Past Feature Article

Diabetes and High Blood Pressure - A Combo which Should not be Ignored!

By: David Saljoughian, Rite Aid Pharmacist at Store 5933 in Orinda, California

Having high blood pressure and diabetes can result in serious complications, so it should not be ignored! High blood pressure (hypertension) also occurs more commonly in people with type 2 diabetes than in people without diabetes, and because it is a "silent" disease with no obvious symptoms, many people do not seek medical attention.

High blood pressure contributes to the development and progression of the long term complications of diabetes, such as eye disease, kidney disease, and various forms of heart disease. According to the guidelines of the American Diabetes Association, people with diabetes should maintain their blood pressure less than 130/80 mmHg to reduce the risk of these complications. Because high blood pressure can further aggravate the kidneys, people with any signs of kidney disease, should maintain their blood pressure less than 125/75 mmHg.

Your doctor or another health care provider should check your blood pressure at every visit, though your doctor may also request that you check your blood pressure at home to see how it runs at different times throughout the day. More than one blood pressure check from your doctor is required to confirm a diagnosis of hypertension. Several research studies have shown that good blood pressure control reduces the risk for heart disease (including heart attacks and stroke), kidney disease, eye disease, and even complication associated deaths.

People with diabetes should make a plan to reduce their high blood pressure with the assistance of a dietitian and a health care provider using the following helpful hints:

Lifestyle changes in people with diabetes have been proven to help with blood pressure control. Weight loss of even 10 to 20 pounds can help control elevated blood pressure in people who are overweight. This can be achieved with mild calorie restriction (250-500 less calories per day).
Many people with diabetes are sensitive to sodium and will benefit from limiting the amount of salt in their diets. We should remember that most of the salt that we eat comes from processed (packaged) foods which should be eliminated or at least reduced from the diet. Sodium intake should be less than 2400 mg (one teaspoon) per day.
Alcohol should be limited to no more than 2 drinks per day for men and no more than one drink per day for women. One serving is equal to 1 ounce of liquor, 5 ounces of wine, or 12 ounces of beer.
Smoking cessation is highly recommended in people with diabetes with high blood pressure. Many nicotine replacements such as patches, gum, spray or inhalers, are now available to help people quit smoking.
Regular physical activity plays a vital role in preventing cardiovascular disease, and it improves blood sugar levels as well. People with diabetes should consult with their health care provider prior to starting a physical activity program. Moderate physical activity such as walking or riding a stationary bicycle for 30 minutes each day is encouraged. Activity can even be split into several 5 to 10 minute segments throughout the day.
Finally, stress management training may help the person with diabetes to handle stressful life situations and help with positive lifestyle changes.

Drug Therapy:
People who have diabetes and have consistent blood pressures readings greater than or equal to130/80 mmHg (or 125/75 mmHg with kidney disease), but less than 140/90 mmHg should work on lowering their blood pressure through lifestyle modifications for about three months. If they have not achieved their blood pressure goals at that time or if their blood pressure is consistently greater than or equal to 140/90 mmHg to start, drug therapy will probably be necessary to control their blood pressure and prevent diabetic complications. In general, most people with diabetes may need more than one type of high blood pressure medication. A physician will select one or more blood pressure medications by the individual drug?s capacity to lower blood pressure, protect the kidneys from injury, and avoid side effects. Angiotensin-converting enzyme (ACE)- inhibitors and angiotensin II receptor blockers (ARBs) are usually recommended for lowering blood pressure in patients with diabetes because they also have kidney-protective effects. Many blood pressure medicines also require certain blood tests to be monitored. Be sure to ask your doctor if you need any follow-up lab work when starting a new medication. Blood pressure medicines are also very important to take it exactly as prescribed to achieve the desired result of lowered blood pressure.

It must be emphasized again that high blood pressure, regardless of its cause, is one of the primary risk factors for heart disease, stroke, kidney disease and diabetes. Reaching goals for blood pressure and blood glucose are not always easy and on-going support from family and friends may be necessary to help make and maintain the changes necessary. Most importantly, however, people with diabetes must take an active role in their own diabetes care plan to successfully meet their goals.

References

American Diabetes Association. Position Statement. Treatment of hypertension in adults with diabetes, Diabetes Care. 2002; 25:S71-S73.
Grossman E, Messerli FH, Goldbourt U. High blood pressure and diabetes mellitus: are all antihypertensive drugs created equal? Arch Intern. Med. 2000; 18:1345-1346.
Guzman CB, Sowers JR. Special considerations in the treatment of diabatic hypertension Prog. Cardiovascular Dis. 1999; 41:461-470.
Gress TW, Nieto FJ, Shahar E, et al. Hypertension and anti-hypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J. Med. 2000; 342:905-912.