Diabetes can DOUBLE your risk of stroke, so why aren’t patients told to cut their blood pressure



10:44 GMT, 5 June 2012

Gauging the problem: Many diabetics do not appreciate the importance of keeping their blood pressure down

Gauging the problem: Many diabetics do not appreciate the importance of keeping their blood pressure down

Adrian Scott was driving on a dual carriageway at 70 miles per hour when he felt a sensation like an electric shock strike his left side.

‘I managed to pull over using my right hand and leg to control the car,’ recalls Adrian, 60, a broadcasting technology consultant from Alhampton, Somerset.

‘But by the time I came to a stop, I’d lost all feeling in my left side. I immediately realised I had the symptoms of a stroke and called 999 on my mobile.’

Adrian, who is married with two grown up children, was rushed to hospital, where a scan confirmed he had suffered a haemorrhagic stroke, caused by a blood vessel bleeding in his brain.

This type of stroke is particularly dangerous — a third of sufferers die within 30 days.

Adrian survived his stroke in June 2009, although he has been left with pins and needles and numbness on his entire left side, which cause stiffness and make him tire easily and slur his words.

However, he was alarmed when doctors explained what had probably triggered it — type 2 diabetes, a condition he was diagnosed with just a year before, in 2008.

The condition more than doubles the risk of stroke because it can increase blood pressure.

Unfortunately, while most diabetics are aware of the importance of controlling their blood sugar levels, many don’t appreciate the importance of keeping their blood pressure down, too.

Indeed, strokes among diabetics have reached record highs, according to new figures from the National Diabetes Audit — around 16,000 people with diabetes suffered a stroke in England in 2009/10, a 57 per cent rise since 2006/07.

Being overweight increases the stroke and heart attack risk in us all, but people with diabetes are at high risk even at normal weight because the condition is associated with high blood pressure. This is because in diabetes the cells that line the blood vessels and maintain normal blood pressure can become damaged.

Hidden danger: People with diabetes are at high risk of stroke or heart attack as well as elevated blood sugar levels

Hidden danger: People with diabetes are at high risk of stroke or heart attack as well as elevated blood sugar levels

‘Diabetes damages the walls of all blood vessels both large and small and so does high blood pressure,’ explains Dr Gerry Rayman, head of services at the Diabetes and Endocrine Centre at Ipswich Hospital NHS Trust. ‘The combination can be highly dangerous.’

It is the damage that diabetes does to
the large blood vessels in the brain that causes strokes. These blood
vessels either burst and bleed into the brain, causing a haemorrhagic
stroke, or become narrowed or ‘furred up’, allowing a clot to form and
triggering what is called a thrombotic stroke.

This narrowing is made worse by high
blood fat levels and high blood pressure — both of which are more common
in diabetics — leading to ‘a triple whammy’ effect, as Dr Rayman
describes it.

This is why controlling blood pressure is
so vital. Indeed, the upper target for diabetics is a blood pressure
reading of no higher than 130/80, which is lower than the 140/90 target
for the general population.

7.7bn – The annual cost to the NHS of treating diabetes-related complications

A new survey published by the charity Diabetes UK has found over half of the 2.9 million diagnosed diabetics in Britain have erratic blood pressure. This is significantly more than the 30 per cent of the general population who have high blood pressure.

Diabetics die up to ten years earlier than non diabetics — this is mainly due to complications including stroke, heart attack and kidney failure.

But Dr Rayman says many people with diabetes simply don’t realise the risks.

Type 1 diabetes is an auto-immune condition that usually develops in childhood while type 2 is linked to obesity. High blood pressure is a risk in both, although the incidence is greater in type 2.

‘The problem is that some doctors will try to soften the blow of a type 2 diagnosis by saying it’s “mild” and not as serious as type 1 which requires insulin injections. Being told that it is “a touch of diabetes” and can be controlled by tablets instantly downgrades perception of the risks.

‘But every case of diabetes should be regarded as serious.’

High blood pressure is the second most important symptom to control in diabetes apart from blood sugar, adds Baroness Young, chief executive for Diabetes UK. She believes high blood pressure is becoming the norm amongst diabetics.

Added risk: Diabetes damages the walls of all blood vessels, large and small, and so does high blood pressure

Added risk: Diabetes damages the walls of all blood vessels, large and small, and so does high blood pressure

‘Diabetics need a structured education programme so they realise how serious it is and what the risks are and be offered support to manage their condition.’

There is now greater emphasis on controlling blood pressure in diabetics, using drugs such as beta-blockers and angiotensin-converting enzyme (ACE) inhibitors. But many patients fail to take their medication.

Blood pressure drugs often have side-effects including a dry cough, dizziness and stomach upsets — and consequently research has shown that up to 50 per cent of patients stop taking their drugs within a year.

‘Drug treatment can be tricky in that some people suffer side-effects, but this can be overcome by trying different combinations of drugs,’ says Dr Rayman. ‘The worst thing patients can do is give up taking the tablets completely.’

Lifestyle changes including losing weight, taking more exercise and reducing salt intake can also have a significant impact.

‘Sometimes just taking a pill on its own is not enough,’ says Libby Dowling, clinical adviser with charity Diabetes UK.

Adrian Scott started taking blood pressure-lowering medication after his diabetes diagnosis, but his blood pressure continued to fluctuate. This uncontrolled blood pressure and his weight (at 6ft 6in he weighed 20st) put him at even higher risk of a stroke. Unfortunately, he didn’t appreciate the dangers.


‘I knew my blood pressure was high as my GP would remark there was room for improvement — but I don’t think I realised how big a stroke risk this posed,’ he says.

Like most people, Adrian knew what he should be doing to look after himself, but admits: ‘I suppose I never thought a stroke or a heart attack would happen to me.

‘I thought if you took the pills to control your symptoms — metformin for my blood sugar, blood pressure drugs for my hypertension and statins for my cholesterol — everything would be fine. How wrong I was.’

Indeed, when Adrian was admitted to hospital his blood pressure was sky-high, at 180/120. ‘Now I think that instead of dealing with individual symptoms I should have addressed the systematic cause — my lifestyle,’ he says.

But as Libby Dowling acknowledges, ‘it can be hard to motivate diabetics to make lifestyle changes. Losing weight can be difficult and lots of patients need support to do this.

‘All diabetics should be referred to dietitians for advice about healthy eating, but there are long waiting lists and sometimes that doesn’t happen.’

Adrian’s blood pressure is now much better controlled due to his efforts to eat fresh, home-cooked food in smaller portions, using an exercise bike and rowing machine at the gym twice a week, and reducing his stress levels by working from home more.

‘I’m still struggling with my weight, but I am taking small steps every day to bring it down. It will be a slow process, but I want to get there.’

Although his GP did mention that he should lose weight Adrian feels he was too polite about it.

‘He should have given me a good telling-off,’ he says.

‘When I saw patients in hospital who had been left very badly disabled by a stroke, I wished I’d had the risks drummed into me more. I had a very lucky escape from something far worse.

‘I don’t blame my GP — my health was down to me. And like a lot of people I was in denial.

‘I just wish I’d taken my blood pressure seriously and maybe I could have prevented my stroke.’

Visit diabetes.org.uk; stroke.org.uk/strokemonth