Controlling blood pressure with a healthy lifestyle

For adults with diabetes, monitoring and controlling blood pressure is as important as controlling blood glucose. High blood pressure, also called hypertension, affects between 20% and 60% of people with diabetes and is a major factor in the development of heart disease, kidney disease, and stroke.

Once high blood pressure develops if it was correctly diagnosed then it is a lifelong condition that must be treated with drugs and lifestyle modifications. Whether your blood pressure is high or still in the normal range, taking steps now to reach or maintain a healthy blood pressure level will help you prevent serious problems in the future.

What is high blood pressure

Each time the heart beats, it contracts and then relaxes, acting as a pump to push blood throughout the body. The term "blood pressure" describes the force the blood against the walls of the arteries as it is circulated through the body. Blood pressure is measured in millimeters of mercury, or mm Hg, and recorded as two numbers: systolic blood pressure, the press of the blood against the arteries when the heart is contracting, over diastolic blood pressure, the pressure of the blood against the arteries when the heart is at rest between beats.

Normal blood pressure is considered to be a systolic pressure of less than 130 mm Hg and a diastolic pressure of less than 85 mm Hg, which would be written as <130/85 mm Hg.

High blood pressure, or hypertension, is when the force of the blood against the arteries is significantly greater than normal, sharply increasing the risk of heart disease and other complications. For people with diabetes, who have an increased risk of heart disease, recommended blood pressure goals are lower than those for the general population. Research shows that in people with diabetes, better health outcomes occur when blood pressure is below 130/80 mm Hg; lower levels are even better.

Why is blood pressure control so important? Like diabetes, hypertension is an independent risk factor for heart disease. Untreated high blood pressure places extra stress on the blood vessels and arteries, damaging them over time. Untreated high blood pressure can cause atherosclerosis, or hardening of the walls of the arteries that supply blood to the heart, kidneys, eyes, brain, and other organs. Atherosclerosis can lead to heart disease, kidney disease, and stroke and increase the severity of diabetic complications. High blood pressure also forces the heart to work harder to pump blood, which eventually may cause it to become enlarged and work less efficiently. This is called heart failure.

Aggressive treatment of high blood pressure, with a target blood pressure of <130/80 mm Hg, results in decreased incidence of stroke, heart attack, and overall mortality and also decreases the incidence of micro vascular (small blood vessel) complications such as diabetic eye disease and kidney disease.

In addition to diabetes, several other factors increase a person's likelihood of developing high blood pressure:

•  Higher body weight. Being overweight can increase the risk of high blood pressure by two to six times.

Age over 65.

Family history of hypertension. If other people in your family have or had high blood pressure, you are more likely to develop it.

In some cases, certain drug hormone therapy or hormonal contraceptives, or pregnancy may lead to high blood pressure, which usually resolves after the childbirth or when the drug or therapy is discontinued. In the majority of cases however, the underlying causes of high blood pressure are not well understood. Fortunately, necessary to know the exact, of high blood pressure to treat it effectively.

Managing blood pressure

Aggressive treatment of high blood pressure (or management of a current, healthy blood pressure level), means adopting and maintaining healthy behaviors, many of which are also important for optimal diabetes control. Following the five "M's" of blood pressure management can help you meet both you blood pressure and diabetes goals.

Monitor. Everyone with diabetes should know his blood pressure level and should have it measured at home frequently and in every doctor or nurse visit. Blood pressure should be measured while you are seated with your arm supported at the level of your heart, after you have had a few minutes to rest quietly. Blood pressure should be taken twice, and levels above 130/80 mm Hg should be confirmed on at least two subsequent office visits before hypertension is diagnosed. To improve the accuracy of blood pressure readings, try to avoid eating,, consuming caffeine, or exercising for 30 minutes beforehand.

Medicate. Medicines that lower blood pressure are a very important component of treating high blood pressure. Recent research studies clearly show that using drugs to treat high blood pressure in people with diabetes greatly reduces their risk of heart disease, kidney disease, other serious complications, and death.

There are many types of drugs available to treat high blood pressure. Some of the more common ones are angiotensin-converting enzyme (ACE) inhibitors, betablockers, calcium channel blockers, and diuretics. Many people are surprised to learn that it may take three or more different drugs to control their blood pressure. Each drug has unique effects and is an important part of your treatment regimen. If you are experiencing side effects from your medicines or have any questions about how they work, discuss them with your physician. Never stop taking one of your blood pressure medicines without checking with your doctor first.

Maintain a healthy weight. Being overweight greatly increases the risk of developing high blood pressure and other cardiovascular complications. Where your extra weight is stored is also a factor: People who store excess fat around their waist are more likely to develop high blood pressure than those who carry it in their hips and thighs.

Regardless of body type, losing even a small amount of excess weight can have a very positive impact on blood pressure. One research study found that a weight loss of about two pounds reduced blood pressure by approximately 1 mm Hg. Other studies have seen more significant reductions in blood pressure with an average
weight loss of five to ten pounds. If your blood pressure currently is normal, maintaining a healthy weight can help you prevent high blood pressure in the future.

Move (exercise). Research indicates that regular exercise decreases blood pressure even when it does not lead to weight loss-although increasing your level of physical activity can certainly be helpful in reaching and maintaining a healthy weight. If you aren't very active now, you do not need to take up jogging or a high-intensiry aerobics class to start reaping the health benefits of exercise. While more intense activities and longer amounts of exercise time will provide greater benefits and more immediate results, even low-intensiry activities such as walking, golf, yard work, and household chores help lower blood pressure and keep you healthy when done regularly. An initial goal of 30-45 minutes of accumulated activity daily is a great way to get started. Planning three 10-minute activity sessions per day may make it easier to fit exercise into your schedule.

