Have Diabetes? Why You Need to Know Your Blood Pressure Numbers

Work with your doctor to reduce diabetic hypertension
A doctor listening to his patient's heartbeat with a stethoscope

If you have diabetes, experts say you should watch your blood pressure numbers in addition to your blood sugar numbers.

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This is because having diabetes puts you at a higher risk of high blood pressure and the possible problems it can cause throughout your body. These include heart attack, stroke, kidney disease and even retinal issues.

“People with diabetes tend to have a higher average blood pressure than people without diabetes,” says cardiologist Michael Rocco, MD. “So, not only are both of those conditions related to adverse cardiovascular events, but they often occur in tandem in people with diabetes.”

New treatment guidelines

Now, a recent study published in the Journal of the American Medical Association (JAMA) recommends a new threshold of when your physician should start treating your high blood pressure if you have diabetes. It also suggests a target level for you to meet and maintain.

According to the article, if you have diabetes and high blood pressure, the recommended standard guidelines for starting drug therapy begin with a blood pressure reading of above 140 systolic and above 90 diastolic.

“How low to treat is a little more controversial,” Dr. Rocco says. “However, a treatment to get below 140 over 90 is a reasonable goal for most individuals.”

If you’re diabetic and have high blood pressure, you want to reduce your risk of suffering a large vessel, cardiovascular event or a smaller, microvascular event such as a retinal problem, kidney disease and neuropathy or a dysfunction of peripheral nerves that can cause numbness or weakness.

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The benefits of lowering blood pressure

One interesting aspect of the new study, Dr. Rocco points out, is that it looked at individuals with baseline blood pressures above and below 140 systolic.

“They found that generally treating blood pressures above 140 to get them under 140 resulted in greater reduction of most of these cardiovascular and microvascular risks,” he says. “The patients achieved somewhere between an 11 to 13 percent reduction for every 10 millimeter reduction in their blood pressure.”

Dr. Rocco adds that while all of the groups benefited by lowering their blood pressure, the group that got below 130 didn’t see the same additional significant benefit in reduction for overall mortality and coronary heart disease. But they did benefit from reduction of stroke, retinopathy and reduction of protein in their urine.

“Therefore the goals for therapy and starting point for initiating therapy may be influenced by the outcomes you are trying to prevent,” he says.

A customized plan of action is best

The exact cutoff point for how far to treat the reduction of your blood pressure may vary from person to person, Dr. Rocco says. So you always need to consult with your physician to set your goals.

“The newer data suggests that the target blood pressure needs to be individualized to the patient, based on their individual risks and the risk of the medications prescribed by their physician,” Dr. Rocco says.

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Your doctor may consider a lower treatment goal, for example, if you had a previous stroke, family history of stroke or protein in your urine. A recent statement issued by the American College of Cardiology (ACC) and American Heart Association (AHA) recommends considering a target of 130/80 in people with prior heart attack, stroke, TIA, aortic aneurysm or peripheral arterial disease.

The choices of anti-hypertensive medications will depend on other clinical issues that the person may have. For example, someone who has had heart failure or coronary disease would be advised to use a different regimen including beta-blockers and ACE inhibitors or angiotensin-receptor blockers.

“The specific choices of the drugs may vary, depending on other issues such as diabetes, heart failure, angina chest pain or ethnicity,” Dr. Rocco says. “But ultimately, lowering blood pressure by any means is beneficial.”

Lifestyle plays a part, too

Lifestyle issues are especially important for diabetics, so make sure you control your weight, exercise regularly, restrict salt, quit smoking and maintain a nutritious diet. By doing so, you may be able to reduce your medications.

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