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Treating High Blood Pressure

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Treating High Blood Pressure

If you have diabetes (type 1 or type 2), you are at risk for high blood pressure (hypertension), as well. According to the American Diabetes Association, almost one in three American adults have high blood pressure, and two out of three people with diabetes report taking prescription medications to lower their blood pressure. But do you really need to take medication for your blood pressure? Isn’t cutting back on salt or losing a few pounds enough to get your blood pressure to goal? Let’s take a look at how hypertension is treated.

High blood pressure, defined

You’ve had your blood pressure checked  on countless occasions each time you go to a doctor’s visit. You might have a home blood pressure monitor that your doctor has asked you to use, as well. What do the numbers mean?

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High blood pressure is when blood flows through your arteries at a higher-than-normal pressure. Blood pressure is measured as two numbers: systolic and diastolic. Systolic pressure (the first or top number) is the pressure when the heart beats and pumps blood out of the heart. Diastolic pressure (the second or bottom number) is the pressure between heartbeats. High blood pressure is defined as a sustained blood pressure of 140/90 mmHg or higher.

Left untreated, high blood pressure raises the risk of heart attack, stroke, kidney disease and other health problems.

Blood pressure goals for diabetes

The American Diabetes Association’s Standards of Medical Care in Diabetes — 2021 recommend the following blood pressure goals for people with diabetes:

· Less than 130/80 for those with high blood pressure with existing heart disease or at high risk for heart disease

· Less than 140/90 for those with high blood pressure at a lower risk for heart disease

· 110–135/85 for pregnant women with pre-existing high blood pressure

However, as with blood sugar goals, blood pressure goals should be individualized. That means working with your provider to set a realistic goal that takes into account factors such as heart disease risk, age, presence of kidney disease, lifestyle considerations, possible side effects from medication and patient preference.

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Healthy lifestyle strategies

High blood pressure is treated and managed in a number of different ways. A healthy lifestyle is the cornerstone for everyone who has high blood pressure. That’s because lifestyle management not only lowers blood pressure, it also helps medications work better, improves other aspects of heart health, and, for the most part, has very few adverse effects.

DASH eating plan

A DASH (Dietary Approaches to Stop Hypertension) eating plan focuses on the following:

· Eating vegetables, fruits and whole grains

· Including fat-free or low-fat dairy products, fish, poultry, beans, nuts and vegetable oils

· Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products and tropical oils such as coconut, palm kernel and palm oils

· Limiting sugar-sweetened beverages and sweets.

Another goal of the DASH plan is to reduce the amount of sodium in your diet to less than 2,300 milligrams (mg) daily or, in some cases, less than 1,500 mg daily. To learn more about the DASH eating plan, visit the website of the NIH. Meeting with a dietitian can be helpful, as well; he or she can help you with an eating plan that allows you to meet both your blood sugar and blood pressure targets.

Physical activity

Being physically active is a key part of managing blood pressure. It also helps you manage your blood sugars and your weight, strengthen your heart, lower stress and improve sleep.

Aiming to be active for 30 minutes at least five days a week is the goal. That may seem impossible if you aren’t active now. Keep in mind that shorter sessions of activity count! In other words, start off with five or 10 minutes at a time, and build up to doing five or 10 minutes several times a day. Check with your doctor before starting an activity program. For ideas on how to get started, visit HelpGuide.

Weight loss

Aiming for and reaching a healthy weight can make a big difference in your blood pressure. Even losing just 3% to 5% of your body weight can lead to improvements. Plus, weight loss helps with your diabetes management and other health conditions, too.

Losing weight doesn’t (and shouldn’t) mean going on a drastic diet or cutting out entire food groups altogether. The point is to make reasonable changes that you can stick with long-term. Again, a dietitian can help you get started. Get more ideas here. 

Limit alcohol

Drinking too much alcohol can raise your blood pressure. You don’t necessarily need to stop drinking alcohol, but it’s a good idea to talk with your doctor about what a safe amount is for you. In general, limit alcohol to no more than two drinks a day for men and no more than one drink a day for women. A drink is 12 ounces of beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce 100-proof spirits.

