Diabetes and Hypertension

Hypertension (high blood pressure) is a very real problem for people with type 2 diabetes. Come to think about it, I don't know anyone in our support group with type 2 diabetes that did not have hypertension when they were diagnosed. Yes, many are able to handle their blood pressure (BP) by other means than medication, but some needed the BP medications to manage their blood glucose.

If doctors did not put people on BP medications, most would have faster and more severe forms of diabetes complications, including eye disease and kidney disease. In addition, having diabetes makes BP and other heart and circulation problems more likely. This is because diabetes damages arteries and makes them targets for hardening (atherosclerosis). Atherosclerosis can cause high blood pressure, which if not treated, can lead to blood vessel damage, stroke, heart failure, heart attack, or kidney failure.

Compared to people with normal blood pressure readings, men and women with hypertension more often have:

• Coronary artery disease (heart disease)
• Strokes
• Peripheral vascular disease (hardening of the arteries in the legs and feet)
• Heart failure

Even blood pressure that's at the higher end of normal, called prehypertension (120/80 to 139/89) impacts your health. Studies show that people with prehypertension have a two to three times greater chance over 10 years of developing heart disease.

Blood pressure readings vary, but most people with diabetes should have a reading of no more than 140/80. The first, or top, number is the "systolic pressure," or the pressure in the arteries when your heart beats and fills the arteries with blood. The second, or bottom, number is the "diastolic pressure," or the pressure in the arteries when your heart rests between beats, filling itself with blood for the next contraction.

There is some “expert” disagreement with the above numbers and some groups feel that BP readings should be 130/75-80. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels.

Usually, high blood pressure has no symptoms. That's why it's so important to check your blood pressure regularly. You should get it checked at any doctor visit and follow your doctor's recommendations about checking your blood pressure at home, too. If you do have a proper BP cuff and way to test at home, do this on a regular basis and ask your doctor when you should do this. There is some truth to the “white coat syndrome” so don't be afraid to talk to your doctor about this.

ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) are kinds of medications that are often used to treat high blood pressure for people with diabetes. Although other high blood pressure medicines are available, ACE inhibitors and ARBs treat high blood pressure and also prevent or slow kidney disease in people with diabetes.

Note: Some blood pressure medicines may make your blood glucose and lipid levels worse. Blood pressure medicines can also cause erectile dysfunction. Talk with your doctor about the side effects of prescribed medicines.

Other drugs used to treat high blood pressure in people with diabetes include drugs known commonly as "water pills" or diuretics, which help the body get rid of extra fluid.

Most doctors use ACE inhibitors or ARBs first, then add other anti-hypertension drugs if needed.