With every beat of the heart, the walls of the body’s blood vessels are pressed upon as blood is pumped through them. For people with high blood pressure, the pounding is more intense and can damage the blood vessels, leading to a heightened risk of a heart attack or stroke. Hypertension, the technical term for high blood pressure, affects 2 out of 3 people with diabetes and makes them more vulnerable to heart disease. Fortunately, lifestyle changes and medications can help to take the pressure off.
After measuring blood pressure, the health care provider gives you two numbers. The top number (systolic pressure) and bottom number (diastolic pressure) are the maximum and minimum pressures, respectively, from the beginning of one heartbeat to the next. “Systolic is a more important prediction of heart disease than diastolic pressure,” says Henry Black, MD, a clinical professor of internal medicine at New York University’s Langone Medical Center, “particularly at ages over 50.”
The American Diabetes Association (ADA) recommends getting your blood pressure taken at every routine diabetes checkup. With mild hypertension (a systolic blood pressure between 130 and 140 mmHg), a doctor may recommend weight loss, an eating plan, and more physical activity to bring levels down. If that doesn’t work within three months, or if you have more severe hypertension, blood pressure medication may be needed. “With diabetes, there is a sense of urgency to get high blood pressure treated promptly,” says Black. “In my opinion, to spend any time with [only] lifestyle changes in a person with diabetes is putting them at risk.”
Meds to the Rescue
There are eight or nine classes of antihypertensive medications, says Black. This provides a lot of options for people with diabetes, who often need to take more than one blood pressure medication to reach their target.
The antihypertensive medications that receive top billing for diabetes patients are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Angiotensin II is a hormone that triggers the blood vessels to constrict, increasing pressure. Both ARBs and ACE inhibitors lower blood pressure by cutting down on angiotensin’s activity. There is evidence that these drugs can help prevent heart and kidney disease, and they are commonly used as the first line of defense against high blood pressure. Plus, a recent large study found that an ACE inhibitor could prevent retinopathy (eye damage) and nephropathy (kidney damage) in people with diabetes (high blood pressure is known to contribute to eye and kidney disease).
Diuretics are another class of antihypertensive medications. They are frequently used when multiple drug therapies are necessary to reach blood pressure goals. Diuretics work by flushing excess water and sodium from the body. Sometimes blood glucose–lowering medications need adjustment when diuretics are used.
If more blood pressure control is needed, doctors may turn to three additional types of antihypertensive medications: beta blockers, renin inhibitors, and calcium channel blockers. These drugs employ various strategies involving hormones and nerves to lower blood pressure by keeping blood vessels from constricting.
|While even natural whole foods typically have at least some sodium, processed foods tend to be loaded with it.|
|Instead of This||Eat This|
|Canned vegetables*||Frozen or fresh vegetables|
|Deli turkey||Turkey breast roasted at home|
|Garlic or onion salt||Garlic or onion powder (or fresh)|
|Table salt||Lemon juice or zest, vinegar|
|*You can also look for low-sodium versions of canned veggies or canned soups, or remove 40 percent of sodium from canned vegetables or meats by rinsing them with water before use.|
|For more information on the DASH diet, which can help lower blood pressure, visit www.nhlbi.nih.gov/health/health-topics/topics/dash/.|
Eating for Health
The federal government’s Dietary Guidelines for Americans, 2010 recommends that people with diabetes, high blood pressure, those over 50, and African Americans keep their sodium consumption to less than 1,500 mg per day. “The first thing is salt restriction,” says Toby Smithson, RD, LDN, CDE, a spokesperson for the Academy of Nutrition and Dietetics and the founder of DiabetesEveryDay.com. Where does most of the sodium in the diet come from? Not a shaker, says Smithson: “Seventy-five percent of the sodium we eat comes from processed food.” A salt-restricted diet may seem a bit bland at first, she says, but after about two weeks the taste buds acclimate, and suddenly low-salt foods will taste, well, salty.
The Dietary Approaches to Stop Hypertension (DASH) diet is heralded as the ideal eating pattern for lowering blood pressure. It is rich in fruits, vegetables, whole grains, and low-fat dairy, while limiting red meat, sugar-sweetened beverages, and saturated fats. What makes the diet special, according to Smithson, is that the list of recommended DASH foods focuses on three nutrients: calcium, potassium, and magnesium. These minerals are thought to work together to lower blood pressure, Smithson says. Yet she cautions that people with diabetes still need to be aware of their carbohydrate intake on the DASH diet. If you have kidney disease or are taking ARBs or ACE inhibitors, check with your provider to keep potassium levels in check.