Hypertensive individuals prone to develop diabetes

One in every 4 individuals with high blood pressure or hypertension may be more likely to develop diabetes, suggests a multi-country study with icddr,b.

Diabetes prevalence is rising rapidly in middle- and low-income countries. Photo: GMB Akash / icddr,b

Published in Journal of Obesity, the recent findings emerged from COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka) multi-country study being conducted since 2016 with icddr,b, based on analysis of around 2500 hypertensive individuals’ data from rural regions in the three countries.

Dr Aliya Naheed, head of Initiative for Non Communicable Diseases at icddr,b and the Bangladesh lead of COBRA BPS, shares that around 23 percent of hypertensive individuals in Bangladeshi rural communities were found experiencing diabetes.

Additionally around 24 percent were found with borderline diabetes (prediabetes), which indicate that around 47 percent of the individuals living with hypertension are at a high risk of developing complications related to diabetes.

The researchers defined prediabetes as fasting plasma glucose (FPG) between 100 and 125 mg per decilitre (dL) without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication.

The estimates in Bangladesh is lower than  that in Sri Lanka where individuals had the highest crude prevalence of ‘prediabetes or diabetes’ (73.1 percent) with hypertension, but higher than that in Pakistan (39.2 percent).

People with hypertension should watch their food and be physically active. Photo: David Hold / CC BY-SA 2.0

“Our research also found that the risk of developing diabetes is higher with individuals who are aged, have more education, or better socio-economic status,” says Dr Naheed.

“It was interesting to observe that those with a greater waist (bigger tummy) had a higher possibility of developing diabetes along with hypertension. This was not detected when a hypertensive patients had a higher body mass index (BMI), which is commonly used for measuring obesity and overweight,” she adds.

“This suggests that people with hypertension should watch their food everyday and be physically more active when they find their tummy size is increasing” she alerted.

World Health Organization (WHO) cautions that diabetes prevalence has been rising more rapidly in middle- and low-income countries. Dr Naheed stressed that urgent public health efforts are needed to integrate diabetes screening and control within hypertension management programs in rural Bangladesh and other countries in South Asia.

She strongly emphasised the roles of community health workers and media for increasing public awareness about self-screening of waist circumference and promotion of lifestyle modifications for reducing the risk of diabetes among the hypertensive patients.

The COBRA-BPS intervention strategy is a simple pathway for integrating management of hypertension in primary care facilities, and strengthening capacity of the government health work force, by providing health information materials which enable workers to promote healthy eating, physical activity, weight management and control of blood pressure among hypertensive individuals.

Supported by Joint Global Heath Trials Scheme of the UK Department for International Development, the Medical Research Council, and the Wellcome Trust, the trial is expected to provide evidence of a pragmatic low-cost solution for preventing the premature deaths from NCDs in South Asian countries.