Treating High Blood Pressure in Diabetics

Effective blood pressure control is an important goal if you have diabetes. The dangers of high blood pressure in diabetes are so serious that the combination of well-controlled blood sugar and well-controlled blood pressure makes a powerful impact on long-term health (quality of life, number of complications, ultimate lifespan). As you aim for your blood sugar goals, make sure that maintaining your target blood pressure is an essential goal too.

Doctor in a wheelchair testing blood pressure on a patient who is also in a wheelchair
Huntstock / Getty Images

Treatment Goals

High blood pressure can cause heart disease and kidney damage—these risks are higher if you have diabetes.

If you have diabetes, your target blood pressure is less than 130/80. Studies have consistently shown that significant improvements in long-term cardiovascular and kidney health do not become apparent until blood pressure is reduced to this level. For this reason, your healthcare provider will closely follow your blood pressure and create a treatment plan so you can attain your target numbers.

Some studies have suggested that people who have preexisting kidney problems benefit most from blood pressures less than 120/80.

Non-Drug Therapy

The official guidelines of both the American Heart Association and the American Diabetes Association state that blood pressures in the range of 130-139/80-89 should first be treated with non-pharmacologic (no medicine) options.

These options include:

  • Weight loss
  • Salt restriction
  • Dietary changes
  • Quitting smoking
  • Limiting alcohol intake

If you have diabetes, strict adherence to these rules can lower your blood pressure enough so that drug therapy may not be needed. Even if they don't lower your blood pressure enough, these changes can work along with drug therapy and ultimately lead to better blood pressure control.

Drug Therapy

Drug therapy is a necessary step for most people who have high blood pressure. Blood pressure management is a little different for people who have diabetes. Research has been done to determine which drug or drug combination is the best for treating high blood pressure in patients with diabetes.

Blood pressure medications recommended for people who have diabetes:

An ACE inhibitor is almost never given in combination with an ARB. Beta-blockers, calcium channel blockers, and diuretics. which are commonly prescribed for the treatment of high blood pressure without diabetes, are not used as often for lowering blood pressure if you have diabetes. However, your healthcare provider may select medication in one of these categories for you based on other factors and your overall medical condition.

Kerendia (finerenone) is approved for the treatment of chronic kidney disease associated with type 2 diabetes to lower the risk of certain kidney and heart complications.

A Word From Verywell

If you have diabetes, blood sugar control is vital for maintaining your best health. There are also common conditions that can accompany diabetes, and high blood pressure is one of them. If you have recently been diagnosed with hypertension (high blood pressure), your healthcare provider might suggest lifestyle modifications to see if you can reach a target blood pressure without medication—or eventually with a low dose of medication.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S125-S150. doi:10.2337/dc21-S010

  2. Grassi G, Mancia G, Nilsson PM. Specific blood pressure targets for patients with diabetic nephropathy? Dia Care. 2016;39(Supplement 2):S228-S233. doi:10.2337/dcS15-3020

Additional Reading
  • Brenner, BM, Cooper, ME, de Zeeuw, D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345:861.
  • Buse, JB, Ginsberg, HN, Bakris, GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007; 115:114.
  • Daly, CA, Fox, KM, Remme, WJ, et al. The effect of perindopril on cardiovascular morbidity and mortality in patients with diabetes in the EUROPA study: results from the PERSUADE substudy. Eur Heart J 2005; 26:1369.
  • Gaede, P, Vedel, P, Parving, H-H, Pedersen, O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: The Steno type 2 randomized study. Lancet 1999; 353:617.
  • Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288:2981.
  • Zillich, AJ, Garg, J, Basu, S, et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension 2006; 48:219.

By Craig O. Weber, MD
Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years.