Diabetic with high blood pressure

By: Sue Cotey and Andrea Harris, RNs

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

If you have diabetes, you’ve probably already started counting carbs and exercising more to keep your blood sugar stable.

But you may be neglecting another, often silent problem that can go hand-in-hand with diabetes: high blood pressure. Also known as hypertension, the condition occurs in as many as two-thirds of people with diabetes.

If you have both conditions and either is out of control, your risk of blood vessel damage increases, heightening the likelihood of complications like heart attack, stroke or kidney failure. If both conditions are unmanaged, the risk is even greater.

Here are six suggestions to help keep your blood pressure in check.

RELATED: Have Diabetes? Why You Need to Know Your Blood Pressure Numbers

1. Get up and move

Exercise is an important part of any healthy lifestyle. It strengthens the heart and makes it pump more efficiently, so it is particularly critical if you have hypertension.

To improve cardiovascular health and maintain your weight, try to get 150 minutes each week of aerobic activity. You want to spread this over at least three days, with no more than two consecutive days without exercise. This can include walking, cycling and swimming.

2. Eat fresh, natural foods

If you find yourself struggling to figure out which foods in the grocery aisles have too much sodium, here’s a good tip to follow: Food in its natural state is best. Skip over processed foods and opt for fresh fruits and vegetables, whole grains and lean meats.

RELATED: 3 Natural Ways to Control Your High Blood Pressure

3. Reduce salt

If you are planning to start a low-sodium diet (no more than 1,500 mg per day), the first step is to get rid of the salt shaker. In its place, use salt-free herbs, spices and other seasonings.

It’s also important to watch for hidden sodium in the foods you eat. The following items are typically high in sodium so try to avoid them:

  • Processed foods, such as hot dogs, packaged lunch meats and salami
  • Canned foods
  • Prepared or frozen dinners (even ones labeled “lean” or “healthy” may still be high in sodium)

When eating vegetables that aren’t fresh, opt for frozen over canned. Foods labeled low- or reduced-sodium are usually good options.

4. Take your medication

If you have diabetes and high blood pressure, you may be taking medications that help relax blood vessels so they don’t constrict.

The important thing about these medications is that you must take them regularly. Forgetting just one day can result in a high blood pressure pretty quickly so be sure to resume any missed doses as soon as possible. If this is an area where you have trouble, it is worth making an effort to fix it.

RELATED: Easy Everyday Habits That Can Keep Your Heart Healthy

5. Limit alcohol

If you have diabetes, it is important to learn how to monitor your alcohol intake. First, talk to your health care provider to make sure it is alright for you to consume any alcohol. This is particularly important if you also have hypertension, because consuming large amounts of alcohol often increases blood pressure.

The common recommendation for moderate alcohol consumption is one drink daily for women and up to two drinks daily for men. One drink equals 4 ounces of wine, 12 ounces of beer, or 1 ounce of distilled spirits.

6. Don’t smoke

If you are a smoker, quitting will greatly reduce your heart disease risk. When you smoke, your blood vessels constrict, which can raise blood pressure and also cause the release of hormones that work against insulin. This may raise blood sugar or increase your risk of getting diabetes if you don’t already have it.

Another important thing about quitting smoking is to be ready to work to keep your weight down after you stop. But take it one step at a time. Your doctor can help you create a plan to keep your weight in check while kicking the smoking habit.

As you work to keep your blood pressure in check, remember to talk to your health care provider about your target blood pressure goals. There are overall guidelines, but each patient may have different targets suggested by their provider.

Fifteen good foods for high blood pressure

Many researchers have found that certain foods can lower high blood pressure. We look at which foods work and how to incorporate them into a healthful diet.

1. Berries

Share on PinterestBlueberries and strawberries contain anthocyanins, which can help reduce a person’s blood pressure.

Blueberries and strawberries contain antioxidant compounds called anthocyanins, a type of flavonoid.

Researchers conducted a large study with more than 34,000 people with hypertension.

They found that those with the highest intake of anthocyanins — mainly from blueberries and strawberries — had an 8 percent reduction in the risk of high blood pressure, compared to those with a low anthocyanin intake.

