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Updated April 30, 2008

Navigating Your Way to Optimal Health

by Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Gregory Hood, M.D.

The goal for blood pressure for adults with diabetes is less than 130/80 mm Hg. If your blood pressure exceeds this level, your diabetes care team will likely recommend that you reduce your sodium intake and increase your intake of fruits, vegetables, and low-fat dairy products; avoid excessive alcohol consumption; increase your level of physical activity; and make an effort to lose weight if you’re overweight.

You may also be prescribed blood-pressure–lowering drugs if lifestyle measures don’t produce the desired change or if your blood pressure is higher than a certain cutoff. People with a systolic blood pressure of 130–139 mm Hg or a diastolic blood pressure of 80–89 mm Hg are usually advised to start with lifestyle and behavior changes alone, and if target blood pressure levels are not reached in three months, to begin drug therapy. People with a systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure 90 mm Hg or higher are usually advised to start blood-pressure–lowering drug therapy right away, in addition to lifestyle and behavior changes.

Taking care to lower blood pressure gradually to avoid any complications is a goal for elderly people. If medicine is necessary, your physician will likely prescribe either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). It is not uncommon for two or three different drugs to be used to reach blood pressure goals. It is important to be aware that ACE and ARB therapy, as well as some other antihypertensive drugs, should not be used during pregnancy.

Smoking cessation. Cigarette smoking contributes to one of every five deaths in the United States and is the leading avoidable cause of premature death. Smoking is related to the early development of cardiovascular disease as well as the microvascular complications of diabetes (such as eye and kidney disease). If you are a smoker, you and your physician should discuss a plan for quitting. Counseling or other forms of treatment should be a routine part of your diabetes care.

Aspirin therapy. If you are over 40 years old, your physician will recommend aspirin therapy to prevent cardiovascular events, including stroke and heart attack, unless there is a reason for you not to use it. Research has shown reductions of 20% in strokes and 30% in heart attacks with aspirin therapy. Although doses of 75 to 325 mg a day have been studied, there is no evidence to support a specific dose, so using the lowest possible dose may help reduce side effects.

Everyone with diabetes should consider aspirin therapy except those under the age of 21 because of an increased risk of a rare but potentially deadly disorder called Reye syndrome, which is associated with viral infection and aspirin use in this age group. The beneficial effects of aspirin therapy have also not been studied in people younger than 30.

Preventing other complications
Retinopathy (diabetic eye disease) is the leading cause of new cases of blindness in adults under age 65. Uncontrolled blood glucose levels damage small blood vessels in the eye, weakening the blood vessel walls and allowing fluid or blood to leak into the retina, the light-sensitive part of the eye that sends visual signals to the brain. The presence of retinopathy is strongly related to how long a person has had diabetes. In people with Type 1 diabetes, retinopathy rarely appears before the fifth year of having the condition; however, the risk for retinopathy is greater for people with Type 1 than for those with Type 2 diabetes.

High blood pressure and nephropathy (kidney disease) are also associated with an increased risk of retinopathy. The risk for retinopathy can be reduced with control of blood glucose and blood pressure levels.

Also in this article:
Monitoring for Control and Complications
Symptoms of Diabetes

Laura Hieronymus is the program coordinator for an American Diabetes Association–recognized education service, and Gregory Hood is a practicing internist. They are diabetes care and education providers at Drs. Borders & Associates, PSC, in Lexington, Kentucky.

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