A correlation between Blood sugar and blood pressure in Diabetic Patients

Santosh Kumar Yadav1, Awadhesh k. Arya1, Lalit P.Meena1, Kamlakar Tripathi1

1
Department of Medicine, Institute of medical sciences, Banaras Hindu University

Varanasi 221005

Corresponding author:

Dr. Lalit P.Meena

Asst.Professor
Dept of Medicine
Institute of medical Science
Banaras Hindu University Varanasi221005
Email: drlpmeena @gmail.com
Cont.No. +91542677433

Abstracts:
Background: Diabetes mellitus and blood pressure are critical combination for the
development of macro and micro vascular disease. Blood pressure (BP) variability is
associated with increased cardiovascular event in diabetic and non-diabetic patients.
Objective: To evaluation of the prevalence of blood pressure systolic and diastolic in
diabetic and non-diabetic patients.
Study design: cross sectional study
Place & duration: This study was conducted in OPD in department of medicine, Institute of
Medical Sciences, Banaras Hindu University Varanasi from Jan 2013 to April 2013.
Patients and method: The studies examine 400 patients, with 200 diabetic and 200 non
diabetic. In diabetic patient (108 male &female 92) mean age (89±18) year and 200 non
diabetic patients 102 male 98 female, mean age (82±20) years. The difference between two
group was measured by sample t-test ≤ 0.05 was taken significant.
Result: The prevalence of diabetes mellitus was 69 Bihar, 30 Jharkhand, 22 MP, 11 Nepal
and68 from Uttar Pradesh. The mean of systolic blood pressure of Diabetic patients are
146mmhg and the mean of Diastolic blood pressure of diabetic patients are 92mmHg.
Conclusion: In patients with Diabetic mellitus at higher risk for cardiovascular events,
targeting systolic blood pressure is greater than 120mmHg so it is concluded that diabetic
mellitus was more affected the blood pressure.

Keywords used: Blood pressure, Diabetes Mellitus, Hypertension, Cardiovascular disease.

Introduction: Diabetes mellitus increases the risk of cardiovascular disease by a factor of
two to three at every level of systolic blood pressure1. Because cardiovascular risk in patients
with diabetes is graded and continuous across the entire range of levels of systolic blood
pressure, even at pre-hypertensive levels, the Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
(JNC 7) recommended beginning drug treatment in patients with diabetes who have systolic
blood pressures of 130 mmHg or higher, with a treatment goal of reducing systolic blood
pressure to below 130 mm Hg2.There is, however, a paucity of evidence from randomized
clinical trials to support these recommendations. The Action to Control Cardio vascular Risk
in Diabetes blood pressure trial tested the effect of a target systolic blood pressure below 120
mm Hg on major cardiovascular events among high-risk persons with type 2 diabetes. We
present here the main results of the ACCORD BP trial. The presence of hypertension in
patients with DM significantly increases the risk of myocardial infarction, stroke, and all
cause mortality. The coexistence of the conditions also increases the risk of heart failure,
nephropathy, and other micro vascular events. It is well known that high prevalence of
hypertension has been reported in diabetes mellitus for those patients who had cross age
above 35year.The prevalence rate of hypertension for diabetic patients who have much higher
than the 17.4% subject without diabetes. This study inform to evaluate the relationship
between hypertension and non-insulin diabetes.7

Material and Methods: The epidemiological study of diabetes mellitus was conducted
between January 2013 and April 2013 during out patients department (OPD) of S.S. Hospital
Banaras Hindu University Varanasi. A total 400 patient’s data have collected in out door
patients in which proforma have been completed. In proforma age sex geographic and socio
economic status, Systolic blood pressure, diastolic blood pressure was recorded. Because it
was not practical to perform oral glucose tolerance test in all subject of this large population,
they were screened by glucometer either fasting state or 1 hour of a meal. Those Patients who
meet the following criteria were deemed as diabetic patients:(1 )whole blood glucose sugar
when fasting >5.7mM or 2 hour postprandial >11.5mM on screening with glucometer.
(2)Patients who have given 100gm glucose oral glucose tolerance test(OGTT) have blood
sugar >6.7mM or postprandial >12.2 mm.(3) Patients history treated with Insulin injection
regularly. Diabetic Patients blood pressure was measured by mercury sphyganomanometer
with a 10 X 20 cm cuff after resting with 15 min. sitting position. Always sphyganometer
were calibrated before each patient’s blood pressure measurement. Patient’s systolic blood
pressure was recorded at first perception of sound and diastolic blood pressure was recorded
at completed disappearance of sound also recorded heart beat of each patients. Patients which
have systolic blood pressure >160mmHg and diastolic blood pressure.>90 or treated with
antihypertensive drug were deemed to high blood pressure patient. The mean blood pressure
of these patients derived by following formula, (systolic blood pressure /3)+ ( (diastolic blood
pressure x 2/3). A staff nurse participating in this work as a 1 month training course on
operating sphyganometer and glucometer. These Blood pressure data collected by many
questionnaire including name of patients age ,sex, living area, habitats length and weight and
physical activity of patients, income and history of diabetic patients in family with blood
pressure. Two hundred patients were identified to be diabetic in which 50 patients were
consent for further investigation of blood cholesterol, creatinine high density lipoprotein and
salt ion according to protocol of world Health organisation(WHO).The duration of blood
glucose level control also recorded. In this study approximately 100 patients considered as
non insulin dependent diabetes which is characterized as highly polyurea, polydipsea, weight
loss at time of diagnosis and have been treated with insulin injection within 1 year. Some
patients are randomly selected as comparison groups that mach with age, sex with diabetic
patients. Among them 20 have normal blood glucose tolerance on oral glucose tolerance test.

