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Diabetes and high blood pressure
Managing the ‘Silent Killer’

Many people with continuous high blood pressure, or hypertension, do not know they have it. Since elevated blood pressure is almost always symptom-free, it is called a ‘silent killer.’ If you have diabetes, you likely also have high blood pressure. In Canada, only 44 per cent of people with diabetes have their blood pressure under control.

A large part of managing diabetes involves preventing complications. Heart disease, stroke, kidney and eye disease are all related to high blood pressure. Up to 80 per cent of those with diabetes die from heart disease or stroke.

High blood pressure damages the body’s blood vessels, causing them to clog or weaken. Many medical complications experienced by those with diabetes have been attributed to high blood pressure. It is considered one of the most preventable causes of disease and death. Treating hypertension in people who have diabetes reduces the rate of heart disease, stroke, eye disease, progressive kidney failure and death.

What is blood pressure?

Your heart is a pump circulating blood throughout the body. Blood is pumped into blood vessels called arteries. Blood pressure is the amount of force blood puts on artery walls.

What do the numbers mean?

When blood pressure is measured, two numbers (such as 130/80 mm Hg) are reported. The first number measures the force placed on the artery walls as the heart pushes blood out into the arteries. This is called systolic blood pressure. The second number is the force remaining in the arteries when the heart relaxes. This is diastolic blood pressure. Most people with diabetes should have their blood pressure below 130/80 mm Hg.

Blood pressure targets

Certain levels of blood pressure will not harm the arteries. However, if your blood pressure stays consistently above target values, you have hypertension. By keeping blood pressure in target range, you provide the best protection for your arteries.

Can blood pressure be too low?

Yes. Enough pressure is needed in the arteries to circulate blood, providing necessary oxygen and nutrients to the body. Generally, it is best to keep the systolic blood pressure (top number) above 90. Symptoms of low blood pressure include feeling dizzy or lightheaded, nauseous, or having blurred vision. If blood pressure becomes too low, you may faint.

Risks of high blood pressure

Uncontrolled high blood pressure can bring serious risks:

• eye disease, which can cause blindness
  
• aneurysm (a weakened blood vessel that can burst)
  
• dementia (a decline in cognitive function and intellectual abilities)
  
• impotence (difficulty with penis erections)
  
• heart attack
  
• heart failure
  
• kidney failure
  
• stroke
  
• peripheral arterial disease, or PAD, where plaque builds up in the arteries limiting blood flow to the arms and legs
  
• and death.

What makes blood pressure rise?

About five per cent of people with high blood pressure have a medical condition that causes their blood pressure to rise. This is often related to hormones or the kidneys. For such people, treating the condition helps control blood pressure. Taking certain types of medications like the birth control pill, corticosteroids and decongestants, can also affect blood pressure.

For the rest of the population, certain factors contribute to high blood pressure. These are:

• aging
  
• family history of high blood pressure
  
• smoking
  
• diet high in sodium (salt)
  and saturated fats
  
• excessive alcohol intake
  
• lack of exercise
• being overweight, especially carrying fat around the waist
  
• and stress.

Preventing and controlling high blood pressure

You cannot change your age or your family history. However, you can control seven factors that affect your blood pressure. These are smoking, diet, exercise, drinking alcohol, weight loss, stress management and taking your blood pressure medications as prescribed.

While medication is sometimes needed to manage blood pressure, changing your lifestyle is the cornerstone of blood pressure management. Even if you do take blood pressure medication, controlling other factors remains key.

Smoking

Smoking damages blood vessel walls. This damage hardens blood vessel walls, making blood pressure rise. Many public and private programs can help you stop smoking. Talk to your health care provider to find one in your area.

Diet

Research has shown that eating a healthy diet can reduce your risk of developing high blood pressure. It can even reduce blood pressure that is already elevated. Many experts in hypertension recommend the DASH (Dietary Approaches to Stop Hypertension) diet. This diet is rich in fruit, vegetables, low or non fat dairy products, poultry, fish, beans, seeds and nuts. It promotes eating less saturated and trans fats, red meats and sugars.

Diets higher in sodium are also associated with elevated blood pressure. Table salt is one of our most common food seasonings. This mineral is made of sodium chloride (39 per cent sodium, 61 per cent chloride). It is sodium that makes blood pressure rise.

The average Canadian diet contains about 3500 mg of sodium – far too much. An adequate amount is less than 1500 milligrams per day. The Canadian Hypertension Society recommends no more than 2300 milligrams per day.

