fruits and vegetables and exercise regularly.
Stage 1 hypertension (Mild)	140 - 159	90 - 99	Have your blood pressure checked and see your doctor regularly. Medication may be prescribed along with lifestyle modifications.
Stage 2 hypertension (Moderate)	160+	100+	Have periodic blood pressure checks and keep accurate test results records. See your doctor regularly. Limit consumption of high-sodium foods. Maintain healthy exercise and lifestyle habit

** Top number (systolic blood pressure) = blood pressure during heart contraction
** Bottom number (diastolic blood pressure) = blood pressure when heart relaxes

Hypertension Risk Factors

• Age: The risk of developing high blood pressure increases with age;
• Gender: Women generally have a lower risk of developing high blood pressure than men;
• Family history: A family history of hypertension increases one’s individual risk for the disease;
• Obesity, sedentary lifestyles, lack of exercise;
• Emotional risks: Anger, stress and depression can trigger a temporary rise in blood pressure;
• Poor diet: High sodium consumption, particularly found in many processed foods;
• Smoking, consumption of alcohol or coffee;
• Certain medications;
• Some chronic health conditions.

DIABETES

Diabetes is a serious chronic disease that often occurs together with hypertension. The World Health Organization (WHO) estimates that 285 million people worldwide currently suffer from diabetes – over six percent of the world’s adult population. Future projections reflect the diabetes epidemic; the WHO projects that the number of diabetics will reach 438 million within 20 years, or close to eight percent of the overall projected adult population.

Statistics from Thailand’s Ministry of Health show the number of Thai patients with diabetes has continued to grow in recent years, especially among younger Thais.
 

What is diabetes?

To gain a better understanding of this serious and growing threat, Better Health consulted Dr. Varaphon Vongthavaravat,a board-certified endocrinologist with extensive experience treating patients with diabetes. “Diabetes is a term that describes the body’s inability to properly convert carbohydrate-containing foods and glucose (sugar) into energy, resulting in high levels of blood sugar,” Dr. Varaphon explains. “This typically occurs when the pancreas is not able to produce enough insulin, or no insulin at all, or when cells in the body such as fat, liver and muscle cells, become resistant to insulin’s effects. The condition leads to a dangerous build-up of glucose in the blood, which can lead to numerous health complications.” [Insulin is a naturally-occurring hormone the body uses to deliver glucose from the blood stream to the body’s cells for use or to be stored].

There are two main types of diabetes – type 1 and type 2. “Type 1 diabetes is less common than type 2 diabetes,” notes Dr. Varaphon.“In Thailand, about five percent of diabetes patients have type 1, the type in which the body produces no insulin at all. Type 1 patients typically require daily insulin injections to keep their blood glucose under control; high, uncontrolled blood glucose is extremely serious and can cause the patient to lose consciousness and eventually can be fatal.”

Most cases of type 1 diabetes are diagnosed during childhood. Research has traced the cause of type 1 diabetes to the immune system’s mistakenly destroying insulin-producing cells in the pancreas.

Type 2 is the much more prevalent form of diabetes, accounting for about 95 percent of diabetes cases. It’s usually diagnosed in adults aged 40 and older. “Type 2 diabetes describes the condition where the pancreas does not produce enough insulin, and where the cells of the body become resistant to the effects of insulin,” Dr. Varaphon says. “The development of type 2 diabetes is usually more gradual than type 1, but it can lead to equally severe consequences if not kept under control.”

Diagnosing diabetes

A simple blood glucose test is the most common method for diagnosing diabetes; one or more of the following test results indicates diabetes:Blood glucose level of 126 milligrams per deciliter (mg/dL) or higher after an eight-hour fast;

• The presence of diabetes-related symptoms (e.g. frequent urination, weight loss, thirst, itchy skin) in conjunction with a blood glucose level of 200 mg/dL or higher following a test taken at any time of the day;
• Blood glucose level of 200 mg/dL or higher two hours after consuming 75 grams of glucose dissolved in water;
• Hemoglobin A1c (HbA1c) level of 6.5 percent or higher.

Test results are used to identify those at greater risk of developing diabetes. “People whose blood glucose level falls in the range of 100 to 125 mg/dL as indicated by a test conducted after fasting, are considered to be at high risk for developing diabetes,” explains Dr. Varaphon. “Unless they take action and make significant changes to their eating habits and lifestyle, they’re putting themselves at risk for a disease which, along with obesity, high cholesterol and high blood pressure, leads to serious, potentially-fatal damage to blood vessels and organs.”
If you have diabetes

Many type 2 patients enjoy a normal, healthy adulthood by keeping blood sugar levels under control through good nutrition habits and regular exercise. “When that isn’t enough to maintain healthy blood glucose levels, medication may also be prescribed,” notes Dr. Varaphon. “If the blood sugar levels are still not under control, doctors typically add insulin to the treatment regimen. For type 1 diabetes cases, it’s very common for patients to take insulin, which they can administer by self-injection on a daily basis.”

The goal of diabetes treatment is to keep blood sugar, body weight, blood pressure and cholesterol levels within a healthy, normal range, thereby preventing potential complications and allowing for a good quality of life. “Those who achieve a better quality of life,” says Dr. Varaphon, “are patients who fully understand the objective of their diabetes treatments and strictly follow their doctor’s recommendations.”
Don’t ignore these warning signs

Consult your doctor if you experience any of the following symptoms:

• Frequent daytime and nighttime urination;
• Frequent, excessive thirst;
• Fatigue and unexplained weight loss (likely resulting from an inability to convert glucose into energy);
• Constant feelings of hunger;
• Itchy skin and/or frequent skin infections, especially fungal infections and leucorrhea;
• Blurred vision;
• Leg pain (caused by vascular problems that inhibit circulation).

Who’s at risk for diabetes?

You may be at risk for type 2 diabetes, as well as complications including heart disease, chronic kidney disease and stroke, if you . . .

• are over 40 years of age;
• have a family member with diabetes;
• are overweight (i.e. body mass index (BMI) above 25)
• have high blood pressure and high blood sugar (each is strongly correlated with the other);
• have high cholesterol;
• are a woman who had diabetes while pregnant or gave birth to a high
• birth weight baby (over 4 kg);
• don’t exercise regularly;
• drink alcohol and/or smoke.

Eat healthy, Live healthy – despite hypertension and diabetes

Good eating habits and healthier choices are critical to keep hypertension and diabetes under control. To enjoy healthier living despite these chronic diseases, patients should:

• Make smart carbohydrate choices, including whole-grain foods;
• Avoid foods that are heavily seasoned, oily, salty or too sweet;
• Eat a fiber-rich diet including plenty of vegetables and low-sugar fruits;Exercise 30 minutes or more five times per week, based on your doctor’s recommendation;
• Avoid smoking and limit alcohol consumption;
• Consult your doctor before taking any medicine, especially steroids and hormone replacement medication;
• Always follow your doctor’s instructions for taking diabetes and any other medications;
• Take charge of your health by learning as much as you can – and continue updating your knowledge – about managing your health and chronic conditions.