Enjoy berries as a snack or sweet treat after meals, or add them to smoothies and oatmeal.

2. Bananas

Bananas contain plenty of potassium, a mineral that plays a vital role in managing hypertension. One medium-sized banana contains around 422 milligrams of potassium.

According to the American Heart Association, potassium reduces the effects of sodium and alleviates tension in the walls of the blood vessels.

Adults should aim to consume 4,700 milligrams (mg) of potassium daily. Other potassium-rich foods include:

  • avocado
  • cantaloupe and honeydew melon
  • halibut
  • mushrooms
  • sweet potatoes
  • tomatoes
  • tuna
  • beans

People with kidney disease should speak to their doctors about potassium, as too much can be harmful.

3. Beets

Drinking beet juice can reduce blood pressure in the short and long terms.

In 2015, researchers reported that drinking red beet juice led to lower blood pressure in people with hypertension who drank 250 milliliters, about 1 cup, of the juice every day for 4 weeks. The researchers noticed some positive effects within 24 hours.

In this study, those who drank 1 cup of the beet juice every day had an average drop in blood pressure of around 8/4 millimeters of mercury (mm Hg). For many, this change brought their blood pressure within the normal range. On average, a single blood pressure medication reduces levels by 9/5 mm Hg.

The researchers suggested that beet’s high levels of inorganic nitrate caused the reduction in blood pressure.

It may help to drink a glass of beet juice each day, add beets to salads, or prepare the vegetables as a healthful side dish. Beetroot juice products are available for purchase online.

4. Dark chocolate

This sweet treat may lower blood pressure. A review of 15 trials suggests that cocoa-rich chocolate reduces blood pressure in people with hypertension or prehypertension.

Choose high-quality chocolate that contains a minimum of 70 percent cocoa, and consume a single square, or a piece measuring about 1 ounce, each day.

A range of dark chocolate is available for purchase online.

5. Kiwis

A daily serving of kiwi can reduce blood pressure in people with mildly elevated levels, according to results of one study.

The researchers compared the effects of apples and kiwis on people with slightly high blood pressure.

They found that eating three kiwis a day for 8 weeks resulted in a more significant reduction in both systolic and diastolic blood pressure, compared with eating one apple a day for the same period. The authors suspect that the bioactive substances in kiwis caused the reduction.

Kiwis are also rich in vitamin C, which may significantly improve blood pressure readings in people who consumed around 500 mg of the vitamin every day for about 8 weeks.

Kiwis are also easy to add to lunches or smoothies.

6. Watermelon

Watermelon contains an amino acid called citrulline, which may help to manage high blood pressure.

Citrulline helps the body to produce nitric oxide, a gas that relaxes blood vessels and encourages flexibility in arteries. These effects aid the flow of blood, which can lower high blood pressure.

In one study, adults with obesity and prehypertension or mild hypertension who took watermelon extract showed reduced blood pressure in the ankles and brachial arteries. The brachial artery is the main artery in the upper arm.

Researchers have also found that animals given a diet rich in watermelon had better heart health. In one study, mice who drank a solution containing watermelon juice had 50 percent less plaque in their arteries than the control group.

The mice who drank the solution also had 50 percent less low-density lipoprotein cholesterol, which many describe as bad cholesterol, and they showed 30 percent less weight gain than the control animals.

To boost watermelon intake, add the fruit to salads and smoothies, or enjoy it in a chilled watermelon soup.

7. Oats

Oats contain a type of fiber called beta-glucan, which may reduce blood cholesterol levels. Beta-glucan may also lower blood pressure, according to some research.

A review of 28 trials concluded that higher consumption of beta-glucan fiber may lower both systolic and diastolic blood pressure. Barley also contains this fiber.

Start the day off with a bowl of oatmeal, or use rolled oats instead of breadcrumbs to give texture to meat or vegetarian burger patties.

Oats are available to purchase online.

8. Leafy green vegetables

Leafy green vegetables are rich in nitrates, which help to manage blood pressure. Some research suggests that eating 1–2 servings of nitrate-rich vegetables every day can reduce hypertension for up to 24 hours.

