Not all blood pressure drugs are created equal when it comes to lowering blood pressure in people with diabetes. Here’s what Johns Hopkins doctors recommend.
For every five-point increase in blood pressure, your risk of a heart attack or stroke increases by 20–30%. Add in having diabetes, and that risk is two to four times higher. Diabetes also increases the risk of developing kidney and eye disease. And having high blood pressure makes these two diabetes complications even more likely. So it’s no wonder that some experts refer to diabetes and hypertension as the “deadly duet.”
Now for the good news: Gaining control of your high blood pressure can help minimize the effects of diabetes on your health. In fact, it may have an even greater effect on lowering the risk of heart attack, stroke, and other diabetes complications than keeping your blood glucose (sugar) under control. But not all doctors aggressively treat high blood pressure in people with diabetes. Here’s what you need to know about blood pressure control if you have diabetes.
Your Blood Pressure Goals -- If you have diabetes, your blood pressure goal is lower than that of the general population. That’s because high blood pressure can exacerbate many of the long-term complications of diabetes. Instead of aiming for less than 140/90 mm Hg, you should be keeping your blood pressure below 130/80 mm Hg. This isn’t always easy and will take some work on you and your doctor’s part.
Your Treatment Plan -- Lowering blood pressure to less than 130/80 mm Hg usually can’t be done with lifestyle measures alone or by taking a single blood pressure-lowering drug. Even the use of two blood pressure drugs typically isn’t enough. What works? Often a combination of lifestyle measures and at least three blood pressure medications.
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But not all blood pressure drugs are created equal when it comes to blood pressure lowering in people with diabetes. The best medications are those that not only lower blood pressure but also slow the development or progression of diabetes complications -- such as heart attack, stroke, and kidney disease.
Often, the first drug tried in someone with high blood pressure and diabetes is an ACE inhibitor. This drug protects the kidneys and reduces the risk of heart attack and stroke in addition to its blood pressure–lowering effects. An ACE inhibitor is usually combined with a thiazide diuretic, which is also kidney protective and prevents heart attacks and strokes. When side effects from an ACE inhibitor, particularly a dry cough, are troublesome, an angiotensin II receptor blocker (ARB) can be used instead. Some doctors begin blood pressure lowering with a thiazide diuretic in people with diabetes.
In the Antihypertensive and Lipid- Lowering Treatment To Prevent Heart Attack Trial (ALLHAT), people with diabetes received just as much benefit from a thiazide diuretic as people without the disease. If necessary, an ACE inhibitor can be added to the diuretic.
But a thiazide diuretic and an ACE inhibitor (or ARB) may not be enough to control blood pressure. When this happens, your doctor may add a long-acting calcium channel blocker, a beta-blocker, or an alpha-blocker as the third or fourth drug.
