Type 2 Diabetes and High Blood Pressure: What’s the Connection?

Diabetes and high blood pressure share an intricate relationship. Diabetes puts you at greater risk of high blood pressure and vice versa.

The major problem is you can’t feel high blood pressure but if it is present, your risk of cardiovascular disease increases significantly.

Here we learn more about it, along with what you can do to manage both your blood pressure and your type 2 diabetes.

What is Blood Pressure?

Blood pressure readings are a very simple measurement that shed some light as to how well your heart (and metabolic system) is functioning.

Blood pressure is a routine test that is performed at most, if not all, medical visits. People often have home blood pressure machines and you can also find them located inside many store pharmacies.

The purpose of the heart beating is to pump blood to the rest of the body and supply it with the oxygen and nutrients it needs. Each time it beats, it’s like turning on the water spigot to a hose – the water runs through the hose and exerts pressure on the insides of the hose, which forces it along the hose.

The hoses your heart pumps blood through are called arteries. When the heart contracts, the pressure increases (this is called “systolic” or the top blood pressure number) and when it relaxes the pressure decreases (this is “diastolic” or the bottom number). 

Your blood pressure will be read in terms of both of these numbers, so “120 over 80 or 120/80” – this means 120 mm Hg is the blood pressure at it’s highest (systolic pressure) and 80 mm Hg is the lowest reading (diastolic pressure).

What is Normal Blood Pressure?

Cardiologist Dr. Adam Splaver informs that blood pressure ranges have recently been updated.

The old blood pressure ranges are:

Normal: Less than 120/80

Prehypertension: 120-139/80-89

Stage 1 hypertension: 140-159/90-99

Stage 2 hypertension: 160/100

Stage 3 or Hypertension crisis: 180/110

The new blood pressure ranges are:

Normal: Less than 120/80 – normal levels haven’t changed because obviously they are considered ‘normal.’ 

Elevated: Systolic between 120-129 and diastolic less than 80 – the new guidelines have completely eliminated the range of ‘prehypertension.’ Now the ‘elevated’ category is within a lower range and experts hope that this will help identify blood pressure elevations earlier so that lifestyle changes can be made earlier, which means less risk of heart attack and stroke.

Stage 1: Systolic between 130-139 or diastolic between 80-89 – the range for stage 1 hypertension has now been lowered. 

Stage 1 is still the category where lifestyle changes will be recommended. According to the American College of Cardiology prescription medication should only be recommended to people in stage 1 hypertension who:

• Have already had a cardiovascular event such as a heart attack or stroke
• Are at high risk of heart attack or stroke based on age
• Have diabetes or chronic kidney disease
• Have a high atherosclerotic calculated risk

Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg – the range for stage 2 hypertension has now been lowered. Since heart disease is one of the world’s leading killers and high blood pressure plays a significant role in heart disease, the levels have been lowered for earlier detection, prevention, and management, and to help account for complications that can occur at lower numbers.

Hypertensive crisis: Systolic over 180 and/or diastolic over 120 – this is considered very high and needing medical attention. Patients may need prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

If you experience this reading with any sort of chest pain, shortness of breath or weakness, call 911 immediately. If no symptoms, wait a few minutes and take your blood pressure again, seeking urgent care if it continues to remain elevated.

The Diabetes and High Blood Pressure Connection

Diabetes does increase risk for high blood pressure. Dr. Splaver explains that “high blood sugar levels causes damage to the tiniest of vessels of the body thereby ‘gumming up’ the works to get vital nutrients to the organs that they supply. When small vessels are damaged, the heart and vascular tree have to raise pressures to get blood flowing to the vital organs to ensure not only their function but in some cases their survival.”

So you see, it’s high blood sugar levels that causes damage to vessels, leading to greater risk of high blood pressure. And when you have type 2 diabetes, high blood pressure increases your risk for:

• Heart disease
• Stroke
• Kidney disease
• Eye problems

This is why you need to concentrate your efforts on gaining good control of your blood sugar and A1c levels.

Of course, there are other risk factors that can contribute to the development (or worsening) of high blood pressure. 

• Stress
• Poor diet
• Obesity
• Sedentary lifestyle
• Smoking
• Sleep apnea
• Metabolic syndrome
• Thyroid disorders
• Genetics/ family history
• Age

As you can see by this list, with the exception of the last 2, there are many lifestyle changes you can implement that can combat high blood pressure.