Examples of leafy greens include:

  • cabbage
  • collard greens
  • fennel
  • kale
  • lettuce
  • mustard greens
  • spinach
  • Swiss chard

To consume a daily dose of green vegetables, stir spinach into curries and stews, sauté Swiss chard with garlic for a tasty side dish, or bake a batch of kale chips.

9. Garlic

Share on PinterestEating garlic can increase a person’s nitric oxide levels.

Garlic is a natural antibiotic and antifungal food. Its main active ingredient, allicin, is often responsible for associated health benefits.

Some research suggests that garlic increases the body’s production of nitric oxide, which helps the smooth muscles to relax and the blood vessels to dilate. These changes can reduce hypertension.

One study reported that garlic extract reduced both systolic and diastolic blood pressure in hypertensive people.

Garlic can enhance the flavor of many savory meals, including stir-fries, soups, and omelets. Using garlic instead of salt can further promote the health of the heart.

10. Fermented foods

Fermented foods are rich in probiotics, which are beneficial bacteria that play an important role in maintaining gut health. Eating probiotics can have a modest effect on high blood pressure, according to a review of nine studies.

The researchers reported more enhanced effects when study participants consumed:

  • multiple species of probiotic bacteria
  • probiotics regularly for more than 8 weeks
  • at least 100 billion colony-forming units a day

Fermented foods to add to the diet include:

  • natural yogurt
  • kimchi
  • kombucha
  • apple cider vinegar
  • miso
  • tempeh

Some people prefer to take concentrated probiotic supplements every day. Probiotic supplements are available for purchase online.

11. Lentils and other pulses

Lentils are a staple of many diets around the world, as they are an excellent source of vegetarian protein and fiber.

In 2014, researchers who studied the effects of a diet rich in pulses on rats reported decreased levels of blood pressure and cholesterol. A total of 30 percent of the rats’ diet comprised pulses, including beans, peas, lentils, and chickpeas.

Lentils are very versatile. Many people use them as a vegetarian alternative to minced beef or to add bulk to salads, stews, and soups. A range of lentils is available for purchase online.

12. Natural yogurt

The America Heart Association has reported that yogurt may reduce the risk of high blood pressure in women.

The researchers found that middle-aged women who consumed five or more servings of yogurt each week for 18–30 years showed a 20 percent reduction in the risk of hypertension when compared to similarly aged women who rarely ate yogurt.

The men in the study did not appear to have the same benefits, but their yogurt intakes tended to be lower.

It is important to note that the National Dairy Council in the U.S. funded this research.

Unsweetened yogurts, such as natural or Greek yogurts, tend to have more benefits. Enjoy them with fruit, nuts, or seeds for a healthful snack or dessert.

13. Pomegranates

Drinking 1 cup of pomegranate juice daily for 28 days can lower high blood pressure in the short term, according to the findings of a study from 2012. The researchers attributed this effect to the fruit’s antioxidant content.

While pomegranates can be enjoyed whole, some people prefer the juice. When buying pre-packaged pomegranate juice, check to ensure that there is no added sugar.

14. Cinnamon

Cinnamon may also help to reduce blood pressure, at least in the short-term.

An analysis of three studies showed that cinnamon decreased short-term systolic blood pressure by 5.39 mm Hg and diastolic blood pressure by 2.6 mm Hg. However, more research is needed.

Add cinnamon to the diet by sprinkling it over oatmeal or freshly chopped fruit, as an alternative to sugar. Cinnamon is available to purchase in various forms.

15. Pistachios

Share on Pinterest Consuming pistachio nuts may decrease a person’s risk of hypertension.

Pistachios are healthful nuts that may decrease hypertension.

One study reported that including pistachio nuts in a moderate-fat diet may reduce blood pressure during times of stress. This may be because a compound in the nuts reduces the tightness of blood vessels.

It is important to note that the California Pistachio Commission of Fresno and the American Pistachio Growers funded this small-scale study.

Other studies have found that other nuts, such as almonds, had a similar effect.

Snack on plain pistachios, toss them into salads, or blend them into pestos. Unsalted nuts are more healthful and available to purchase online.

