Treatment of Complications
High Blood Pressure and Heart Disease
All patients with diabetes and high blood pressure should adopt lifestyle changes. These include weight reduction (when needed), following the Dietary Approaches to Stop Hypertension (DASH) diet, smoking cessation, limiting alcohol intake, and limiting salt intake to no more than 1,500 mg of sodium per day.
High Blood Pressure Control. Patients should aim for blood pressure levels of less than 130/80 mm Hg (systolic/diastolic).
Patients with diabetes and high blood pressure need an individualized approach to drug treatment, based on their particular health profile. Dozens of anti-hypertensive drugs are available. The most beneficial fall into the following categories
- Diuretics rid the body of extra sodium (salt) and water. There are three main types of diuretics: Potassium-sparing, thiazide, and loop.
- Angiotensin-converting enzyme (ACE) inhibitors reduce the production of angiotensin, a chemical that causes arteries to narrow.
- Angiotensin-receptor blockers (ARBs) block angiotensin.
- Beta blockers block the effects of adrenaline and ease the heart’s pumping action.
- Calcium-channel blockers (CCBs) decrease the contractions of the heart and widen blood vessels. Like ACE inhibitors and ARBs, certain calcium channel blockers (diltiazem and verapamil) can reduce urine protein loss caused by diabetic kidneys.
Nearly all patients who have diabetes and high blood pressure should take an ACE inhibitor (or ARB) as part of their regimen for treating their hypertension. These drugs help prevent kidney damage. [For more information, see In-Depth Report #14: High blood pressure.]
Improving Cholesterol and Lipid Levels. Abnormal cholesterol and lipid levels are common in diabetes. High LDL (“bad”) cholesterol should always be lowered, but people with diabetes also often have additional harmful imbalances, including low HDL (“good”) cholesterol and high triglycerides.
Review Date: 05/05/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.