Extremely high blood pressure, not just diabetes, may be responsible for severe organ damage due to hypertensive emergencies in African-Americans with diabetes, a new suggests.
The study, which was the largest of its kind, included 783 diabetic and 1,001 non-diabetic patients from a New Jersey hospital emergency department that serves mainly African-American communities.
It is the first study to look at the risk factors and prevalence dramatic increases in blood pressure in diabetic African-Americans, a population largely affected by complications of high blood pressure.
“Our study found that both diabetics and non-diabetics with hypertensive emergencies had similar rates of severe injury to target organs,” said the lead author of the study, Irina Benenson, in a statement.
“Combined with the fact that diabetics with hypertensive emergency also had significantly higher levels of blood pressure, this suggests that the occurrence of severe damage to vital organs is not because of just diabetes but because of the accompanying severely elevated blood pressure,” she added.
Benenson indicates that hypertensive emergencies are associated with life-threatening damage to the brain, heart, and kidneys.
She says the risk of hypertensive emergencies in diabetic African-Americans was significantly higher in those with cardiovascular conditions, kidney disease, and anemia.
How was the Study Conducted?
Using electronic medical records, the study identified diabetic patients with hypertensive crisis who visited the emergency department of Newark Beth Israel Medical Center, in Newark, NJ from June 2013 to May 2016.
Diabetic patients with hypertensive emergencies were compared with non-diabetic patients based on important demographic and clinical characteristics.
In analyzing data, researchers found that patients with diabetes accounted for 52.27% of all hypertensive emergencies during the study period.
There were 264 diabetic patients with hypertensive emergencies and 519 diabetic patients with hypertensive urgencies.
The majority of patients were African Americans (88.6%).
Researchers found the odds of hypertensive emergencies were strikingly higher in diabetic patients with hyperlipidemia, coronary artery disease, congestive heart failure, renal insufficiency, and low hemoglobin.
Acute or worsening heart failure was the most frequent acute target organ injury followed by myocardial infarction. Diabetic and non-diabetic patients had similar rates of target organ injuries.
The researchers conclude the development of hypertensive emergencies in patients with diabetes was not because of diabetes per se but because of coexisting highly elevated blood pressure.
Tight blood pressure control may decrease the risk of hypertensive emergencies in this patient population.
They note that having medical insurance and access to a healthcare provider did not decrease the chances of complications due to severely elevated blood pressure.
“Given the fact that the presence of severely elevated blood pressure is the strongest driver of damage to vital organs in individuals with diabetes, the most important intervention for preventing hypertensive emergencies would be to better manage patients’ blood pressure,” said Benenson.
“Carefully selected interventions that improve patients’ adherence to medications, and strategies that help providers to overcome clinical inertia, or a failure to increase therapy when blood pressure goals are unmet, may potentially reduce target organ damage associated with hypertensive emergencies.”
The study was published in Clinical and Experimental Hypertension.
- Irina Benenson, Frederick Andrew Waldron, Shelly A. Jones Dillon, Shreni N. Zinzuwadia, Nkehci Mbadugha, Natali Vicente, Ela Aris, Adedamola M. Adeboye & Christine Makdisi (2018)Hypertensive emergencies in diabetic patients from predominantly African American urban communities, Clinical and Experimental Hypertension, DOI: 10.1080/10641963.2018.1516774
Managing high blood pressure in diabetics may prevent life-threatening organ damage. 2018, 23 October. EurekAlert. Retrieved October 25, 2018, from https://www.eurekalert.org/pub_releases/2018-10/ru-mhb102318.php