People with diabetes are twice as likely to have a stroke or develop heart disease as those without the condition, and high blood pressure also increases the risk of heart disease. Understanding the connection between these three conditions is the first step toward managing them.

What is considered high blood pressure?

High blood pressure happens when blood pushes harder against the blood vessels than normal and the problem persists over time. Blood pressure involves two readings:

  • Systolic pressure: Appears on top or first, and measures the force of blood when the heart muscle contracts to pump the blood
  • Diastolic pressure: Appears on the bottom or second, and measures the force of blood when the heart muscle relaxes

Normal blood pressure is a systolic blood pressure of less than 130 mm Hg and a diastolic blood pressure of less than 90 mm Hg, or “130 over 90.” Blood pressure is considered elevated when the systolic pressure is between 130 and 139 mm Hg and the diastolic pressure is greater than 90. High blood pressure consists of two stages:

  • Stage 1 hypertension: 130 to 139 mm Hg systolic pressure or 80 to 89 mm Hg diastolic pressure
  • Stage 2 hypertension: 140 mm Hg or higher systolic pressure or 90 mm Hg or higher diastolic pressure

What is diabetes?

Diabetes is a condition where the body doesn’t properly regulate blood sugar levels.

There are two types:

  • Type 1 diabetes is usually diagnosed early in life. It happens when the pancreas doesn’t make insulin, a hormone that controls blood sugar.
  • Type 2 diabetes can develop at any time but is most common in middle-aged and older adults. It happens when body cells don’t properly respond to insulin and/or the body doesn’t produce enough insulin. This type of diabetes is most common.

Although type 1 diabetes can increase the risk of heart problems, this article focuses on type 2 diabetes due to its commonality and its relationship to blood pressure and heart disease management.

What is heart disease?

Heart disease is a group of medical conditions that affect the heart. When people use the term heart disease, they most often mean coronary artery disease (CAD), which occurs when less blood flows to the heart than normal, thereby increasing the risk of heart attack.

What is the connection between blood pressure and heart disease?

When blood exerts too much pressure on the walls of the arteries for a prolonged period, it can damage the blood vessels. The damage makes the blood vessels stiffer and less flexible. Blood then has a more difficult time passing through them. Not only can this raise blood pressure, but it can also mean a drop in blood and oxygen supply to the heart. This can result in coronary artery disease (CAD) and other heart symptoms like chest pain or angina.

High blood pressure also leads to the heart requiring more energy to pump blood throughout the body. Over time, this can lead to the heart growing and stress on the valves of the heart. 

What is the connection between blood pressure and diabetes?

When blood sugar levels are elevated for prolonged periods due to type 2 diabetes, the walls of the arteries can stiffen. These changes increase the force required for blood to move through the arteries, raising blood pressure.

Diabetes can also damage the kidneys, making them unable to properly remove toxins from the body. This increases blood volume and raises blood pressure. When blood pressure levels become elevated, the excess force of blood can further damage the kidneys, leading to an even bigger increase in blood pressure.

What is the connection between heart disease and diabetes?

Diabetes contributes to coronary artery disease and other types of heart disease in more than one way. First, the changes in blood vessels that occur due to elevated blood sugar can decrease blood flow to the heart. Secondly, excess blood sugar can damage the nerves that control the heart.

What else contributes to high blood pressure, heart disease and diabetes?

High blood pressure, heart disease and diabetes have some common risk factors and causes, including:


Excess body fat puts strain on the heart and can disrupt bodily processes that control blood pressure. In addition, people who are obese are more likely to develop insulin resistance, a condition where cells don’t properly respond to insulin. This increases the risk of diabetes. Studies have found that health risks are greatest when people have excess belly fat.

High cholesterol

Cholesterol is a waxy substance that is present throughout your body, but can cause problems when present in excess. Excess cholesterol can lead to build-up in arteries that decreases blood flow. This can raise blood pressure and cause heart disease. Having high cholesterol also increases the risk of type 2 diabetes.

Lack of physical activity

Regular exercise strengthens the heart muscle and helps burn glucose. People who live a sedentary lifestyle are more likely to develop high blood pressure, heart disease and type 2 diabetes.

Lifestyle changes for high blood pressure, heart disease and diabetes

Healthy lifestyle changes can lower blood pressure and blood sugar levels to protect the heart and lower the likelihood of heart attack and stroke.

