For people with diabetes high blood pressure is a common problem. In one study, the prevalence of hypertension among people with Diabetes type 2 was 85.8% at blood pressure thresholds of 130/80 mm Hg and above.
For people suffering from both high blood pressure and diabetes, blood glucose level management is made more difficult because there risks for damage to the cardiovasular system and the brain, a greater prevalence should be given to the blood pressure-lowering aspects of the DASH diet in the formulation of the diabetes plate. This article will help you to understand how to manage high blood pressure with type 2 diabetes through dietary means.
What is High Blood Pressure (Hypertension)?
Your blood pressure is the pressure your heart maintains pushing blood through your blood vessels and around your body.
There are two numbers used to describe blood pressure, measured in millimetres of mercury (mmHg). The first is the high figure (systolic blood pressure), in terms of the most amount of pressure your heart applies when beating to push blood around your body. The second is the low figure and is called diastolic blood pressure. It measures the pressure in your arteries when your heart rests between beats, it's the lowest amount of pressure. The ideal blood pressure would be between 90/60mmHg and 120/80mmHg.
High blood pressure is defined as 130 mmHg or higher for the systolic number, or 80+ mmHg (millimetres of mercury) or higher for the diastolic pressure. High blood pressure affects men more than women (5% more) although complications resulting from it are felt more by women.
Table Format created by Heart.org
What are the Problems associated with High Blood Pressure?
While there are few symptoms initially, high blood pressure causes significant damage to the human body over time. It is twice as likely to strike a person with diabetes than a person without diabetes, and there is a higher risk of developing Diabetes type 2 if you have been diagnosed with hypertension.
Common Hypertension Symptoms
- Headaches
- Nosebleeds
- Fatigue
- Confusion
- Blurred Vision
- Irregular heartbeat
- Chest Pain
- Blood in Urine
Long Term Problems of Hypertension
- Heart failure
- Vision loss
- Stroke
- Kidney disease
Besides Diabetes type 2, hypertension is also a primary risk factor for cardiovascular diseases, including stroke, heart attack, heart failure and aneurysm.
How to Measure Blood Pressure
If you are at risk of diabetes or suffering from symptoms mentioned above or have been diagnosed as either prediabetic or are actually diabetic, it is good practice to monitor your blood pressure. Since your blood pressure needs to be measured at different times of the day, a home monitor is worth investing in. Simple monitors are inexpensive and easy to use. Follow instructions provided by the manufacturer.
Below are some tips for choosing a monitor
- Opt for an upper arm monitor as it is more precise.
- Automated monitors with a self inflating band are best.
- Clear, easy to read digital readout.
- Smartphone sync to wirelessly transfer the readings to an app. Tracking blood pressure over time is a great way to identify problematic times or foods.
Usage
- Avoid anything that might influence your blood pressure such as chewing or drinking caffeinated or alcoholic beverages for at least 30 minutes beforehand.
- Rest for five minutes in a comfortable chair with your legs uncrossed.
- Support your arm so your elbow is at or near heart level.
- Wrap the inflatable band over bare skin.
- Don't talk during the measurement.
- Leave the deflated band in place, wait a minute, then take a second reading. If the readings are close, average them. If not, repeat again and average the three readings.
- Track your blood pressure readings, including the time of day.
Diabetes Risks
High blood pressure is twice as likely in a person with diabetes than without diabetes, but this varies with age. In addition, there is a higher risk of developing Diabetes type 2 if you have already been diagnosed with hypertension.
Despite being easy to treat, 46% of cases of high blood pressure go undiagnosed according to World Health Organisation (WHO), this is primarily because those affected don’t realise they have a problem - there are few symptoms to notice.
Less than half of adults (42%) with hypertension are diagnosed and treated.
High blood pressure is routinely screened for when assessing risk factors for prediabetes. When you consider that around 30-40% of adults in western Europe have high blood pressure and 10.3% of men and 9.6% of women aged 25 years and over have diabetes, screening for high blood pressure on a regular basis is a simple preventative measure for diabetes type 2 that anyone can do from the comfort of their own home.
Other risk factors:
- Increase with age
- Overweight, high BMI
- Inactivity
- Excessive alcohol consumption
- Poor stress management, anxiety
- Familial history of HBP
- Ethnic group
How to Treat High Blood Pressure
Below are some simple steps that can be done every day to greatly reduce blood pressure.
