Hypertension and Diabetes: Evil Twins

How is your blood pressure? Studies show that high blood pressure (also known as hypertension or HTN) can cause and worsen many diabetes complications. So what makes blood pressure go up, and how can you get it down?


Diabetes and high blood pressure are closely related. In fact, the majority of people with diabetes also have high blood pressure. Both can damage blood vessels, injuring hearts, kidneys, eyes, sexual organs, and more.

Both have dozens of drug treatments — at least ten different categories of drugs for each condition. High blood pressure and Type 2 diabetes have similar causes, including bad food, lack of physical movement, and stress.

According to the blog Diabetes Update, having higher-than-normal blood glucose may raise blood pressure by forcing the heart to pump harder. Or insulin resistance may in some way raise blood pressure. Anyway, they go together, and both need to be taken seriously.

What is high blood pressure?
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 vessels are to become damaged.

Blood pressure is measured in millimeters of mercury (mmHg) and is 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.

Medical guidelines
So how high is too high, and what can you do about it? The American Diabetes Association (ADA) guidelines say a blood pressure level of greater than 140/80 should be treated with drugs. Anyone over 120/80 should be advised on “lifestyle changes.”

By drugs, the ADA means “an ACE inhibitor or an angiotensin receptor blocker (ARB).” ACE inhibitors and ARBs both block the action of angiotensin, a body chemical that narrows blood vessels.

ACE inhibitors usually have generic names ending in “pril,” like lisinopril or captopril. These drugs seem to protect kidneys, which makes them good choices for people with diabetes.

ARBs’ generic names end in “sartan” like losartan and olmesartan. They are similar to ACE inhibitors but may have fewer side effects. Both categories are widely available in generics, so they should be affordable.

There are at least nine other categories of blood pressure drugs, including water pills (diuretics) and beta blockers, which block adrenalin action. The ADA cautions that “Multiple-drug therapy (two or more agents at maximal doses) is generally required to achieve blood pressure targets.”

If you need “two or more agents at maximal doses,” that means these drugs aren’t very effective. So maybe there are other things we can do.

One thing is diet. The ADA recommends a

Dietary Approaches to Stop Hypertension (DASH)-style dietary pattern including reducing sodium and increasing potassium intake; moderation of alcohol intake; and increased physical activity.

The DASH diet “emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts.” Sounds healthy, but because high blood pressure and diabetes are so closely linked, whatever diet brings your blood sugar down will probably be good for your blood pressure, too.

People with high blood pressure are usually advised to follow a low-sodium diet. Avoiding packaged foods and sauces and using spices other than table salt are the best ways to reduce sodium.

Exercise is good for both diabetes and blood pressure. Vigorous, moderate, or mild exercise is all good. Aerobic exercises or meditative exercise like yoga and tai chi seem to help, but strenghtening and stretching exercises can have benefits as well. For blood pressure, I would go with what makes you feel the most relaxed during and afterward.

Alternative approaches
Since high blood pressure drugs aren’t very effective, you might want to supplement them with other scientifically supported approaches.

• Home monitoring. Checking your blood pressure regularly will show you what makes it go up and down. You could use it to determine what kind of exercise is best for you. In studies, people who home monitored reduced their blood pressure by 10 to 20 points.

Magnesium supplements. Take 500 to 1000 milligrams a day.

• Herbs. Cinnamon, cardamom, garlic, and many other herbs have been shown to lower blood pressure. Cinnamon also reduces blood sugar, so probably we should all be taking it.

• Aromatherapy. Some scents cause relaxation and have been shown to lower blood pressure. One is lavender. You can put some on your skin, spray some in the air, or put a lavender cachet in your room.

Amy Campbell gave some other suggestions in this blog entry.

• Relaxation may be the most important thing. Reduce your stress. Talk less, because talking raises blood pressure. (Check your blood pressure when you’re talking and see how high it goes.) Pay more attention to your breathing.

One would think treatment of a condition called “hypertension” would include relaxation, but doctors rarely prescribe it. The UK Hypertension Society’s guidelines don’t even mention relaxation, meditation, or prayer.

For me, true relaxation was the answer. I was running high (150/100), and I am not insulin resistant. For me, it was all about stress, and I needed some peace. When I learned to stop worrying, my blood pressure dropped to 125/75.

There are different kinds of high blood pressure, and people with diabetes may need different approaches, including drugs. But I think everyone will benefit from finding peace. These are stressful times. There’s too much to worry about. But if you get your blood pressure under control, you will probably feel less anxious. I do.

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  • jim snell

    thank you David Spero for excellent article.

    I am on pills plus diet and finally arrested the
    high blood pressure.

    This is non trivial and your excellent blog addresses this issue.

    Blessings and thanks.

  • Joe

    In the US and UK, relaxation is a dirty word. People who rest -even when seriously ill- are seen as lazy and people who meditate are labeled wackos. Prayer is OK, as long as you keep it brief and centered around a political agenda rather than spiritual fulfillment.

    We are urged starting with preschool to drone away until we drop, and then go quickly so we’re not a drain on the economy.

    Sounds jaded, eh? Forty years in the US workforce will do that to you. Remember, we had to pass a law in this country to keep employers from firing people because they took time off to care for their sick child. And we wonder why the’re is an epidemic of high blood pressure?

  • Joseph Marcincuk

    I was wondering whether you advocate Transcendental Meditation (as taught by a licensed instructor) which I have read is good for shaving 2-3 points off one’s blood pressure and seems pretty natural. I find it ironic to think that diabetics who spend so much time monitoring their blood glucose levels would jump at the chance to engage in more self-monitoring (their blood pressure) although I hope those blood pressure measurers on the exercycles at the gym are accurate…

  • David Spero RN

    Joe, I agree with you. Both the epidemics of hypertension and Type 2 diabetes are socially caused. A spiritual and/or a social revolution might help.

    Joseph, I think TM or any other kind of meditation will be a good plan for you. Just give it time, because it takes practice before you start seeing benefits. We wrote about it here.

  • Bean Bag

    Interesting about the relaxation part. I tried meditation (one episode Al Sears method this time) and found my BP went even higher after.

    I never liked meditating, instead of relaxing it gave me the opportunity to spin thoughts in my head over and over and worry about a bunch of problems.

    It got to the point where I worried every second if I was really meditating.

    Maybe that lavender thing might work. Haven’t tried it.

  • Joe

    Bean Bag, There are ways to meditate without what people traditionally think of as “meditating.” Do something relaxing that causes you to focus on something -anything- other than your worries.

    If I can get outside on a nice day I will sit quietly and observe nature. I might watch a particular bird or squirrel and just focus on everything the animal does. Other times I will concentrate on how many smells I can detect on the breeze. Other times it’s sounds, or if I’m near a beach, waves. Waves are particularly good for me. The point is to focus away from worrying thoughts onto something simpler and enjoyable for you. My wife likes the sound of fountains. Whatever you choose, if you enjoy it and can focus on it, you will reap the same benefit as sitting in the lotus position chanting.

    Some people use recordings of sounds, although I don’t find them as effective as nature first hand. And fresh air is *always* good, even if you’re only on a balcony.