Controlling blood pressure is one of the ABCs of diabetes treatment, according to the American College of Physicians, which include:

• A – Glucose control
• B – Blood pressure control
• C – Cholesterol control

A healthy blood pressure reading is one of the most important factors in preserving kidney function and reducing the risk of cardiovascular disease. People with diabetes diagnosed with high blood pressure can help keep their disorder under control by scheduling the following tests with their healthcare provider:

• Every three to four months
  
  
• Glycohemoglobin test. This blood test measures the average amount of glucose in blood over the past few months.
  
  
• Blood pressure check.
  
  
• Weight check.
  
  
• Each year
  
  
• Cholesterol test. This testing includes total cholesterol, LDL (“bad”) cholesterol, VLDL (“very bad”) cholesterol, HDL (“good”) cholesterol and triglycerides.
  
  
• Microalbuminuria test. A urine test that can detect early kidney disease.

Lifestyle changes can significantly improve a patient’s blood pressure. Steps that can and should be taken to lower and control blood pressure include:

• Quitting smoking. This is perhaps the most important action a smoker can take to promote good health. Among its many other health hazards, smoking elevates blood pressure.
  
  
• Proper diet. A registered dietitian can assist in nutritional counseling to help control glucose (blood sugar) and maximize cardiovascular health. Recommended diets typically are rich in high-fiber plant foods, allow adequate lean protein and “good” fats (e.g., olive oil, nuts), limit sodium, sugars, starches and saturated fats, and avoid trans fats.
  
  
• Improving levels of cholesterol. Unhealthy types of cholesterol play a major role in creating the fatty deposits that can narrow arteries and cause blood pressure to rise. In addition, diabetes tends to increase the damage caused by cholesterol and other lipids, such as triglycerides, and to make it occur more quickly.  The physician may prescribe cholesterol drugs if necessary.
  
  
• Weight loss. Loss of weight in the abdominal area (central obesity) can immediately reduce blood pressure and helps to reduce the size of the heart. Weight loss accompanied by salt restriction may allow people with mild hypertension to reduce or eliminate their need for medication, under their physician’s guidance.
  
  
• Regular aerobic exercise. Patients should generally get 30 to 45 minutes of physical activity each day if possible. Activity at least three to four times a week is helpful for regulating high blood pressure. Regularity of the exercise is more important than the intensity of the workout. Individuals should consult with their physician before starting an exercise program.
  
  
• Limiting consumption of alcohol, such as a maximum of one drink a day for women and two drinks a day for men, if approved by a physician. One drink is defined as one 5-ounce glass (148 milliliters [ml]) of wine a day, one 12-ounce (355 ml) beer or one 1.5-ounce serving (44 ml) of 80-proof distilled spirits. Physicians advise some patients, such as those who are prone to hypoglycemia or have hypoglycemia unawareness, to avoid alcohol.
  
  
• Limiting sodium intake to 2,400 milligrams (2.4 grams) and salt (sodium chloride) intake to 6,000 milligrams (6 grams) a day, according to guidelines of the American Diabetes Association. One teaspoonful of table salt contains 2 grams of sodium and 5 grams of salt.
  
  
• Taking medications as prescribed.
  
  
• Limiting consumption of caffeine.
  
  
• Stress management. Emotional as well as physical factors may play important roles in the development of hypertension.

In addition to these lifestyle changes, patients are often prescribed medications to reduce blood pressure (antihypertensives). In many cases, more than one drug is required to bring high blood pressure under control. Because of the potential for side effects, patients should carefully discuss options with their physician. Blood pressure medications include:

• ACE inhibitors. These medications are among the most frequently prescribed blood pressure drugs for people with diabetes. ACE inhibitors are vasodilators that help reduce blood pressure by inhibiting the substances in the blood that cause blood vessels to constrict. Recent studies suggest that this class of drugs may be superior to others in preventing stroke, heart disease and kidney disease in patients (especially those with diabetes) with risk factors for vascular disease, and may even benefit people with type 2 diabetes who have normal blood pressure. They are also useful in patients with heart disease. Many physicians prescribe ACE inhibitors to diabetic patients as the primary blood pressure drug but add additional drugs to increase effectiveness.
  
  
• Angiotensin-II receptor blockers (ARBs). Like ACE inhibitors, these drugs have been shown to protect patients from kidney damage in addition to lowering blood pressure.
  
  
• Calcium channel blockers. These vasodilators inhibit the flow of calcium into heart and blood vessel tissues, which reduces tension in the heart, relaxes blood vessels and lowers blood pressure. They are commonly prescribed for those with diabetes and are particularly effective when used in combination with ACE inhibitors or angiotensin-II receptor blockers.
  
  
• Diuretics. Medications that promote the formation of urine in the kidneys, causing the body to flush out excess fluids and minerals, especially sodium. These are often the first medications given to reduce high blood pressure in nondiabetics, are frequently prescribed for people with diabetes as well and may help prevent kidney damage. Though commonly used, they may have unwanted side effects, such as low potassium levels (hypokalemia). Some studies indicate that diuretics may cause hyperglycemia and be a risk factor for diabetes.
  
  
• Alpha blockers and beta blockers. Medications that inhibit alpha and beta receptors in the nervous system. This relaxes arteries, decreases the force of the heartbeat and reduces blood pressure. Beta blockers are especially useful in patients with heart disease. However, they can mask symptoms of hyperglycemia, such as increases in pulse rate and blood pressure. For example, the heart rate may not increase as it normally would during episodes of hyperglycemia. Beta blockers may also make hyperglycemia last longer, worsen glucose control and possibly lead to secondary diabetes. 

The majority of patients with high blood pressure will need to take medications for the rest of their lives to control the condition. In some cases, two or three antihypertensives may be given. Recent studies have shown that such a combination of drugs not only lowers blood pressure, but also may reduce the risk of stroke and ischemic heart disease.

Some blood pressure medications can affect a patient’s glucose levels, a particular concern for people with diabetes. Patients should consult with their physician about this potential risk when deciding on medications.

Other research has suggested that some patients with only slightly elevated blood pressures may eventually be able to stop taking medications and control their condition solely through lifestyle changes, such as losing weight and maintaining a low-salt diet. Strategies such as exercise, nutrition plans and, especially, changes in medication should not be undertaken on one’s own, but first discussed with one's physician.

Researchers have also been exploring the genetic roots of high blood pressure. Identifying genes that cause high blood pressure in a particular patient could help physicians to prescribe the most effective antihypertensive drug.

Treatment options for low blood pressure, which is far less common than high blood pressure, may include drugs that raise blood pressure (antihypotensives), caffeine, increased consumption of salt, or compression stockings worn on the legs.