Elevated blood pressure (hypertension) is a common problem in people with diabetes.
Along with elevated cholesterol and obesity, it is one of the major risk factors for heart disease.
Although there is some controversy regarding blood pressure(BP) goals in people with DM, the American Diabetes Association (ADA) recommended a goal BP of <130/80.
The top number is the systolic BP.
This is the pressure exerted on the blood vessel walls when your heart is beating.
The bottom number is the diastolic BP.
This is the pressure when your heart is relaxed.
The BP goal is lower in diabetics due to the high "background" risk of heart disease in diabetics.
This risk is further increased once BP levels rise.
Make sure that your pressure is measured correctly.
You should be seated with your arm at heart level when the measurement is obtained.
Ideally, you should sit for five minutes before a measurement is obtained.
If you are overweight, ask for the large cuff.
A regular-sized cuff will not be accurate.
Falsely elevated measurements may be caused by anxiety, "white coat hypertension" and/or improper technique.
It is thus important to confirm elevated measurements with a second office-based reading.
If the average systolic value is 130-139 mmHg, or if the average diastolic value is 80-89 mmHg, the ADA recommends a three month trial of "lifestyle therapy".
This typically includes a recommendation for weight loss (5-7% if overweight), exercise (30 minutes per day once cleared by cardiologist), salt restriction (<1500-2000 mg daily), and alcohol restriction (<2 servings per day in men and <1 serving per day in women).
This is otherwise known as the "Dash" diet: Dietary Approaches to Stop Hypertension.
If the principles of the DASH diet are followed, reductions in hypertension can be significant If the ADA goals aren't achieved by lifestyle changes, medical therapy will be considered.
If BP values are greater than 140 mmHg systolic of 90 mmHg diastolic at initial or follow-up visits, medical therapy is typically recommended.
Angiotensin converting enzyme inhibitors (ACE) and Angiotensin receptor blockers (ARB) are often the first medications recommended in people with diabetes and hypertension.
A dry non-productive cough is seen in ~20% of people treated with ACE inhibitors.
In some people, the cough is severe enough to stop therapy.
Quinapril and Enalapril are commonly used ACE inhibitors.
Most of the ACE inhibitors are available as generics.
Both the ACE inhibitors and the ARB's are equally effective.
If one class isn't tolerated, the other may be substituted.
Consider night-time medication dosing, especially if you are taking more than one anit-hypertensive.
There is some data to suggest that the ACE inhibitors and ARB's provide benefits (reduction in heart disease risk) beyond what can be explained by blood pressure reduction.
Although the results of these studies are conflicting, this is more support for selecting these medications as first-line drugs.
Since both the ACE inhibitors and the ARB's can raise serum potassium levels, kidney blood tests should be monitored on a regular basis.
Other drugs commonly used to control hypertension include diuretics ("fluid pills"), calcium channel blockers, and beta-blockers.
Most people with diabetes will require 2-3 medications to achieve the goal of <130/80.
Hypertension is an important risk factor for heart disease in people with diabetes.
Make sure your pressure is monitored on a regular basis.
Consider obtaining your own BP cuff.
This will allow you to take measurements outside of the doctor's office.
Make a comittment to improving your lifestyle.
Make a difference in your life today!