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If you’ve been diagnosed with diabetes, you likely already understand how important it is to manage your blood sugar. But did you know you also need to be aware of your blood pressure?
Having diabetes puts you at an increased risk for high blood pressure. In fact, people with diabetes are twice as likely to develop high blood pressure, or hypertension. Being aware of your blood pressure readings and working to keep your numbers within normal range is essential for your overall health.
If you develop high blood pressure and it’s not treated, it can quickly become uncontrolled and negatively impact your heart health.
Here’s what you need to know about uncontrolled hypertension and diabetes. We’ll discuss how diabetes affects blood pressure, why the two are connected, and what can be done to address both.
People with diabetes and high blood pressure are four times more likely to develop heart disease. About two-thirds of adults with diabetes have higher-than-normal blood pressure or take blood pressure medications to manage hypertension.
When you have diabetes, glucose (sugar) builds up in your bloodstream. This excess sugar damages your blood vessels and forces your kidneys to work harder.
As the damage progresses over time, the walls of your blood vessels will stiffen, making it harder for blood to flow properly.
Likewise, your kidneys will become less efficient at filtering waste from your body, and you may retain salt and water. Ultimately, your blood pressure will go up as your arteries become narrower and less flexible and as your body starts retaining more salt and fluids.
Diabetes often isn’t diagnosed until as many as 10 years after its onset. During that time, high blood sugar is negatively impacting the blood vessels and kidneys. It’s possible that those effects have been building toward high blood pressure for quite some time.
This, in turn, can cause microvascular (small blood vessel) and macrovascular (large blood vessel) complications such as:
Having uncontrolled high blood pressure could also increase the risk for diabetes. Scientists are still studying the connection between the two conditions.
Anywhere from 50 percent to 80 percent of people with type 2 diabetes also have hypertension. This high blood pressure may be uncontrolled because a person doesn’t know they have it, or the medications they’re taking aren’t working.
Sometimes, uncontrolled hypertension is related to how diabetes impacts the body. Since diabetes causes your body to hold on to salt and water, makes your blood vessels stiffer and narrower, and damages your kidneys, this can make it difficult to manage high blood pressure.
Diabetes is the leading cause of kidney disease. If you have kidney disease or the blood vessels reaching the kidneys become stiff and narrow, you’re more likely to have uncontrolled or resistant hypertension despite treatment to lower blood pressure.
Diabetes and kidney disease disrupt your hormones and nerve signals, which increases the risk of developing high blood pressure. More specifically, some hormone systems in your body — like the renin-angiotensin-aldosterone system (RAAS) — become overactive. This not only interferes with how your body’s insulin works, but it can also contribute to elevated blood pressure.
One reason is that hormones like angiotensin 2 and aldosterone weaken insulin’s signal inside of your cells. The cells are then unable to activate the enzyme that produces nitric oxide. Nitric oxide is what tells your blood vessels to relax and widen. So, when your blood vessels don’t open as wide as they should, this can lead to higher blood pressure.
People with diabetes also tend to retain more glucose and sodium in the blood due to an increase in the amount of sodium-glucose cotransporter 2 (SGLT2) in the kidneys. More sodium leads to an increase in blood pressure.
In addition, inflammation in the body and around the blood vessels — especially in people with diabetes and obesity — may play a role in the development of high blood pressure in diabetes. Some types of bacteria in the gut may also contribute to the risk for high blood pressure.
If you have diabetes and hypertension, it’s important that you’re monitoring both your blood sugar and your blood pressure at home. See your primary care doctor regularly so they can check your blood pressure and your A1c levels (a blood test that measures your blood glucose levels over the last three months).
Knowing these numbers can help you and your healthcare team make adjustments to effectively manage both conditions. Here are other key elements your physician may include in your treatment plan.
Your healthcare provider may prescribe hypertension medications to lower blood pressure. These medications can include:
There’s also evidence that ACE inhibitors, ARBs, SGLT2 inhibitors, and GLP-1 receptor agonists may help slow the progression of kidney disease. They may be especially helpful if you have diabetes with kidney disease.
If you have diabetes and uncontrolled hypertension, your healthcare provider will also recommend some lifestyle changes. These may include:
If you smoke cigarettes, you may want to consider quitting. When you have diabetes, smoking lowers your good cholesterol levels, makes it harder to exercise, and raises your blood pressure.
Finally, managing your stress levels and prioritizing your sleep can also be beneficial.
When you have diabetes, seeing your healthcare provider on a consistent basis is an important part of your treatment plan. They can:
You also need to know when to get help for extreme fluctuations in blood sugar levels or blood pressure. Here are some general guidelines, but never hesitate to contact your healthcare provider if you’re concerned.
The best way to prevent diabetic emergencies is to live a healthy lifestyle. This includes making nutritious food choices and getting plenty of physical activity. But sometimes even the best-laid plans can go awry without warning.
If you experience extreme hyperglycemia (high blood sugar) or extreme hypoglycemia (low blood sugar), these conditions can lead to diabetic coma or insulin shock. It’s important to call 911 or get to the nearest emergency room as soon as possible.
Symptoms of diabetic coma, caused by high blood sugar, include:
Meanwhile, symptoms of insulin shock, caused by low blood sugar, include:
Most of the time, people with high blood pressure don’t have any symptoms. One study found nearly 60 percent of adults in the U.S. with uncontrolled hypertension don’t know they have it.
If left untreated for a long time, your blood pressure can become dangerously high and cause a hypertensive emergency.
If your blood pressure is 180/120 mm Hg (a measurement in millimeters of mercury) or higher and you have chest pain, shortness of breath, vision changes, or other troubling symptoms, call 911 or get to an emergency room.
If you have extremely high blood pressure but no symptoms, you may have severe hypertension. Call your healthcare provider as soon as possible to determine your next steps.
On DiabetesTeam, people share their experiences with diabetes, get advice, and find support from others who understand.
How has diabetes affected your blood pressure, and what have you done to address it? Let others know in the comments below.
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