Statistical Analysis: We have used (SPSS) a statistical Package for social sciences by
which we calculate the test. The mean of systolic and diastolic blood pressure were calculated
from continuous measurements and t test were used for significant of different in continuo
variable in comparison group.X2 test was used to examine the difference in prevalence
variable in various group of patients. Multiple regression study were analysed for examine
the association between diabetic and hypertensive where other risk were adjusted.

Result: A total of all diabetic subjects who show normal blood glucose were proving to have
impaired glucose tolerance and to be diabetic through high blood pressure. If patients who
have initially classified as non diabetic has under gone oral glucose tolerance test. We would
have detected 95% subject have high prevalence rate of diabetes.

The Patients adjusted on the basis of sex and age having prevalence rate of hypertension in
diabetic was 50% which was of non diabetic subjects. These patients were compared with
non hypertensive patient or narmotensive subject, the hypertensive patients are older in
comparison of younger.

In our cross sectional study of 400 patients in which 200 normal patients and 200 diabetic
patients in which 102 male and 98 female mean age ( 82+20) .In diabetic 200 patients 108
male and 92 female mean age ( 89+18).

Diabetic Patients:

Male Female Mean age SBP DBP

No. Of 108(54%) 92(46%) 89_+18 146(mmHg) 92(mmHg)
Diabetic
Patients 200
No. Of Non 102(51%) 98(49%) 82+20_ 120(mmHg) 80(mmHg)
diabetic 200

Geographical distribution:

State Bihar Jharkhand M.P. Nepal U.P.

No. of Patients 200 69(34.5%) 30(15%) 22(11%) 11(5.5%) 68(34%)
 Descriptive Statistics

Std. Sig.
Para. Min. Max. Mean Median Mode Deviation Variance p-value

AGE 10 90 48.54 50.00 50a 15.399 237.132

DBP 30 104 77.36 80.00 80 10.050 101.006 .099
SBP 90 180 121.33 120.00 110 15.794 249.458 .005
RBS 73 285 166.99 155.00 154 44.115 1.9463 .001

180
160
140
120
100
80 DBP
60 SBP
40 RBS
20
0
48.54 50 50a
Age (year)

Fig.1 showing the correlation between systolic blood pressure and diastolic blood pressure
with random blood sugar in Diabetic Patients.

A Table show that their standard and regression coefficient for independent variable
significantly associated with diabetes and included in multiple regression model. In which
subjects were included significantly associated with diabetic after adjustment with their age,
sex, Body mass index (BMI) family history of diabetic patients and their physical activity
work. for every 1 mmHg blood pressure increase in prevalence of diabetes increase by 0.08
%.It is observed that those patients treated with anti hypertensive drug have a prevalence rate
5.8 %( p<0.0001) is higher than the those does not treated with antihypertensive drug.

In second Table subject which have treated under antihypertensive treatment were excluded
Diabetes remain significantly associated with high blood pressure. There was a significant
increase in diabetes prevalence with increase in MAP where as other risk factors were multi
variated adjusted. In multiple regression analysis MAP among diabetic patients who with
more Body mass Index (BMI) and no any treatment with antihypertensive drug also living in
urban area of India.

For statistical analysis t test had used and p value < 0.05 was consider as significant.

Discussion:

In our current study analysis data from Institute of medical science BHU Varanasi, Patients
come from different area and different state. This association were independent of potential
confounding including age sex educations and smoking and alcohol consumption and where
consistently present when metabolic variables were analyse discontinuous or categorical
variables. There are several notable points in our finding.

Although sympathy vagal balance is reported to be a major determinant of BP variability in

healthy subjects, BP variability is also affected by atherosclerotic changes in the vascular
wall in patients with cardiovascular disease3 the increase in BP variability may be partly
explained by the diminished bar reflex function associated with increased stiffness and
reduced compliance of large elastic arteries 4. In this respect, BP variability has been attracting
attention as a possible predictable marker for atherosclerotic disease development,
progression, and long-term prognosis5.

Previous studies showed that elevated fasting blood glucose is more closely related to
brachial-ankle pulse wave velocity in elderly people20 and in ARIC study elevated fasting
blood glucose contributed to the increase in arterial stiffness in middle aged people.
Therefore, elevated fasting blood glucose may contribute to increased BP variability in
hypertensive through the reduction of arterial compliance. In this context, the therapeutic
manoeuvres available, such as improvement of hyperglycemia by anti-diabetic agents, may
be important for the decrease in BP variability6.

Conclusion
Our findings suggest that pre-hypertension could serve as an early marker of adverse Cardio
metabolic profile in apparently healthy Indian adults and early detection and control of pre-
hypertension could potentially reduce the burden of CVD in this Indian population. Diabetic
hypertensive as compared to their non diabetic counterparts show increased 24 hour BP
variability. Raised fasting blood glucose levels are associated with increased BP variability in
diabetic patients.

Our study was investigated with finding of various prevalence of diabetes and hypertension
was positively associated with basic metabolic rate of patients. Although diabetic patients in
lowest BMI show week but statistically significant with their blood pressure which was much
found in very high BMI group patiets.9, 10

A relation between hypertension and diabetes duration of diabetic patients have severity of
hypertension related to duration of diabetes. The prevalence of nephropathy in diabetic
patients known to increase with duration of diabetes and it is main cause of hypertension in
diabetic patients. There should be association between with other factor such as
atherosclerosis, weight gain, and hypertension altogether play role in non insulin dependent
diabetes.11, 12

In diabetic patients renal disease cause hypertension and markedly increase the risk of
development of nephropathy which associated with decline function of glomerular apparatus
and reduce the filtration of blood .In diabetic patient with non insulin dependent diabetes,
blood pressure was similar in all group by initial urinary concentration of albumin and no
correlation found between blood pressure and urine albumin at follow up13, 14.

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