Sodium comes from three sources. It does occur naturally in some foods. However, this only accounts for 11 per cent of daily sodium intake. Another 12 per cent of sodium is added during cooking or at the table. The worst source (77 per cent) comes from processed or restaurant foods. Foods like hamburgers, hot dogs, deli meats and canned soups are high in sodium. Avoid any products listing sodium content of 400 milligrams or more per serving on the food label.

To help reduce sodium intake, the Canadian Stroke Network has developed the website Sodium 101 (www.sodium101.ca). This website is a great resource. It provides useful tips, explains how to read food labels, and even gives links to the nutritional information for some of Canada’s restaurant chains.

Carrying fat around your waist increases the risk of diabetes, high blood pressure, heart disease and stroke.

To properly measure your waist:

Figure how much ‘bad’ belly fat you are carrying by measuring your waist circumference.

• Stand with your feet about a foot apart.
  
• Measure waist circumference by placing a tape measure around the abdomen at the level of the top of the upper hip bone (iliac crest) in the front. Keep the tape measure parallel to the floor.
  
• Make certain the tape measure is snug, but not pressing on the skin, before reading it.
  
• Measure at the end of a normal expiration (outward breath) of air.

You can find a video about how to do this on the Heart and Stroke Foundation of Canada’s website (www.heartandstroke.ca).

Alcohol

Drinking too much alcohol can raise blood pressure. If you do drink, keep hypertension under control by staying within the recommended limit. Have no more than two standard size drinks per day. Women should have a maximum of nine per week, men 14. In this era of super sized food and beverages, remember how much alcohol is considered a standard size drink.

Exercise

Physical activity is essential to maintaining healthy blood pressure. You should be exercising 30 to 60 minutes, four to seven days per week. The level of activity should be above and beyond normal daily movement. Aim for a moderate level like jogging, cycling or swimming. A quickly paced walk also qualifies.

Stress

Managing stress is closely linked to managing blood pressure. When stressed, the body responds by releasing hormones called adrenaline and cortisol. These hormones increase heart rate and blood pressure.

We are all unique. What each of us considers stressful and how we cope is individual. You can deal with stress in healthy and unhealthy ways. Smoking, overeating and drinking too much alcohol are unhealthy ways to cope. Try to find healthy coping strategies that work for you:

Medications

Taking your blood pressure medication as prescribed is another important part of managing your blood pressure. (Still, don’t forget about the lifestyle changes!) Your health care provider will determine which medication will work best for you. Often, two to three medications are required to control blood pressure.

Several different categories of high blood pressure medications exist. People with diabetes are commonly prescribed an angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin receptor blocker (ARB). A diuretic or calcium channel blocker is frequently added.

Home blood pressure monitoring

Monitoring blood pressure at home can help improve your control and treatment. It provides feedback on how medications and lifestyle changes affect your blood pressure. Many health care providers are suggesting home blood pressure monitoring to their clients.

Blood pressure monitors are available at most pharmacies. Look for a device recommended by the Canadian Hypertension Society. Check for the approval symbol on the label. A list of approved monitors can be found at hypertension.ca/chs/deviceendorsements/devices-endorsed-by-chs/.

Be sure the device you purchase has the proper size cuff for your arm. The staff in the store can help you decide on the best monitor for you. Finally, read and follow the manufacturer’s directions.

Proper technique for blood pressure measurement

The Canadian Hypertension Education Program provides the following directions for proper blood pressure measurement. Take your blood pressure monitor to your health care provider once a year to have it checked for accuracy.

How to measure

• Measure your blood pressure in the morning before taking medications and eating. Take another measurement before bedtime or taking evening medications. Your health care provider may give you other directions.
  
• Wait at least two hours after a big meal, and at least 30 minutes after a caffeinated drink or a cigarette or cigar.
  
• Visit the bathroom first – a full bladder or bowel can raise your blood pressure.
  
• Sit in a chair that supports your back. Your feet should rest flat on the floor. Do not cross your legs or ankles. Your arm should be supported at the level of your heart.
  
• Place the cuff on your bare arm. Make sure there is no restricting clothing on any part of your arm. If you are wearing a long sleeved shirt, do not push up the sleeve. Remove your arm from the sleeve before taking your blood pressure.
  
• Before measuring your blood pressure, relax for five minutes in a quiet comfortable place. Taking your blood pressure when you are cold, uncomfortable, in pain, stressed or anxious can result in elevated readings.
  
• Do not talk during this five-minute rest period or while your blood pressure is being taken.
  
• Take at least two readings, one minute apart and record them with the date and time.

Although it takes time and effort to keep your blood pressure under control, it is well worth the effort. For more information on hypertension, talk with your diabetes education team.