Poorly controlled BP elevates risk of hypertensive emergencies in diabetics

Managing their high blood pressure is the best way patients with diabetes can avoid hypertensive emergencies, according to research published in Clinical and Experimental Hypertension this fall.

First author Irina Benenson, an assistant professor at the Rutgers School of Nursing, and colleagues looked at 783 diabetic and 1,001 non-diabetic patients in a New Jersey emergency department in an effort to identify risk factors that might contribute to hypertensive emergencies, which can ultimately result in organ dysfunction. Benenson et al. focused on black patients, since the demographic is disproportionately affected by BP complications.

Over a study period of three years, 264 diabetic patients experienced a hypertensive emergency, accounting for 52.3 percent of all hypertensive emergencies during that timespan. An additional 519 reported hypertensive urgencies.  

“Our study found that both diabetics and non-diabetics with hypertensive emergencies had similar rates of severe injury to target organs,” Benenson said in a release. “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.”

According to the research, diabetic patients were more likely to experience a hypertensive emergency if they also had hyperlipidemia (1.66 times more likely), coronary artery disease (2.95 times), congestive heart failure (6.28 times), or renal insufficiency (2.84 times).

Benenson said the risk of hypertensive emergencies in black patients with diabetes was significantly higher in those with cardiovascular conditions, kidney disease and anemia. Having medical insurance or access to a healthcare provider didn’t mitigate the complications associated with elevated BP.

“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,” Benenson said. “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.”