In December, a panel of experts released new guidelines regarding when people over 60 should take drugs to reduce their blood pressure. But the guidelines for those of us with diabetes remain the same.
The panel of 17 academics reported its findings in the Journal of the American Medical Association, after reviewing data from the last five years. The full text of its report, "2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults," is free online. It concluded that people over 60 need to keep their blood pressure below 150/90, rather than the 140/90 level previously recommended.
The guideline for people with diabetes remains at 140/90, meaning a systolic blood pressure of no more than 140 and a diastolic pressure of less than 90. The systolic pressure reflects the pressure on our blood vessels when our hearts contract, while the diastolic number reflects the pressure when our heart relaxes between beats.
This is actually less stringent than some experts had previously recommended. Many doctors tell those of us with diabetes to keep our blood pressure at a level no higher than 120/80. And if we don’t, they will tell us to take our medicine, usually angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).
High blood pressure is the most frequent chronic health problem affecting adult Americans. One-fourth say they have it, according to a new study by the Pew Research Center, while 11 percent say that they have diabetes.
High blood pressure also is the most common chronic health problem for people who have diabetes. Two-thirds of American adults who told the U.S. Centers for Disease Control and Prevention that they have diabetes said they also have blood pressure at or over 140/90.
Since high blood pressure is so common, some think it’s no big deal. But it is just about as serious as having diabetes and we all know how serious that is. Having both chronic conditions can be a double whammy, because both can lead to heart disease, stroke, or eye, kidney and nerve diseases.
The truth is that most people don’t keep very close track of their blood pressure. And, we just can’t go by the last reading we had at the doctor’s office. It’s not just the infamous "white-coat syndrome," in which people become nervous at the doctor’s office and have higher readings than they normally would at home.
We know from experience that medical professionals can be rushed, and rushing doesn’t work when testing blood pressure. For example, I have had nurses check my blood pressure as soon as I came into the room. I’m sure they knew that patients are supposed to sit still for five to 10 minutes before having their blood pressure checked, but they were too rushed and my numbers were predictably high. (You can actually test your blood pressure better at home, as I wrote here.)
But if your blood pressure level is above 140/90 when you or your nurse checks it correctly, you need to manage it. Taking a drug, such as an ACEI or ARB, is the common shortcut. But shortcuts can lead to side effects. Other strategies work for some people, but the experts agree that losing weight is the best strategy.
That’s why high blood pressure and high blood sugar are twin problems for people with diabetes, and why getting our weight down to a normal BMI is the surest way to reach both goals.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.