Treating High Blood Pressure in People With Diabetes

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An important part of taking care of yourself is keeping your blood pressure under control. High blood pressure -- also called hypertension -- raises your risk for heart attack, stroke, eye problems, and kidney disease. As many as two out of three adults with diabetes have high blood pressure. Having your blood pressure checked regularly and taking action to reach your blood pressure target can prevent or delay diabetes problems.

What is high blood pressure?

Blood pressure is the force of blood flow inside your blood vessels. When your health care team checks your blood pressure, they record two numbers, such as 130/80 mmHg. You'll hear them say this as “one-thirty over eighty.” Both numbers are important:

• The first number is the pressure as your heart beats and pushes blood through the blood vessels. Health care providers call this the “systolic” pressure.
  

• The second number is the pressure when the vessels relax between heartbeats. It's called the “diastolic” pressure.
  

When your blood moves through your vessels with too much force, you have high blood pressure. Your heart has to work harder when blood pressure is high, and your risk for diabetes problems goes up. High blood pressure is a problem that won't go away without treatment.

What is the recommended target for blood pressure?

Both diabetes and high blood pressure increases your risk of heart attack, stroke, and eye and kidney disease. Because of this, people with diabetes have a lower blood pressure target than the general public. The American Diabetes Association (ADA) and the National Institutes of Health recommend a target blood pressure of less than 130/80 mmHg for people with diabetes. When you keep your blood pressure below 130/80 mmHg, you'll be lowering your risk for diabetes problems.

How will I know if I have high blood pressure?

High blood pressure is a silent problem -- you won't know you have it unless your health care provider checks your blood pressure. The ADA recommends that you have your blood pressure checked at every office visit, or at least two to four times a year.

What treatments are recommended?

Both lifestyle changes and medication help control blood pressure. Treatment differs from one person to the next. Work with your health care provider to find a treatment that's right for you.

Lifestyle changes

Lifestyle changes can help control your blood pressure as well as your blood glucose and blood lipids (cholesterol) levels. From the steps below, decide which steps you would be willing to try.  If you need more information about how to make these changes, talk with your health care team.

Make Wise Food Choices

• I'll eat a serving of fruit at each meal.
  

• I’ll eat one or two servings of vegetables at lunch and at dinner.
  

• I’ll switch to low-fat or fat-free dairy products (such as low-fat cheese and skim milk).
  

• I’ll eat whole-grain breads (such as whole-wheat bread) and cereals.
  

• I’ll eat nuts or peanut butter sometimes.
  

• I’ll choose lean meats and meat substitutes (such as chicken without the skin, fish, lean beef such as flank steak or chuck roast, boiled ham, or pork tenderloin).
  

• I’ll cook using low-fat methods such as baking, roasting, broiling, or grilling.
  

• I’ll add little or no salt to my food at the table and during cooking.
  

• I’ll try herbs and spices instead of salt
  

• I’ll check food labels and choose foods with less than 400 mg of sodium per serving.
  

Lose Weight or Take Steps to Prevent Weight Gain

• I’ll cut down on calories and fat.
  

• I’ll try to be more physically active than I am now.
  

Be Physically Active

• Before I start a new routine, I’ll check with my doctor to find out which activities will be safe for me.
  

• I’ll try to do a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.  If I’m just starting out, I’ll start off with 5 minutes a day and gradually add more time.
  

Be Careful With Alcohol

• I’ll talk with my health care team about whether it’s wise for me to have alcoholic beverages.
  

• If and when I drink alcoholic beverages, I’ll limit myself to one serving a day (for women) or two servings a day (for men).
  

Quit Smoking

• I’ll talk with my health care team about methods that can help.
  

Medications

Several types of medication are available.  Not everyone takes the same blood pressure medication, and many people take more than one kind. Which ones you take will depend on your blood pressure readings and other factors such as cost.

ACE inhibitors -- These medications lower blood pressure by keeping your blood vessels relaxed. ACE inhibitors prevent a hormone called angiotensin from forming in your body and narrowing your blood vessels. These medications also help protect your kidneys and reduce your risk of heart attack and stroke.

ARBs -- These medications keep the blood vessels open and relaxed to help lower blood pressure. Like ACE inhibitors, ARBs protect your kidneys.

Beta blockers -- These medications help lower blood pressure and relax your heart by allowing it to beat slower and less forcefully. Beta blockers help prevent heart attack and stroke.

Calcium channel blockers -- These medications help the blood vessels relax by keeping calcium out of your blood vessels and heart.

Diuretics -- These medications, sometimes called “water pills,” help rid your body of extra water and sodium through urine.

Am I likely to have side effects from my medications?

Some blood pressure medications produce side effects. Always talk to your health care team if you think your medication is causing a problem. Your health care team may be able to substitute another medication.