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How Can I Lower My Blood Pressure?

Great question – and there are many things you can do.

Exercise

Exercise strengthens the heart, making it more efficient at pumping blood.

Aim for 150 minutes of physical activity per week (approximately 30 minutes per day) to reduce your risk for heart disease AND diabetes complications.

Healthy Diet

Very similar principles for a healthy type 2 diabetes diet apply to a healthy diet for blood pressure reduction.

Overall, research indicates that whole food dietary patterns (ones made up of fresh foods) such as the Mediterranean diet or the DASH diet are beneficial in terms of lowering blood pressure.

These diets are characterized by consumption of fresh vegetables and fruits, whole grains, lean meats, poultry, fish, nuts, seeds, eggs and dairy products.

It’s just the case that there are additional parameters that should be considered with type 2 diabetes, such as limiting the total amount of carbohydrates you eat. So in a low carb Mediterranean-style diet, such as we encourage, whole grains are eliminated due to their high carb content. 

You also need to limit fruit and starches, and switch those foods for ample amounts of fresh non starchy vegetables. Again, the reason for this is their carb content and regulating blood sugar is critically important to heart health and blood pressure regulation.

The overall message here is: both a hypertension diet and a type 2 diabetic diet should limit processed and packaged foods in exchange for nutrient dense whole foods.

Reduce “added” salt intake

Because the Western diet is so laden with highly processed foods, sodium intake via “added” salt is rampant and often far exceeds daily recommendations.

While there seems to be a bit of controversy concerning the exact effect of sodium on blood pressure, it’s wise to steer clear of processed foods and use herbs and spices to season foods while going easy on the salt shaker.

However, if you eat a low carb diet with ample vegetables, adding a little sea salt to foods is usually not a problem because you have a higher potassium intake and sometimes that little added salt is needed to balance out the sodium/potassium ratio.

Eat plenty of foods high in potassium, calcium, and magnesium

Each of these minerals helps balance out the effects of sodium. These minerals are found in abundance in many vegetables, fruits, and whole food sources.

Magnesium

Magnesium-rich food sources (per 100 g of the food item):

• Dried basil 711 mg
• Hulled hempseed 700 mg
• Dried cilantro/ coriander 694 mg
• Pumpkin seeds 594 mg
• Unsweetened cocoa 499 mg
• Dried dill 451 mg
• Flaxseed 392 mg
• Brazil nuts 376 mg
• Sesame flour and sesame paste (tahini) 362 mg
• Chia seeds 335 mg
• Raw cashews 292 mg
• Almonds or almond butter 279 mg

Calcium Calcium can obviously be found in dairy products. But it’s also found in non-dairy food sources as well. Green leafy vegetables are not only calcium-rich but they provide around 60% absorbable calcium, while most dairy products only provide around 30%.

Examples of green leafy’s include:

• Bok choy
• Collards
• Kale
• Mustard greens

And each of the foods listed below contains 300 mg, or approximately one-third of your daily calcium intake.

• Almonds – 1/3 cup
• Almond butter – 3-4 tablespoons
• Hazelnuts – 1/2 cup
• Sesame seeds – 2/3 cup
• Sesame seed paste (tahini) – 6 tablespoons
• Chia seeds – 1/2 cup
• Seaweeds like nori, wakame, kombu – 1/2 cup
• Flaxseeds – 1 cup
• Brazil nuts – 1.5 cups
• Almond milk – 1 cup
• Sardines with bones – 3 oz
• Pink salmon with bone

Potassium

Potassium-rich foods (per 100 g of the food item):

• Acorn squash – 437 mg
• Swiss chard – 549 mg
• Avocado – 507 mg
• Edamame – 436 mg
• Spinach – 257 mg
• Tomato – 257 mg
• Chinese cabbage – 252 mg
• And many other vegetables

Limit alcohol and caffeine

Alcohol and caffeine both raise blood pressure, even though one is a stimulant and the other a depressant.

Reduce refined carbs and added sugars

In addition to being terrible for blood sugar control, added sugars have been linked to increased blood pressure.

Refined carbohydrates (ie. white starches such as pasta and bread) have a similar effect, as they convert to sugar very quickly.

