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.

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:

• It is common to begin with an angiotensin-converting enzyme (ACE) Inhibitor
• Angiotensin Receptor Blockers (ARBs) are commonly prescribed

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.