Diabetes Self-Management Blog

Diabetes care usually focuses on blood glucose. But blood pressure (BP) is just as important. High blood glucose and high blood pressure (also called “hypertension”) can both damage blood vessels in similar ways. So you want to control your pressure. But how?

A quick overview of the basics: Blood pressure is a measurement of the force against the walls of your blood vessels as the heart pumps blood through your body. The more force, the more likely your arteries are to become blocked. Blood vessel problems cause many of the complications of diabetes.

Blood pressure readings are measured in millimeters of mercury (mmHg) and are usually given as two numbers — for example, 120 over 80 (written as 120/80 mmHg). The numbers refer to how high the pressure in your arteries could push a column of mercury up a narrow tube.

The first or top number is “systolic” pressure — how hard the blood is pushing during a heartbeat. The second or bottom number is the “diastolic” pressure, when the heart is resting between beats.

According to the National Institutes of Health (NIH), systolic pressure is considered high if it is over 140 most of the time and normal if it is below 120 most of the time. Diastolic pressure is considered high if it is over 90 most of the time and normal if it is below 80 most of the time. A systolic pressure from 120 to 140, or a diastolic from 80 to 89 is classed as “prehypertension.”

According to the American Diabetes Association (ADA), two out of three adults with diabetes have hypertension. To protect blood vessels at risk from diabetes, ADA has long recommended keeping systolic blood pressure below 130, which is tough. Now a new analysis from the INVEST study shows that a systolic below 140 (“moderate control”) is just as good as one below 130 (“tight control”), in terms of preventing heart attack or stroke.

People in the moderate range actually had lower death rates than the tight control group. The over 140 (“uncontrolled”) group had more heart problems and deaths than either of the other groups, but this group included many people with sky-high numbers, not just those a bit over 140.

Self-managing blood pressure
Controlling blood pressure is much like controlling glucose. Whatever diet seems to help your blood glucose is probably also good for your blood pressure. The ADA recommends a low-fat diet; others say low-carbohydrate, and still others, including me, think some kind of Mediterranean diet is best for many people.

But you have to find out for yourself what works for you. Just as in monitoring blood glucose, you can monitor blood pressure with a home monitor. And it doesn’t involve any finger pricks! One study found that frequent monitoring of blood pressure was an effective way to reduce it. This makes sense, because by frequent checking, people can find out what makes their pressure go up and what makes it drop.

Tip: Don’t talk or multi-task while you’re checking your BP. Talking makes most people’s numbers go way up.

One dietary consideration is that hypertension calls for using less sodium. Eating sodium can raise blood pressure, so be very careful about any packaged, canned, or processed food — they’re full of the stuff. Read the labels or eat whole foods. ADA says, “choose foods with less than 400 mg of sodium per serving.” For flavor, try other herbs and spices to replace salt.

Exercise also helps a great deal. And of course, quitting smoking, because nicotine squeezes your blood vessels.

What about relaxation?
Stress raises BP, so relaxation should lower it. Some studies have shown that meditation leads to significant reductions in BP. A study of nearly 600 people in Taiwan and Hawaii found that practicing relaxation each day led to an average systolic BP drop of 11 points, and a diastolic drop of 4.8 points. But frequent monitoring was almost as effective.

I think the effectiveness of relaxation is highly dose-dependent. That means the more you do, the more benefit you will receive. A few minutes a day is probably not enough to make much difference. See this article for some relaxation ideas.

What about drugs?
The sad truth is that today’s world is so stressful that many people can benefit from medicines to reduce blood pressure. All these medicines have side effects, so you need to monitor yourself carefully, report back to your doctor, and be prepared to change medicines several times before you find one or two that work for you.

According to NIH, there are nine different types of blood pressure meds. “Diuretics” are sometimes called “water pills” because they work by flushing excess water and sodium from the body. You usually need to take supplementary minerals like potassium to replace what gets flushed. All the other categories relax blood vessels in various ways. You need to check with your doctor and your pharmacist and educate yourself about which, if any, of these medicines might be best for you.

There are also herbs that may lower blood pressure safely for some people. (Be sure to speak with your doctor if you are considering any herbal treatments for high blood pressure.)

I have to admit I am just learning about the details of hypertension, and I’ve crept into the “prehypertensive” range myself. Have you dealt with hypertension in your life? What has worked for you and what hasn’t?

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