Diabetes and high blood pressure

Overview

High blood pressure (arterial hypertension) is very common in people with diabetes. Both damage the blood vessels and, together, raise the risk of heart attack, stroke, heart failure and kidney disease even more. The good news: the risk falls when both are controlled.

Why they occur together

• insulin resistance and high blood sugar change how blood vessels work and stiffen their wall
• the body holds more salt and water, which raises pressure
• excess weight and physical inactivity are shared factors
• kidney damage from diabetes raises blood pressure, and high blood pressure damages the kidneys further

What target is aimed for

• For most people with diabetes, the doctor aims for a blood pressure below 130/80 mmHg when tolerated.
• European guidelines aim for a systolic of 120–129 mmHg, without going below 120, when treatment is well tolerated.
• The exact target is set individually by the doctor according to age, other conditions and tolerance.

Measuring at home and at the doctor’s

• Home measurement gives the real pressure and helps adjust treatment (see how to measure blood pressure at home).
• In people with diabetes, measuring while standing after sitting or lying down can reveal a drop in blood pressure on standing (dizziness when you get up), which appears when nerves are damaged.
• The 24-hour blood pressure Holter (ABPM) helps when clinic and home readings do not match.

Treatment

• Lifestyle: less salt (under 5 g a day), a healthy weight, a diet with more vegetables and whole grains, regular physical activity, no smoking and little alcohol.
• Medicines: ACE inhibitors or angiotensin receptor blockers (ARBs) are often used, especially when there is protein in the urine; a combination of medicines is often needed. The doctor monitors potassium and creatinine.
• Do not stop or change treatment without consulting your doctor, even when blood pressure reads normal.

Regular check-ups

• blood pressure at every visit and measurements at home
• HbA1c and lipid profile (see diabetes and cholesterol)
• kidney function and urine protein (see kidney function tests)
• ECG and, when there are symptoms or long-standing high blood pressure, echocardiography (see diabetes and the heart)
• eye and foot checks, according to the diabetes care plan