If you’re living with type 2 diabetes, your risk of developing hypertension, or high blood pressure, is about twice as high as that of the general population. Diabetes can also make blood pressure more difficult to keep within the recommended range.

“Uncontrolled hypertension” is a broad term for blood pressure that remains above your treatment goal. It’s different from resistant hypertension, which has a more specific clinical definition and generally means blood pressure remains above goal despite treatment with an appropriate combination of at least three medications.

High blood pressure increases the risk of serious health problems such as heart attack, stroke, and kidney disease. If you’re living with diabetes, it’s important to understand why these conditions often occur together and what may make blood pressure harder to manage.

How Diabetes Increases the Risk of Hypertension and Poor Blood Pressure Control

Diabetes and hypertension have some of the same risk factors. Because of this, people with diabetes have an increased risk of developing high blood pressure, and people with hypertension have a higher risk of developing type 2 diabetes.

In a U.S. study that followed blood pressure trends over more than 20 years, more than 40 percent of adults with diagnosed diabetes had blood pressure that was not under control during most time periods studied.

Insulin Resistance

Both diabetes and hypertension are associated with insulin resistance, a condition in which the body can’t make or use insulin effectively. Insulin is a hormone that regulates glucose (blood sugar). It allows blood sugar to move into the body’s cells and provide the energy the cells need to function properly.

Insulin resistance can affect the vascular system — the body’s network of blood vessels — and cause problems that affect blood flow and blood pressure, such as:

• Endothelial dysfunction (problems with the inner lining of blood vessels)
• Stiffened arteries
• Atherosclerosis (buildup of fat and cholesterol in the arteries)
• Vascular inflammation

Because of these risks, people with diabetes are more prone to hypertension than the general public. In one study of adults with type 2 diabetes and hypertension, about 57 percent had uncontrolled hypertension, defined in the study as blood pressure above 140/90 millimeters of mercury (mm Hg).

Fluid and Salt Retention

Diabetes can damage the kidneys, which is why chronic kidney disease is a serious complication of diabetes. Kidney damage can prevent the body from removing excess water and salt from the body, which often causes edema (swelling), primarily in the legs and feet and around the eyes. Fluid and salt retention can cause high blood pressure and make it more difficult to control, especially in people with chronic kidney disease.

Obesity

Obesity (high body weight) is a major risk factor for developing hypertension. Approximately 75 percent of people with primary high blood pressure — blood pressure that isn’t caused by another condition — also have a higher body weight.

About 90 percent of people with type 2 diabetes are considered obese or overweight, according to a study in Clinical Medicine. People who have a higher body weight have higher amounts of visceral fat and white fat, which puts pressure on the vascular system and organs, including the heart and kidneys.

Sleep Apnea and Diabetes

There’s a high prevalence of sleep apnea with diabetes. Approximately 60 percent of people with diabetes also have obstructive sleep apnea. Both conditions are linked to obesity and metabolic syndrome. Obstructive sleep apnea is a condition in which the upper airway becomes blocked during sleep and disrupts breathing and sleep throughout the night.

In people with sleep apnea, interruptions in breathing cause a drop in oxygen, which causes stress in the body’s cardiovascular system and can lead to high blood pressure. Sleep apnea can also contribute to high blood pressure and make it harder to control.

Managing Uncontrolled Hypertension With Diabetes

Uncontrolled hypertension can often be managed by adjusting medications, making healthy lifestyle changes, treating conditions that affect blood pressure, and following the treatment plan consistently. The best approach depends on your current blood pressure, medications, and overall health. Your treatment plan may include:

• A combination of medications
• Healthy lifestyle changes
• Management of underlying health conditions, such as sleep apnea or chronic kidney disease
• Adherence to the prescribed medications

Medications

If your blood pressure remains above your treatment goal, your doctor may adjust the dose of your current medications or recommend a different combination of blood pressure medicines.

Blood pressure medicines used in people with diabetes may include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin 2 receptor blockers (ARBs)
• Calcium channel blockers
• Diuretics
• Mineralocorticoid receptor antagonists (MRAs), also called aldosterone receptor antagonists
• Beta-blockers

The best choice depends on factors such as your kidney health, other health conditions, current medicines, and possible side effects. Certain MRAs, such as spironolactone, may require blood tests to check your potassium levels and kidney function.

Always talk to your doctor before starting or changing a medication.

Lifestyle Changes

Healthy lifestyle changes can also help lower blood pressure and keep it within your treatment goal. These may include:

• Maintaining a healthy weight
• Getting regular physical activity
• Limiting alcohol
• Eating less salt
• Quitting smoking, which lowers your risk of heart disease

The DASH (Dietary Approaches to Stop Hypertension) eating plan is a heart-healthy way of eating that recommends:

• Plenty of fruits, vegetables, and whole grains
• Lean protein sources, such as low-fat dairy, poultry, fish, beans, and nuts
• Fewer foods with added sugar
• Fewer fatty meats and other foods high in saturated fat

Your doctor can refer you to a registered dietitian if you need help planning healthy meals.

Talk to Your Doctor

Your doctor can help you prevent high blood pressure and manage blood pressure that remains above your treatment goal. It’s also important to keep up with your diabetes care and follow your treatment plans for any other health conditions.

Talk to your doctor before making any changes to your medicines.

Join the Conversation

On DiabetesTeam, people share their experiences with type 2 diabetes, get advice, and find support from others who understand.

Have you been diagnosed with hypertension and diabetes? Let others know in the comments below.