Diabetes and Hypertension

High blood pressure, or hypertension, is a condition that often affects people with type 2 diabetes. It is unknown why there is such a significant correlation between the two diseases, but it is widely assumed that obesity, a high-fat, high-sodium diet, and inactivity have led to a concurrent rise in both conditions. 

Hypertension is known as a "silent killer" because it has no symptoms. A 2002 survey by the American Diabetes Association (ADA) found that "sixty-eight percent of people with diabetes were unaware of their increased risk for heart disease and stroke [as it related to chronic hypertension]."

If you have hypertension, it means that your blood is pumping through your heart with too much force. Over time, consistently high blood pressure tires the heart muscle and can enlarge it. In 2008, 67 percent of adults aged 20 and over with self-reported diabetes had blood pressure rates of greater than 140/90.

In healthy people, a blood pressure reading of 140/90 is considered normal, but for type 2 diabetics, doctors recommend keeping readings lower: 135/80.

What does this mean? The first number (135) is called the systolic pressure; it indicates the pressure as blood pushes through your heart. The second number (80), called the diastolic pressure, is the pressure maintained by the arteries between heartbeats. Healthy people should get their blood pressure checked several times a year, but diabetics need to be more vigilant. In addition to having your pressure checked at least four times each year, the ADA recommends self-monitoring at home, recording the readings, and sharing them with your doctor.

Risk Factors for Hypertension With Diabetes

According to the ADA, the combination of hypertension and type 2 diabetes is particularly lethal and can significantly raise a person's risk of having a heart attack or stroke.

"Research in the last decade has found that lowering blood pressure in patients with type 2 diabetes leads to sizable reductions in death rates. Many experts believe that lowering blood pressure may be the most important step—even more important than reducing blood sugar—that people with diabetes can take." Having type 2 diabetes and high blood pressure also increases your chances of developing other diabetes-related diseases, such as retinopathy, which may cause blindness, and kidney disease.

There is also significant evidence to show that chronic hypertension can speed the arrival of cognitive problems associated with aging, such as Alzheimer's disease and/or dementia. That is because the blood vessels that supply the brain can become blocked with fatty deposits just like the heart. In a 2009 Clinics in Geriatric Medicine article, Dr. Obisesan wrote, "Hypertension is recognized as the most consistent risk factor for stroke and, importantly, Alzheimer's disease."

Many factors put people at greater risk for high blood pressure besides uncontrolled diabetes. Remember, your chances of having a heart attack or stroke are raised exponentially if you meet more than one of the following risk factors:  

  • family history of heart disease
  • stress
  • high-fat, high-sodium diet
  • sedentary lifestyle
  • advanced age
  • obesity
  • smoking
  • too little potassium or vitamin D
  • too much alcohol
  • chronic diseases like kidney disease, diabetes, and/or sleep apnea 

Preventing Hypertension With Diabetes

There are many minor lifestyle changes that can lower your blood pressure. Most are dietary, but daily exercise is always included and is mandatory. Most doctors advise walking briskly for 30 minutes every day, but any aerobic activity can make your heart healthier. The American Heart Association recommends a minimum of "150 minutes per week of moderate-intensity and/or 90 minutes per week of vigorous cardio-respiratory exercise." 

In 2009, Diabetes Care touted the effectiveness of exercise to make the diseased heart stronger. "The normal aging process is associated with vascular stiffness, a process that is accelerated by type 2 diabetes; [however]…the stretching of collagen fibers during aerobic exercise can result in a decrease of arterial stiffness," wrote Dr. Kenneth M. Madden.

Work directly with your doctor to develop an exercise plan, especially if you haven't exercised before, are trying something more strenuous, or if you are having trouble meeting your goals. Start with five minutes of brisk walking each day and increase it over time. Take the stairs instead of the elevator, or park your car farther from the store entrance.

Get more tips for small steps to better fitness.

You may be familiar with the need for improved eating habits, such as removing sugar from your diet, but eating heart-healthy also means cutting out salt, high-fat meats, and dairy products. Try these tips for improving the standard American diet:

  • fill-up on several servings of vegetables at meal times
  • switch to low-fat dairy products
  • make sure processed foods contain less than 400mg of sodium
  • avoid table salt
  • choose leans meats and fish, or meat substitutes
  • cook using low-fat methods like grilling and baking (avoid fried foods)
  • eat more fruit
  • eat more whole (not processed) foods
  • switch to whole-grain pastas, breads, and brown rice
  • eat smaller meals  
  • don't skip breakfast

Treating Hypertension With Diabetes

While some people can improve their type 2 diabetes and hypertension with lifestyle changes, most require medication. Depending on their overall health, some people require more than one medication to reduce their risk. High blood pressure medications fall into five distinct categories: ACE inhibitors, ARBs, beta blockers, calcium channel blockers and diuretics. Some medications produce side effects, so keep track of how you feel and be sure to discuss any other drugs you are taking with your doctor.  

Learn more about drugs to treat type 2 diabetes.