Manage stress. The body responds to stress by releasing stress hormones, such as adrenaline, which can raise both blood pressure and blood glucose levels. Observational studies of large groups of people suggest that chronic stress may play a role in the development of high blood pressure. The absence of a strong social support network and the lack of good coping or decision-making skills are also associated with high blood pressure. Studies that have tried using stress management techniques such as meditation, relaxation, and biofeedback to lower blood pressure have had somewhat inconsistent results. Many studies showed that stress management had a beneficial effect on blood pressure, but in most cases, this benefit did not reach statistical significance.

Even though stress-management techniques are not yet a proven treatment for high blood pressure, learning to better manage stress, making healthier lifestyle choices, and expanding your network of social support are good for your health and may result in immediate and tangible changes in how well you feel on a day-to-day basis.

Healthy eating

How you eat can have a big effect on your blood pressure. Many studies have examined the effects of individual nutrients (including sodium, magnesium, potassium, and calcium) on blood pressure. However, the most powerful study results have come from those in which participants changed their intake of several nutrients at once. In fact, following a generally healthful diet that is low in fat and saturated fat and high in fruits, vegetables, whole grains, and low-fat dairy products may be one of the most important things you can do to control or prevent high blood pressure. Keeping alcohol consumption moderate is also important, since excessive alcohol intake is known to increase high blood pressure.

Sodium. Numerous studies have identified a link between high dietary sodium intake and increased blood pressure. Sodium, along with chloride, is one of the two nutrients in table salt and, as many people are aware, decreasing the amount of sodium in the diet can be useful in managing hypertension.

Most people who have high blood pressure should try to limit their daily sodium intake to less than 2400 milligrams per day (about the amount in one teaspoon of table salt), although research studies have found that a very-low-sodium diet (with salt intake around 1500 milligrams or less per day) is even more beneficial. Reducing sodium intake involves more than just cutting back on the amount of salt you put on your food. About 75% of the sodium in the typical American diet is not added at the table but comes from processed foods. Foods that are particularly high in sodium include convenience and canned foods, packaged mixes, processed meats, condiments, salty, snack foods, and fast foods.

Alcohol. Excessive alcohol consumption can exacerbate high blood pressure, and people with hypertension are advised to limit the amount of alcohol they consume. Women should have no more than one drink per day, and men should limit alcohol to two drinks per day. One drink is equal to 1-11/a ounces of distilled spirits, 5 ounces of wine, or 12 ounces of beer. Guidelines for safe alcohol use should be individualized, and some people may be advised to drink less or not at all. Check with your diabetes team to see what is best for you.

Putting it all together

So what does all this information mean for you? The answer is that hypertension is a complicated condition, and it takes multiple modifications (not just, say, sodium restriction) to prevent or control it.

The good news is that just as hypertension is often part of a group of related health problems (along with diabetes, overweight, and other heart disease risks), the benefits of healthy behaviors also come in bunches. Taking the steps described above to prevent or treat high blood pressure will likely lead to other positive health changes, such as improved blood cholesterol levels, lower weight, and improved fitness. Together, these changes should improve your diabetes control and help you feel better overall.

As always, when making major lifestyle changes, it is helpful to pick a few small goals to start with, adding more when the first changes become routine. Meet with your health-care team to discuss your blood pressure goals and how to reach them. Start today and track your progress; you'll be surprised at what you can accomplish.

Hows your sodium intake?

The average sodium intake in the United States is between 6,000 and 11,000 milligrams per day-more than twice the recommended 2,400 milligrams per day, and far more than our bodies require. Cutting back on the amount of sodium you eat can help you to treat, and potentially, prevent, high blood pressure.

Do you have a high-sodium diet?

Write down how many times per week you eat the following foods:

•  Frozen dinners

Canned soups, vegetables, tomato sauces

Seasoned packaged rice, grain, potato, or soup mixes

Processed meats such as sausage, bologna, and hot dogs

Processed cheeses, cottage cheese, and cheese spreads

Salty snack foods such as chips, salted nuts, and cheese snacks

Fast foods and restaurant foods

Smoked or pickled foods such as smoked ham, sauerkraut, and pickles

Condiments and sauces such as soy sauce, ketchup, steak sauce, and salad dressings

Table salt and seasons salts like garlic salt or onion salt

If you frequently consume many of the foods listed above, your diet would likely be considered high in sodium.

The following tips can help you cut back:

•  Eat plenty of fresh or minimally processed fruits and vegetables, including frozen vegetables seasoned only with herbs and canned vegetables labeled "no added salt."

Choose fresh meats and fish rather than smoked, canned, or processed meats.

Select natural (not processed) cheeses and low sodium varieties of cottage cheese.

Cook rice, pasta, and grains without added salt, and use fewer seasoned, packaged mixes. For added flavor, try cooking rice and grains like bulgur and couscous in low sodium chicken broth.

Rinse canned foods in water to decrease their sodium content.

Cut back on convenience foods, takeout, pizza, and fast food. Try to eat these foods no more than two to three times per week. When you eat out, go to restaurants that cook from scratch and that will serve foods with sauces on the side and without added salt.

Read food labels. Look for snack foods with less than 150-200 milligrams of sodium per serving; side dishes such as rice, soups, and potato mixes with less than 300-350 milligrams of sodium per serving; and frozen meals or fast foods with less than 600-800 milligrams of sodium per serving.

Look for foods and condiments labeled "low-sodium," "reduced sodium," "sodium-free," or "no added salt."

Use garlic, onions, vinegars, spices, herbs and salt free seasonings such as Mrs. DASH to add flavor without adding sodium. (Some salt substitutes contain potassium. Check with your doctor before using these to make sure they are safe for you.)

Don't add salt to foods during cooking, and go easy when salting foods at the table.
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