Healthy diet

Reducing the intake of sodium, trans fats, saturated fats and added sugars can lower blood pressure and blood glucose. Many doctors recommend the DASH diet for hypertension. It focuses on eating a variety of whole grains, fruits, vegetables, lean protein and low-fat and nonfat dairy products, with an emphasis on keeping salt levels low.

Increased exercise

Increasing the amount of physical activity can strengthen the heart while also reducing blood pressure and blood sugar. The U.S. Centers for Disease Control and Prevention (CDC) recommends at least 150 minutes of moderate-intensity exercise per week. Some examples of moderate-intensity exercise include:

  • Walking
  • Playing tennis
  • Playing golf without a motorized golf cart
  • Water aerobics
  • Hiking
  • Shooting hoops
  • Fast-paced dancing

Weight loss

Reaching and maintaining a healthy weight can have a big impact on heart health and diabetes management. Losing just 5 to 10% of your body weight can make a noticeable difference. Often, making the recommended dietary and exercise lifestyle changes is enough to drive weight loss at a steady pace of 1 to 2 pounds per week.

Quitting smoking

Smoking raises blood pressure and increases the risk of developing heart disease. People who smoke are also 30 to 40% more likely to get type 2 diabetes. Prescription medications and over-the-counter nicotine replacement products are available to help you quit. Your primary care provider can discuss your options with you.

Medications for high blood pressure with heart disease and diabetes

If you have high blood pressure and type 2 diabetes and have or are at risk for heart disease, your doctor will likely prescribe one or more high blood pressure medications plus additional treatments. The following are the blood pressure medications most commonly prescribed for people with high blood pressure plus type 2 diabetes.

Angiotensin-converting enzyme (ACE) inhibitors

These medications interfere with the production of angiotensin, a body chemical that causes blood vessels to narrow. Often, ACE inhibitors are the first medications prescribed for people with diabetes and high blood pressure. 

These drugs include:

  • Benazepril hydrochloride (Lotensin)
  • Captopril (Capoten)
  • Enalapril maleate (Vasotec)
  • Fosinopril sodium (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril hydrochloride (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

Angiotensin receptor blockers (ARBs)

These medications prevent the chemical angiotensin from binding to the blood vessels. Doctors may prescribe these drugs for people with high blood pressure and diabetes who also have or are at risk for kidney disease. In addition, doctors prescribe them when ACE inhibitors fail to lower blood pressure.

ARBs include:

  • Candesartan (Atacand)
  • Eprosartan mesylate (Teveten)
  • Irbesartan (Avapro)
  • Losartan potassium (Cozaar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)

Thiazide diuretics

Thiazide diuretics help the kidneys remove more salt and water from the body. Doctors often prescribe them along with an ACE inhibitor or an ARB.

These drugs include:

  • Chlorothiazide (Diuril)
  • Chlorthalidone (Hygroton)
  • Hydrochlorothiazide (Esidrix, Hydrodiuril, Microzide)
  • Indapamide (Lozol)
  • Metolazone (Mykrox, Zaroxolyn)

Beta blockers

Beta blockers reduce heart rate and are commonly prescribed for people with high blood pressure and diabetes and/or those who are most at risk for heart disease or who already have the condition. 

These drugs include:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol (Kerlone)
  • Bisoprolol fumarate (Zebeta)
  • Carteolol hydrochloride (Cartrol)
  • Metoprolol succinate (Toprol-XL)
  • Metoprolol tartrate (Lopressor)
  • Nadolol (Corgard)
  • Penbutolol sulfate (Levatol)
  • Pindolol (Visken)
  • Propranolol hydrochloride (Inderal)
  • Sotalol hydrochloride (Betapace)
  • Timolol maleate (Blocadren)

Calcium channel blockers

When other medications fail to lower blood pressure in people with hypertension and type 2 diabetes, doctors may prescribe calcium channel blockers that prevent calcium from entering muscle cells. This relaxes the heart and lowers blood pressure.

These drugs include:

  • Amlodipine besylate (Norvasc, Lotrel)
  • Bepridil (Vascor)
  • Diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc, DynaCirc CR)
  • Nicardipine (Cardene SR)
  • Nifedipine (Adalat CC, Procardia XL)
  • Nisoldipine (Sular)
  • Verapamil hydrochloride (Calan SR, Covera HS, Isoptin SR, Verelan)

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