Preventing and Treating High Blood Pressure If You Have Diabetes

It’s common to have both diabetes and high blood pressure (hypertension) at the same time. As many as 2 in 3 people with diabetes report that they have high blood pressure or take blood pressure medication. 

These two conditions work together to increase the risk of atherosclerotic cardiovascular disease (ASCVD). ASCVD can lead to stroke, heart attack, kidney disease, and more. So, if you have both diabetes and high blood pressure, you’re at higher risk of ASCVD than if you have either diabetes or high blood pressure alone. 

That means if you have diabetes and hypertension, it’s extra important to treat or prevent high blood pressure. 

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How are high blood pressure and diabetes related?

People with high blood pressure are more likely to have diabetes. And people with diabetes are more likely to have high blood pressure. There’s a close relationship between the two, but the exact cause and effect is still being worked out.

Diabetes and hypertension have similar effects on blood vessels. High blood sugar levels in diabetes inflames and damages the blood vessels. Hypertension also does this, by increasing the stress on blood vessel walls. 

There’s some evidence of early changes to small and large blood vessels in the body before diabetes and high blood pressure are even diagnosed. This raises the possibility that these two conditions interact somehow, or even that they share a common cause. More research is needed to be sure.

EXPERT PICKS: WHAT TO READ NEXT

• High blood pressure is only one part of heart disease. It’s important to understand how diabetes also affects your risk. 

• Prescription medications can increase your blood glucose. These include medications for high blood pressure and cholesterol, among others. 

• So can over-the-counter cold medicines. Learn which medicines to avoid, and which ones are safe for people with diabetes.

What’s certain is that blood vessels can narrow when they’re stressed and damaged. And that affects how blood flows to major organs. That’s why both diabetes and hypertension can lead to health issues like:

• Kidney disease

• Eye disease

• Erectile dysfunction

• Heart attack

• Stroke

The good news is that the better you manage your diabetes and blood pressure, the healthier your blood vessels will be. Close management also lowers your risk for life-threatening complications.

Can high blood pressure cause high blood sugar? 

Hypertension (high blood pressure) and even prehypertension are linked with insulin resistance, a precursor to Type 2 diabetes. Insulin resistance is when the body doesn’t properly respond to insulin, which typically helps cells use glucose in the blood. Without treatment, insulin resistance can eventually lead to diabetes. 

Evidence points to high blood pressure as a risk factor for Type 2 diabetes. This doesn’t mean high blood pressure is a cause. But it means people with hypertension are more likely to develop diabetes. It’s possible that blood vessel damage and inflammation could be to blame.

Can high blood sugar cause high blood pressure?

Most likely yes. Experts know that diabetes can damage the blood vessels of the kidneys, increasing the risk for kidney disease. This, in turn, can increase blood pressure. But research suggests that even insulin resistance (a precursor to prediabetes and diabetes) can contribute to high blood pressure. 

Furthermore, studies suggest that high blood sugar levels in people with Type 1 diabetes increases their risk of developing high blood pressure. Treatment with insulin decreases that risk. 

It’s worth noting here that high blood pressure itself can also cause kidney disease, making this a vicious cycle.

What is a healthy blood pressure if you have diabetes?

The American Diabetes Association recommends a blood pressure of 130/80 mmHg or less for people with diabetes and other risk factors for cardiovascular disease. If you have diabetes and a blood pressure anywhere above 120/80, it’s never too early to start making changes.

If you have diabetes and a blood pressure of 140/90 or above, then you’ll probably need to take high blood pressure medications to drop your blood pressure back to healthy levels.

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Are you at high risk for high blood pressure?

Certain genetic and lifestyle factors can put you at greater risk for developing high blood pressure (also known as hypertension), which can lead to heart disease, stroke, and kidney disease. Understand your risk so you can take steps now to help prevent future health problems. This is for informational use only. It’s not a substitute for professional medical advice, a diagnosis, or endorsement of treatment. Always consult a doctor. By continuing, you agree to our privacy policy and terms of use.

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Six tips to naturally lower your blood pressure if you have diabetes

If you have diabetes and notice your blood pressure creeping up, there are several steps you can take to help lower it. Lifestyle changes can work wonders for improving blood pressure and your overall health. These changes can lower high blood pressure and help prevent it in the first place.

Here are some tips for where to start.

1. Manage your weight

People who fall in the categories of overweight or obesity are at higher risk of health issues, including diabetes. Managing your weight can help lower your blood pressure. A healthy weight is defined as a body mass index (BMI) reading between 18.5 and 24.9. 

Striving to keep your BMI in this range can also help improve diabetes. In fact, according to the American Heart Association (AHA), losing as little as 5 to 10 pounds can help lower high blood pressure.

2. Reduce salt intake

Salt can cause your body to hold on to extra fluid. And this can cause blood pressure to creep up in some people. The AHA recommends most adults consume less than 1,500 mg of sodium (salt) daily to help lower blood pressure. 

