Studies have shown that people with both diabetes and high blood pressure have twice the risk for cardiovascular disease as non-diabetics who have high blood pressure. High blood pressure also significantly increases the risk for kidney disease, diabetic eye disease, and neuropathy.
The goal of treatment for diabetics is blood pressure less than 130/80. This is the level at which there is the greatest reduction in cardiovascular mortality.
Treatment for high blood pressure needs to be aggressive. For those diagnosed with blood pressure 130 – 139 over 80 – 89, treatment for three months with lifestyle changes is appropriate. If there is no improvement, then medication can be added. Those diagnosed with blood pressure of 140 or more over 90 or more should be treated with a combination of lifestyle changes and medication.
Lifestyle changes that have been shown to decrease blood pressure include salt restriction, weight loss if needed, increased physical activity, smoking cessation, and moderation of alcohol consumption.
Diabetes and Blood Pressure Medications
There are many medications available to treat blood pressure. Unless contraindicated because of other medical conditions, first line medications recommended for high blood pressure in diabetics are either angiotensin converting enzyme (ACE) Inhibitors or angiotensin II receptor blockers (ARBs). These medications, in addition to blood pressure treatment, have been shown to help protect the kidneys from damage that can occur with diabetes.
Multiple medications may be needed to achieve the treatment goal of less than 130/80. There are a wide variety of medications available to treat high blood pressure. If the target blood pressure is not achieved on three different drugs, including a diuretic, a referral to a specialist in hypertension is recommended.
In patients who have had a recent heart attack, the use of beta-blockers is often considered to reduce the risk of mortality. Beta-blockers can alter the symptoms of low blood sugars, therefore people with diabetes who are treated with beta-blockers should see a diabetes educator to learn how to prevent, detect, and treat low blood sugars while on these medications.
Learn about Aurora Health Care diabetes programs.