Reduce stress

Stress causes the release of the hormones adrenaline and cortisol, which increase blood pressure. If stress is constant, your blood pressure, along with your blood sugar, can remain high. Plus, stress can lead to some unhealthy habits, such as overeating, not getting enough sleep or drinking too much alcohol.

Find time every day to unwind and “destress.” You don’t need to do yoga or meditate (unless you want to!); going for a walk, taking some deep breaths, keeping a gratitude journal or spending time doing a hobby are great ways banish stress. For more ideas, visit the website of the American Heart Association.

Medication

Lifestyle changes help to lower blood pressure, but sometimes they aren’t enough to get your blood pressure to target. Your doctor may prescribe blood pressure medication, which is used in combination with lifestyle measures. You may even start on medication right away, rather than trying lifestyle changes first. Remember that the goal is to get your blood pressure down to a healthy number and keep you safe.

Depending on your blood pressure reading, your doctor may prescribe more than one blood pressure medicine. For example, if your blood pressure is higher than 160/100, the American Diabetes Association recommends starting on two blood pressure medicines.

There are several classes of blood pressure drugs that are commonly used for people with diabetes. The first two on the list below (ACE inhibitors and ARBs) are recommended as first-line therapy for people with diabetes who have coronary heart disease or who have albuminuria (too much protein in the urine).

ACE (angiotensin-converting enzyme) inhibitors

These medicines help blood vessels to relax and open, which lowers blood pressure. Examples are:

  • Benazepril hydrochloride (brand name Lotensin)
  • Captopril (Capoten)
  • Enalapril maleate (Vasotec)
  • Lisinopril (Prinivil, Zestril)
  • Ramipril (Altace)

ARBs (angiotensin receptor blockers)

These medicines also prevent blood vessels from narrowing. Examples are:

  • Candesartan (Atacand)
  • Irbesartan (Avapro)
  • Losartan potassium (Cozaar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)

Calcium channel blockers

These medicines prevent calcium from entering the cells of the heart and arteries, allowing blood vessels to relax, thereby reducing blood pressure and heart rate. Examples are:

  • Amlodipine besylate (Norvasc, Lotrel)
  • Diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac)
  • Felodipine (Plendil)
  • Nifedipine (Adalat CC, Procardia XL)
  • Verapamil hydrochloride (Calan SR Covera HS, Isoptin SR, Verelan)

Thiazide diuretics

These medicines remove excess water and sodium from the body, which reduces the amount of fluid in the blood. They’re often used in combination with other blood pressure drugs. Examples are:

  • Chlorothiazide (Diuril)
  • Hydrochlorothiazide (HydroDiuril, Microzide)
  • Indapamide (Lozol)
  • Metolazone (Mykrox, Zaroxolyn)

Other classes of blood pressure medicines are available, as well. Beta blockers, for example, are used to help your heart beat slower and with less force. They may be used in people with angina or who have had a previous heart attack.

Another class of drug, called mineralocorticoid receptor antagonists, works to block the effect of aldosterone, a hormone that is made in the adrenal glands. Mineralocorticoid receptor antagonists block the reabsorption of sodium, which leads to water loss and a decrease in blood pressure. These drugs may be used for people with type 2 diabetes who have “resistant” hypertension (hypertension despite being on three classes of blood pressure medication).

Talk with your doctor about the best blood pressure medicine options for you. As with diabetes, everyone is different, and what works for someone else may not be the best choice for you.

More blood pressure advice

High blood pressure is more common in people with diabetes than in people without diabetes. If you have high blood pressure, you may not know it because often, there are no real noticeable symptoms.

  • Make sure your blood pressure is measured at every routine medical visit. And don’t forget to ask for the result once it’s measured.
  • If you’ve been diagnosed with high blood pressure, you should monitor your blood pressure at home. Here are suggestions for choosing a monitor.
  • Take your blood pressure medicine as prescribed, even if you feel well and your blood pressure is at target.
  • Let your doctor know if you have any side effects from your blood pressure medicine. Side effects may include weakness, dizziness, headache, being tired, cough, skin rash or high blood sugar.
  • Everything that you do to manage your diabetes helps your heart health, including your blood pressure.

Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,” “Be Heart Smart: Habits That Can Harm Your Heart,” “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods.”

Living with type 2 diabetes? Check out our free type 2 e-course!

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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