How These Conditions Are Linked

The American Diabetes Standards of Care Diagnostic Criteria for Diabetes
Fasting plasma glucose (FPG) ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least eight hours.
OR
2-hour post prandial (PG) ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT). The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
OR
Hemoglobin A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.
OR
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

How Diabetes and High Blood Pressure Are Related

Researchers believe that diabetes and high blood pressure could have some potential causes and risk factors in common. For example, both conditions have been linked to oxidative stress, insulin resistance, inflammation, and obesity.

Diabetes Contributes to Hypertension

When blood sugars are elevated, it stresses the blood vessels. Damage to the inner linings of the vessels causes them to narrow and begin to accumulate plaque.

The plaque buildup narrows the vessels even more and forces the heart to work harder to pump blood throughout the body.

When the heart has to work harder, the force at which the blood pumps through the body increases, which leads to high blood pressure.

Plaque formation and buildup increase the risk of atherosclerosis—a condition that can increase the risk of heart attack, stroke, and peripheral arterial disease.

Complications

Both diabetes and high blood pressure can be managed through lifestyle changes. For example, a person with these conditions may benefit from being mindful about their diet, starting an exercise routine, quitting smoking, and losing weight.

When untreated or uncontrolled, both conditions can have serious health consequences, including cardiovascular disease, heart attack, stroke, peripheral arterial disease, and kidney disease.

  • Cardiovascular disease is a general term for all diseases of the cardiovascular system. Complications of diabetes and high blood pressure can cause atherosclerosis, heart attack, stroke, and heart failure.
  • Peripheral artery disease (PAD) is the hardening of the arteries in the legs, arms, head, or abdomen. Decreased blood flow from the heart to other parts of the body can cause pain and neuropathy. It can also lead to an increased risk of infection because of slow wound healing, death of tissue, and gangrene. People with diabetes and PAD are at increased risk of serious infections.
  • Kidney disease can occur when high blood sugar or blood pressure causes constriction and narrowing of the blood vessels in the kidneys, which makes them weaker. The blood vessel constriction also reduces blood flow to the kidneys and causes damage. When damaged blood vessels are unable to do their job, they cannot filter and remove fluid and wastes. An excess buildup of fluid can cause blood pressure to get worse, which in turn causes more damage to the kidneys.

People with diabetes and/or hypertension sometimes need to take medication to help control the conditions and avoid complications.

Treatment and Prevention 

Treatment options for elevated blood sugar and elevated blood pressure include a range of lifestyle changes and, in some cases, medication.

Diet

Eating to manage diabetes is not one-size-fits-all, but meal plans that focus on the quality and quantity of carbohydrates—as well as take into consideration a person’s lifestyle, culture, and food preferences—can help people with diabetes manage their blood sugar levels.

Eating for Diabetes

Carbohydrates are the macronutrient that affects a person’s blood sugar levels the most. When carbs are metabolized, they turn into glucose.

Choosing fiber-rich carbohydrates—such as whole grains, non-starchy and starchy vegetables, and legumes—can help reduce blood glucose excursions, while also increasing feelings of fullness and optimizing vitamin, mineral, and antioxidant intake.

Studies have shown that following a plant-based diet, Mediterranean style of eating, or modified carbohydrate diet can help people manage diabetes and reduce their blood sugar.

A good rule is to aim to eat two to three cups of non-starchy vegetables daily or to make half of your plate non-starchy vegetables at each meal.

Eating for Hypertension

If you have high blood pressure, reducing your daily sodium intake (especially if you are salt sensitive) can be an important part of managing the condition.

Choosing foods that are naturally rich in potassium can also help to reduce blood pressure (as long as you do not have any potassium restrictions and do not have kidney disease).

Research has further shown the benefits of Dietary Approaches to Stop Hypertension (DASH) for people with high blood pressure. The DASH eating plan increases fruits, vegetables, whole grains, fresh and dried herbs, unsalted nuts, seeds, legumes, and lean protein while limiting saturated and trans fat, sugar, and sodium.

Exercise

Exercise helps to manage blood glucose levels and high blood pressure by strengthening the heart, helping a person reach and maintain a healthy weight, and utilizing glucose by increasing insulin sensitivity.

Glucose is used for energy and removed from the bloodstream. When your muscles contract, your cells can use glucose for energy.

Studies have shown that regular exercise can reduce your hemoglobin A1C (three-month average of blood sugar levels).

Talk to your doctor before you start an exercise routine if you take medication to lower your blood sugar or blood pressure—especially if you take insulin or oral glucose medication that can cause hypoglycemia.

Smoking Cessation

If you smoke and have diabetes and high blood pressure, quitting can significantly improve your health and make it easier to manage your conditions.

Smoking increases inflammation, raises your bad cholesterol, raises your blood pressure, and reduces the amount of oxygen that is supplied to your organs—all of which make it harder to control diabetes. Quitting can also lower the risk of further blood vessel damage.

Weight Management

Modest weight loss has been shown to improve blood sugar levels significantly. Losing weight helps to improve insulin sensitivity, reduce inflammation, and improve vascular health. Weight loss can also help lower blood pressure by reducing the stress that is placed on the heart.

Studies have shown that losing about 10% of your body weight can improve blood sugar and reduce the need for medication. In some cases, weight loss can put diabetes into remission.

Medication

There are medications that can be used to help people with diabetes and high blood pressure manage the conditions better.

People with type 1 diabetes need to take insulin in the form of infusion or injection daily to manage the condition. People with type 2 diabetes may need to take oral diabetes medications and/or non-insulin injectables or insulin to help manage their blood sugars.

There are several classes of medications that help people with hypertension to control their blood pressure. Your doctor will prescribe medication based on how high your blood pressure is, as well as take into consideration any other health conditions that you have.

You need to take your medication as prescribed to make sure that it can do its job. If you are having trouble taking your medication, talk to your doctor. In some cases, your medication regimen might be able to be made easier for you to follow.

Sometimes, making certain lifestyle changes—like following a certain diet or getting more physical activity—can help you reach a goal of reducing your medications with the help of your healthcare team.

However, you should not take less of your medication or stop taking it without talking to your doctor.

Prevention

As with many health conditions, an ounce of prevention can be worth a pound of cure when it comes to diabetes and high blood pressure.

One of the first steps to preventing high blood pressure is simply knowing that you have it. You should also know what range would be the healthiest for you to aim for. When you know these numbers, you can work with your doctor on how to meet your blood pressure goal.

Preventing type 2 diabetes also requires you to know your numbers. You should know what your blood sugar levels are, as well as what range you should aim for.

If you have diabetes and are concerned about developing high blood pressure, you can take steps to lower your risk, such as:

  • Reducing your daily sodium intake (limiting processed and packaged foods/reading labels)
  • Eating more fruits and vegetables (which are naturally low in sodium)
  • Getting more exercise
  • Losing weight (especially in the abdominal area)

You should also see your doctor for regular checkups, manage your stress the best that you can, and try to get enough sleep. These behaviors can help strengthen your heart and keep your blood vessels in good shape.

A Word From Verywell

While diabetes and hypertension do often go hand-in-hand, having one condition does not mean that you will definitely get the other. You can take steps to manage both conditions and the complications that they can cause. In some cases, the small changes that you make can even prevent or reverse the conditions.

Talking with your doctor and meeting with a registered dietitian or certified diabetes care and education specialist can be a great way to get the support that you need to work on your blood sugar and/or blood pressure goals.

Janelle B. Smith

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