Blood Pressure and HbA1c Levels: Key Insights for Patients

Issues related to blood pressure and glycated hemoglobin?

1.
My father is 71 years old.
During his health check-up, his hemoglobin A1c level was 6.1.
The criteria for passing at the clinic is below 6.
The physician there mentioned that levels below 6.7 do not qualify as diabetes.
However, my research indicates that the threshold is 6.5, and that levels below 6.5 typically do not require medication, just monitoring and lifestyle management.
Despite this, the physician prescribed medication for my father.
After three months of medication, his hemoglobin A1c level decreased to 6.2.
Is this normal? When my father asked the physician, he suggested continuing the medication to prevent his levels from rising to diabetes, but also mentioned that my father could decide whether to continue the medication.
I find this advice unreliable and am quite concerned, so I am seeking your opinion.
Thank you.
2.
The second point is my personal concern.
I have been underweight since childhood.
I am currently 30 years old, 166 cm tall, and weigh 48 kg.
My blood pressure readings are consistently low; today's measurement was 86/59.
The doctors have said that my blood pressure is low but attributed it to my low weight, advising me not to worry too much.
Is this accurate?

Acan, 20~29 year old female. Ask Date: 2021/05/15

Dr. Li Jian reply Internal Medicine

A hemoglobin A1c level of 6.5 or higher can diagnose diabetes.
If the hemoglobin A1c continues to rise, early intervention with glucose-lowering medications may be considered to prevent the onset of diabetes; however, these medications may require out-of-pocket expenses.
For low blood pressure, a consultation with a cardiologist may be appropriate.

Reply Date: 2021/05/15

More Info

Understanding blood pressure and HbA1c levels is crucial for managing health, especially for individuals with risk factors such as age, weight, and family history of diabetes. Let's break down your concerns regarding your father's HbA1c levels and your own blood pressure readings.

1. Understanding HbA1c Levels
Your father's HbA1c level of 6.1% is indeed below the threshold of 6.5% that is typically used to diagnose diabetes. The American Diabetes Association (ADA) defines diabetes as an HbA1c of 6.5% or higher. However, the recommendation to start medication at an HbA1c of 6.1% may stem from a more conservative approach taken by some healthcare providers, especially in older adults or those with other risk factors for diabetes.
The rationale behind this could be to prevent the progression to diabetes, as even slightly elevated HbA1c levels can indicate an increased risk for cardiovascular disease and other complications. The fact that his HbA1c decreased to 6.2% after three months of medication suggests that the treatment is having a positive effect, albeit modest. It is not uncommon for HbA1c levels to fluctuate slightly with treatment, and a decrease, even if small, can be a sign of effective management.

If your father is concerned about the necessity of medication, it may be beneficial for him to have a detailed discussion with his healthcare provider about the risks and benefits of continuing medication versus lifestyle modifications such as diet and exercise. Regular monitoring of his HbA1c and blood glucose levels will help in making informed decisions about his treatment plan.

2. Understanding Low Blood Pressure
Regarding your own blood pressure readings, a measurement of 86/59 mmHg is indeed considered low (hypotension). While low blood pressure can be a normal finding for some individuals, especially those who are lean or athletic, it can also lead to symptoms such as dizziness, fainting, or fatigue. If you are asymptomatic and your healthcare provider has assessed that your low blood pressure is not causing any health issues, it may not be a cause for concern.

However, it is essential to monitor how you feel with these readings. If you experience symptoms like dizziness or fainting, it would be wise to consult a healthcare provider. They may recommend lifestyle changes, dietary adjustments (like increasing salt intake if appropriate), or further evaluation to rule out any underlying conditions that could be contributing to your low blood pressure.

Conclusion
In summary, your father's HbA1c level of 6.1% is a point of concern for some healthcare providers, leading them to recommend medication to prevent progression to diabetes. It is essential to have open communication with his healthcare provider regarding the treatment plan. For your low blood pressure, while it may be benign, monitoring your symptoms and discussing them with your healthcare provider is crucial for ensuring your overall health.
Both situations highlight the importance of individualized care and the need for ongoing dialogue with healthcare professionals to ensure that treatment plans align with personal health goals and conditions.

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