Past Feature Article

Blood Pressure - Under Control

Written By: Linda M. Higgins, R.Ph., Drug Information Specialist

Keeping your blood pressure under control is an important aspect of taking care of yourself. Hypertension (high blood pressure) is twice more likely to occur in people with diabetes than those without. Uncontrolled hypertension increases the risk of heart attack, stroke, heart failure, eye problems, kidney disease and peripheral vascular disease (affects blood vessels outside the heart and brain). Keeping your blood pressure controlled will help delay or prevent other complications.

As many as two out of three adults with diabetes have high blood pressure. It is thought that the link between hypertension and diabetes is related to the increase in blood insulin. Increased blood insulin can affect the kidneys and cause too much salt retention leading to high blood pressure. Also, the increase in blood insulin can promote atherosclerosis (hardening of the blood vessels) which too can lead to an increase in blood pressure.

The following chart shows ranges of blood pressure (BP) levels for adults 18 years and older.

Category	Systolic BP (mm HG)	Diastolic (mm HG)
Normal	less than 120	less than 80
Pre-hypertension	120 - 139	80 - 89
Hypertension - Stage1	140 - 159	90 - 99
Hypertension - Stage2	160 or higher	100 or higher

A more aggressive approach in recent years has occurred to keep blood pressure under control in people with diabetes because of the enhanced risk for coronary disease, vascular disease, and kidney disease. The American Diabetes Association (ADA) and the National Institutes of Health recommend that people with diabetes maintain their blood pressure less than 130/80mmHg. If there is any sign of renal or kidney disease, it is best to try to maintain the blood pressure less than 125/75mmHg.

High blood pressure is considered a “silent killer” or “silent problem”. High blood pressure usually does not cause noticeable symptoms and usually isn’t diagnosed unless your health care provider checks your blood pressure. The ADA recommends that you have your blood pressure checked at every office visit, or at least two to four times a year. Most doctors will diagnose a person with high blood pressure on the basis of two or more high readings, taken on several occasions.

High blood pressure is not curable, but is treatable. Both lifestyle changes and medication help to control blood pressure. Treatment for high blood pressure is individualized and can vary from person to person. Work with your physician to determine the appropriate medication regimen and lifestyle modifications to control your blood pressure.

Lifestyle Changes:

Eating the right types and amounts of foods like fruits, vegetables, beans, whole grains, low fat or fat-free dairy products and lean meats.
Decrease salt intake. Try herbs and spices instead of salt. Read labels to determine sodium content. The current recommendation is to consume less than 2,400mg of sodium a day. Recent research indicates that diets of 1,500mg of sodium a day had even better blood pressure lowering benefits.
Maintaining a healthy weight is important because blood pressure rises as body weight increases. Weight loss of 10 pounds can help lower blood pressure.
Regular physical activity helps to lower blood pressure. Consult your physician before starting an exercise regimen. Moderate exercise such as walking, biking or swimming for 30 minutes may be suggested. Starting gradually and slowly may be needed if you have been inactive.
Speak with your physician to determine if alcohol is safe for you to consume. If so, alcoholic beverages should be limited. Women should drink 1 or fewer alcoholic beverages a day (1 alcoholic drink equals a 12 oz beer, 5 oz glass of wine, or 1&1/2 oz distilled spirits (vodka, whiskey, gin, etc.). Men should drink 2 or fewer alcoholic drinks a day.
Quit smoking. It injures the walls of blood vessels leading to hardening of the arteries

Medications:

There are different types of medications available to control blood pressure. A physician may prescribe one or more medications that work differently to lower blood pressure.

ACE inhibitors (angiotensin-converting enzyme inhibitor) - These medications relax blood vessels to lower blood pressure by preventing a hormone called angiotensin from forming. These medications also help protect the kidneys in patients with diabetes.
ARBs (angiotensin ΙΙ receptor antagonists) - These medications also relax and keep the blood vessels open to help lower blood pressure. Like ACE inhibitors, ARBs also protect the kidneys in patients with diabetes.
Beta blockers- These medications lower blood pressure by reducing the workload on the heart and helping it beat more regularly.
Calcium channel blockers – These medications affect the amount of calcium found in the heart and muscle cells. As a result, the blood vessels relax which lowers the blood pressure and reduces the amount of work the heart has to do.
Diuretics – These medications increase the amount of urine passed to help rid the body of extra water and sodium.

Since high blood pressure is common in people with diabetes, it is necessary to take an active role in the prevention and treatment of this condition. Work with your physician to find the appropriate meal plan, exercise routine and medication regimen to control your blood pressure and blood glucose levels. By doing this, you will help lower your risk of heart disease, stroke, eye problems, kidney problems and nerve disease. This is not always easy and support from family and friends may help to maintain or achieve your goals. Be sure to take advantage of the resources of your diabetes management team. Your Rite Aid Pharmacist is available to help you.