If a curable form of hypertension is found and treated, long-term drug therapy may be avoided. However, in many cases, treatment of the cause does not lead to complete resolution of the elevated blood pressure, and some blood pressure drugs are still needed to keep the blood pressure at goal level (below 130/80 mm Hg).
According to a national committee on hypertension, two of the most important aspects to successfully treating high blood pressure are a trusting relationship with your doctor and the motivation to succeed. Setting goals is the next step and when diabetes and hypertension coexist, the goal is to consistently maintain a blood pressure level lower than 130/80 mm Hg. Lifestyle changes are central to improving blood pressure control in hopes of avoiding or reducing the need for medicines. A heart-healthy lifestyle also improves the effectiveness of medicines when they are needed.
In people who don’t have diabetes but do have blood pressures above 130/80 mm Hg, a period of treatment with lifestyle changes alone can be considered. In people with diabetes, the risk of heart disease, stroke, and kidney failure is so much higher that current guidelines recommend initiating drug therapy at the same time as lifestyle changes.
There is enormous overlap between the lifestyle measures that are beneficial for high blood pressure and those that are helpful for controlling diabetes. Performing regular exercise, losing excess weight and keeping it off, and getting adequate sleep are a start. Studies suggest that your blood pressure may decrease 3–5 mm Hg for every 10 pounds of excess weight lost.
Losing weight is extremely challenging, but the health benefits of doing it are substantial. A sensible reduction in calorie intake along with a regular exercise program is the best way to gradually reduce your weight. Moderate-intensity exercise such as brisk walking is felt to be safer than very vigorous exercise. Intense exercise such as heavy lifting or snow shoveling can raise the blood pressure briefly and stress the heart too much. On the other end of the spectrum, very slow movements such as those done in yoga or tai chi may lower blood pressure.
Reducing sodium intake can be effective in lowering blood pressure. Some people are more sensitive to salt than others, meaning that their blood pressure has a more exaggerated response to salt. People with diabetes and people who are obese tend to be salt sensitive. A low-salt diet has been associated with a reduced risk of cardiovascular disease. Reducing sodium intake to below 2400 milligrams daily has significant benefits for blood pressure, but it can’t be done by just avoiding table salt since the majority of sodium in American diets comes from processed foods. Reading food package labels to select low-sodium foods is therefore also important. Other dietary changes that are helpful include moderating intake of alcohol and caffeine.
It is unclear why, but a vegetarian diet has been shown to have beneficial effects on blood pressure. This is possibly related to an increased intake in fruits and vegetables as well as lower saturated and total fat intake. The DASH diet (Dietary Approaches to Stop Hypertension) is rich in fruits, vegetables, and low-fat dairy products while avoiding saturated fats. It also provides plenty of calcium, potassium, and magnesium, which are important for lowering blood pressure. The combination of salt restriction and the DASH diet is a great start to improving your blood pressure. Information on the DASH diet is readily available on the Internet at www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.