If you have high blood pressure, one effective way to reduce it is to get a dog. Petting a dog can reduce your blood pressure significantly. This four-legged friend also has long-term positive effects in terms of heart health with positive outcomes. However, if a dog doesn’t fit into your lifestyle, there are plenty of other things you can do, such as:
- Exercise
- Diet
- Medication
- Sleep
- Give up bad habits
- Quit smoking
- Reduce alcohol Consumption
How to Manage High Blood Pressure with Diet
The most popular diet recommended for high blood pressure is the DASH (Dietary Approaches to Stop Hypertension) diet. It is a healthy-eating plan specifically designed to help treat or prevent high blood pressure (hypertension).
Studies have shown that the DASH diet can be effective at lowering blood pressure in as little as two weeks.
It’s a dietary pattern rich in micronutrients such as potassium, calcium and magnesium, but limits the intake of sodium. It also limits the intake of not only total fat, but also saturated fat and cholesterol and encourages the consumption of complex carbohydrates and protein.
When you translate it into actual food choices, it’s really similar to other dietary guidelines, like MyPlate or Diabetes Plate Method/Mediterranean diet, as both are rich in:
- vegetables
- fruits
- whole grains
- fat-free or low-fat dairy products
- fish and poultry
- legumes
- nuts and seeds
Both Mediterranean diet and MyPlate limit foods high in saturated fat, such as fatty meats and full-fat dairy products.
Limiting sodium or salt intake
The hypertension-busting aspects of the DASH diet that deviate from other dietary guidelines are primarily based on higher salt restriction. The standard DASH diet limits sodium intake to 2300 mg a day, but for those with high blood pressure, a more extreme version of DASH limits sodium to just 1500 mg a day.
The difference between sodium and salt
1 g of salt (NaCl) is equal to 1000 mg of salt, which contains 400 mg of sodium and 600 mg of chloride. In Europe, you often hear recommendations about salt consumption, and in American guidelines and eating patterns (just like the DASH diet) you can see mentions of sodium restriction, this difference can be confusing, so it’s important to clear the conversion between the two. Dietary guidelines usually recommend no more than 5-6 g of salt per day, which is similar to the DASH diet recommendations. However people still usually consume more, even up to 10 g a day, which can be concerning.
Is it worth taking suppliments?
One alternative to the extreme 1500 mg version of the DASH diet to reduce blood pressure is supplementation with calcium and vitamin D, which might also be a tastier alternative to further salt reduction, potentially mitigating the effect of increased salt intake, but again additional research is needed. It’s safer to include more calcium rich foods in your diet, like low-fat dairy products, poppy seeds or sesame paste, or even oily fish which still contains the fishbone, such as sardines, just like DASH diet recommends.
NOTE: If taking calcium channel blockers to manage your high blood pressure, consult your doctor before considering taking any calcium or vitamin D suppliment.
Heart-healthy diet with Diabetes type 2
There is no ideal meal plan that suits everyone suffering from diabetes, so it's impossible to say that one diet is better than another.
That being said, there are some recommended changes to the DASH diet to make it better suited for Diabetes type 2. As people with type 2 diabetes are also prone to cardiovascular diseases, it’s recommended to follow a heart-healthy dietary plan as well, if the goal is not only lowering high blood pressure, but also to improve the lipid profile. To achieve such goals, you would also need to increase the intake of unsaturated fats such as omega-3, viscous fibre and plant stanols/sterols.
For example, the glucose monitoring device manufacturer, Abbot, and Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022 published by the American Diabetes Association suggests adding more unsaturated fats via oils, nuts and seeds to achieve a healthy balance.
Conclusion
The DASH diet looks to be well suited for those suffering from diabetes type 2 and hypertension. However, insufficient research has been done in this regard, so test with caution.
Since the vast majority of diabetes type 2 sufferers also suffer from high blood pressure at some point during the progression of their illness, a risk that only increases with age and disease progression, trialling a blood pressure reducing strategy/diet is a necessity when it occurs, especially if you want to avoid medication and associated side effects.
If your current diet proves insufficient to prevent high blood pressure, why not give the Dash diet a go?
As with all personalised treatments, trial and error are unavoidable. Careful monitoring of food consumption is recommended and is essential for minimising complications. One great and convenient way to do this is via a food tracking application like DiabTrend.
Sources:
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetes-and-high-blood-pressure
- https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456
- https://www.sciencedirect.com/science/article/pii/S1050173819300684
- https://diabetesjournals.org/care/article/43/Supplement_1/S111/30374/10-Cardiovascular-Disease-and-Risk-Management
- https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.15026#d3e676
- https://www.who.int/news-room/fact-sheets/detail/hypertension