You can keep track of your salt intake by checking the sodium content on nutrition labels. Packaged and restaurant-prepared foods make up 70% of the sodium we eat. So, eating fresh foods and preparing your own meals can help lower your daily salt intake.

3. Follow the DASH diet

The DASH diet (Dietary Approaches to Stop Hypertension) is a set of recommendations to help lower blood pressure. The diet recommends:

• Plenty of fruits and vegetables

• Fiber-filled foods, such as whole grains

• Decreased fat intake, especially saturated fats

• Decreased salt intake

Research shows that following the DASH diet can lower systolic blood pressure — the top number — over 11 mmHg in people with high blood pressure. 

4. Keep active

Regular exercise is an easy way to lower blood pressure, improve diabetes, and lose weight. It also improves your overall health and well-being. One study found that in people with high blood pressure, exercise was just as effective for lowering systolic blood pressure as medications. 

The AHA recommends 150 minutes of moderate-intensity aerobic exercise every week. That could be 20 to 30 minutes a day briskly walking, riding a bike, or dancing. 

5. Quit smoking

Nicotine in tobacco products can lead to high blood pressure and cause a host of health problems. So, cutting down or quitting smoking is one of the best ways to keep your blood pressure down and your heart healthy. There are plenty of resources to help you quit. And your primary care provider can give you information about which method might be best for you.

6. Reduce alcohol intake

Alcohol can raise your blood pressure, especially if you drink a lot of it over time. Cutting back on alcohol significantly lowers blood pressure in people who drink regularly. The AHA recommends the following drinking guidelines:

• For men: no more than 2 drinks per day

• For women: no more than 1 drink per day 

A drink is defined as: 

• Beer: 12 oz 

• Wine: 4 oz

• Spirits: 1.5 oz of 80-proof, or 1 oz of 100-proof 

What are common blood pressure medications for people with diabetes?

If lifestyle changes aren’t enough to lower your blood pressure to safe levels, you may need to add in one or more medications. Here are some common high blood pressure medications for people with diabetes. 

ACE inhibitors and ARBs

The most commonly used medications to lower blood pressure in people with diabetes are:

• Angiotensin-converting enzyme (ACE) inhibitors — like lisinopril and enalapril 

• Angiotensin II receptor blockers (ARBs) — like losartan and candesartan

These medications work on the kidneys to lower blood pressure. 

But they can also slow down kidney damage that high blood sugar can cause. If you’re taking an ACE inhibitor or ARB, a healthcare professional will run blood tests to monitor the health of your kidneys.

Calcium channel blockers

Calcium channel blockers (like amlodipine and nifedipine) also work well to lower blood pressure in people with diabetes. These medications prevent calcium from entering the cells of the heart and blood vessels. This relaxes the muscles in the heart and blood vessels — and lowers blood pressure. 

Calcium channel blockers work especially well in Black people and older adults. People usually tolerate them without issue. But, in rare cases, they can cause swelling of the feet and lower legs. If this happens, be sure to touch base with your healthcare team.

Beta blockers

Beta blockers — like metoprolol and carvedilol — are medications that block the hormone epinephrine (adrenaline). They can treat high blood pressure as well as coronary artery disease and heart failure. 

Beta blockers can also block symptoms of low blood sugar (like a fast heartbeat). So, if you have diabetes and take a beta blocker, make sure to regularly check your blood sugar levels.

Diuretics

Diuretics — or “water pills” — are medications that lower blood pressure by helping the body get rid of excess fluid. In short, they make the kidneys work harder so that you pee more. 

Beyond lowering blood pressure, diuretics can also help people who have heart failure or edema (swelling). 

What else can I do about diabetes and high blood pressure?

Aside from making healthy lifestyle changes and taking high blood pressure medications (if needed), there are other healthy habits you can take up: 

• Keep your blood glucose levels in range. You can do this with a diabetes-friendly diet and medications (if your primary care provider recommends them). Controlling your blood sugar levels can also help with your high blood pressure and overall health.

• Monitor your blood pressure. Get a home blood pressure monitor to keep tabs on your blood pressure. Your readings show how different situations affect your blood pressure. And this can help you and your care team know how well your treatment plan is working. 

• Ask your healthcare provider about aspirin. Some people with high blood pressure should take aspirin to prevent heart disease and stroke. But this isn’t true for everyone with high blood pressure and diabetes. Your primary care provider can help you make that decision based on your risks and other health conditions. 

• Visit your primary care provider regularly. They can help you stay on top of your high blood pressure, diabetes, and other risk factors like high cholesterol. 

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Written by:

Alice Perlowski, MD, MA, FACC

Dr. Alice Perlowski is a board-certified cardiologist and fellow of the American College of Cardiology. She has seen patients and supervised trainees in the academic and private sector, with focuses in interventional cardiology, vascular medicine, preventative cardiology, and women’s heart health.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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