Control blood sugar

Good control of blood sugar will help reduce the thickness of the blood to normal levels, making it easier to pump through the body so that less force is needed, and less damage occurs to blood vessels. 

As a result, your chances of high blood pressure are reduced or your ability to manage levels is increased.

Reduce stress

Physiologically, the body responds to stress by going into “fight or flight mode,” both of which increase heart rate and constrict blood vessels, not to mention increase blood sugar levels.

Check out this information for some ways to reduce your stress levels.

Weight loss

Remember the more mass a person has, the more pressure needs to be exerted to feed the tissues.

Therefore, even a modest weight loss can lead to improved blood pressure levels.

Quit smoking

Smoking constricts blood vessels making the area through which blood is pumped smaller, thereby increasing pressure.

Think of trying to pump water out of a drinking straw instead of a hose, and you’ll get the picture!

Biofeedback

Devices such as RESPeRATE are designed to provide you with feedback that helps your body reset itself.

For instance, the RESPeRATE device promotes deeper, slower breathing by listening to a melody in headphones that ‘adapts’ to your individual breathing rhythm. With just 15 minutes a day studies have shown a significant decrease in blood pressure levels.

Consider supplements

Supplements such as garlic, fish oil, hibiscus and many others may improve blood pressure with relatively few, if any, side effects.

Garlic extract: One study in patients with uncontrolled hypertension found that garlic extract helps reduce hypertension, improve artery stiffness and reduce inflammation in the arteries, all of which can help reduce risk of heart disease and stroke.

Fish oil: In type 2 diabetic patients, fish oil supplementation has been shown to improve the elasticity of artery walls. This improvement within the blood vessels was directly linked with improved blood pressure.

In healthy populations, fish oil has also been shown to significantly improve blood pressure levels.

Hibiscus: Hibiscus, also known as ‘sour tea,’ contains organic acids, polyphenols, anthocyanins, polysaccharides and other heart-protective compounds. And according to research, consuming the tea can help lower both systolic and diastolic blood pressure.

Take medications if necessary

If you do have high blood pressure, medications may be necessary because the goal is you need to lower your pressure to avoid heart disease, heart attack and stroke.

There are several types of medications used to lower blood pressure. They are divided into different “classes” depending on how they work. Below are some examples.

ACE Inhibitors: These lower blood pressure by decreasing a key enzyme that causes blood vessels to narrow. Examples include: Lotensin and Lisinopril.

ARBs: These accomplish the same basic function as ACE inhibitors, but work on a slightly different mechanism. Examples include: Avapro or Cozaar.

Calcium Channel Blockers: Calcium increases the strength and force of contraction in the heart muscles. Blockers reduce this, thereby lowering blood pressure. Examples include: Norvasc and Cardizem.

Beta Blockers: These medications work directly on the heart, reducing the heart rate and blood volume pumped. Examples include: Coreg or Lopressor.

Diuretics: These lower blood volume by increasing urination. Examples include: Lasix or Diuril.

There are a few other classes and hundreds of individual medications within these categories. There are even some that exist as combinations of categories. For more in-depth info, refer to this list from the American Heart Association.

The downside of blood pressure medications is that many of them come with side effects that may include:

• Diarrhea/constipation
• Headache
• Nervousness
• Dizziness
• Headache
• Nausea
• Vomiting
• Rash
• Weight loss/gain
• Heart rate changes
• …among others

If you experience side effects you should consult with your physician. Since there are many varieties of medications available, it may be the case that others may be more suited to you.

If your blood pressure is well controlled on medications, you may want to discuss the possibility of trying to wean off them. But it is unwise, and possibly dangerous, to make changes to your medications without first discussing options with your doctor.

Conclusion

While medications are often necessary, don’t solely rely on medications because a healthy lifestyle can help reduce and control blood pressure as well.

The best part is, if you follow a healthy low carb diabetes diet for blood sugar control, you’ll also be doing your blood pressure a favor!

Take it seriously though. High blood pressure is called the “silent killer” for a reason. You can’t feel it but the consequences (heart attack, heart failure and stroke) can sneak up on you unexpectedly.

Be proactive about caring for your health. Especially since there are so many lifestyle factors you can take charge of.

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