Diabetes and High Blood Pressure: How to Manage Both

Type 2 diabetes and high blood pressure (hypertension) are a dangerous combination, putting your health in jeopardy in a number of ways. That means it’s crucial to take steps to control high blood pressure when you have diabetes.

To start, having type 2 diabetes increases your risk for developing high blood pressure. High blood pressure is a heart disease risk factor on its own, and when you also have diabetes, having high blood pressure puts you at even greater risk. For example, for people who have diabetes, the risk of heart disease increases twofold in men and fourfold in women compared to people without diabetes. If you have diabetes and high blood pressure, your risk of heart disease doubles over that of a person who has high blood pressure alone.

“There’s no doubt that diabetes and high blood pressure are a dangerous duo. They’re both very common and are linked by obesity, which is also very common. Nearly half of all people diagnosed with type 2 diabetes have high blood pressure at the time of their diagnosis,” says Betul Hatipoglu, MD, an endocrinologist at the Cleveland Clinic in Ohio.

How Diabetes Increase Your Risk of High Blood Pressure

Type 2 diabetes is caused by resistance to insulin, the hormone your body needs to use blood sugar for energy. When you have type 2 diabetes, since your body resists insulin, sugar builds up in your blood. “That means your body makes even more insulin, and insulin causes your body to retain salt and fluids, which is one way diabetes increases your risk for high blood pressure,” Dr. Hatipoglu says. For this reason, it’s important to check your blood pressure regularly, just like it is for you to check your blood sugar. Follow your doctor’s recommendations for how often to do both.

Blood pressure is measured by checking systolic pressure over diastolic pressure, measured in millimeters of mercury (mmHg). High blood pressure means having numbers higher than 140/90 mmHg. The first number (systolic pressure) is the pressure inside your blood vessels when your heart beats. The second number (diastolic pressure) is the pressure when your heart is at rest. “Over time, diabetes damages the small blood vessels in your body, causing the walls of the blood vessels to stiffen. This increases pressure, which leads to high blood pressure,” Hatipoglu says.

Lower Blood Pressure Reduces Diabetes Complications

A 2011 article in the journal Canadian Family Physician reviewed the medical literature on type 2 diabetes and high blood pressure. The researchers concluded that lowering blood pressure in people with diabetes and high blood pressure is the single most important way to reduce death and disability related to type 2 diabetes.

In addition to increasing your risk for heart disease, diabetes and hypertension also increase your risk for eye and kidney complications. “The combination of diabetes and high blood pressure is deadly for small blood vessels that supply the eyes and kidneys. Diabetes is the most common cause of blindness in the world,” Hatipoglu says. But here’s the good news about diabetes and high blood pressure: Lowering your systolic blood pressure by 10 points has been shown to lower all diabetes complication risks by 12 percent overall.

“As a general guideline for people with diabetes, the goal is to keep blood pressure at or below 140 over 90. For people with diabetes and kidney disease, the numbers should be kept at or below 130 over 80,” Hatipoglu says.

Healthy Lifestyle Tips for Lower Blood Pressure

“Lifestyle changes are the most important thing anyone can do to manage diabetes and high blood pressure. The benefits are tremendous,” Hatipoglu says. Here are some tips:

  • Exercise on a regular basis.
  • Lose weight if you need to and then maintain a healthy weight.
  • Limit your salt intake to two grams per day. “That’s about one teaspoon. Remember that you can get that much salt in many fast foods and canned foods without adding table salt,” Hatipoglu says.
  • Don’t smoke.
  • Avoid over-the-counter pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs). “NSAIDs can raise blood pressure. Try acetaminophen instead,” Hatipoglu says.
  • Drink alcohol only in moderation. “More than one drink a day for women or two drinks for men can raise blood pressure,” Hatipoglu says.
  • Use the dietary approaches to stop hypertension (DASH) diet plan. “DASH is a Mediterranean-style diet with lots of fruits, vegetables, fish, healthy fats, and whole grains,” Hatipoglu says.

If you have type 2 diabetes and high blood pressure, there’s plenty you can do to control these combined conditions. Work with your doctor to get your diabetes and blood pressure under control and follow these healthy lifestyle tips. Remember that the key to living well with diabetes is preventing diabetes complications. Lower blood pressure may be your most important first step.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *