Controlling Blood Pressure

Why should I worry about blood pressure? I'm way to busy as it is trying to deal with my blood sugar. Because high blood pressure, a common side effect of diabetes, acts as independent risk factor for all the things we are afraid of: heart disease, stroke, kidney failure, and retinopathy. There is a direct relationship among blood pressure and risk, meaning in general the lower your blood pressure, the lower your risk. What exactly is blood pressure? It's the pressure your blood exerts against your blood vessels as it travels through your body. The top number (systolic blood pressure) is the pressure exerted while the heart contracts, and the bottom (diastolic) is the pressure exerted while the heart is relaxed. What should you aim for? Optimal blood pressure is generally defined as less 120/80 mmHg, but for people with diabetes the target is usually a little more lenient at less than 130/80 mmHg (1,2). So if you've been diagnosed with hypertension (high blood pressure), your doctor has likely already given you advice or a prescription to help bring it down. But what if you, like me, are slightly below the hypertension cutoff for diabetes? My blood pressure usually sits somewhere around 140/65 (note that the systolic value is high but the diastolic value is fine), but that's not cool with me since someone my age (22), with my activity level and diet should have a stellar blood pressure. I imagine this increased systolic blood pressure could be the result of atherosclerosis (plaque deposits on the walls of blood vessels causing it to narrow) in my aorta (the major blood vessel leaving your heart) (3). A 2004 study actually found that individuals with type 1 diabetes have a much higher level of isolated systolic hypertension compared to healthy controls, attributing it to vascular stiffening from diabetes (4). What can you and I do now to reduce my blood pressure into an optimal range, and help prevent further damage to our blood vessels?

Well, sadly there doesn't seem to be any quick fix. I've done a fair bit of reading, and it seems I'm already doing everything traditionally recommended (1):

regular exercise
eat a diet high in potassium and fiber, and low in sodium
healthy body weight
don't smoke
limit alcohol
control stress

If you aren't following these guidelines, they are really the bread and butter to controlling blood pressure, so I would definitely advise doing so. I'll expand a bit on the points that might be a bit ambiguous -

how much and what kind of exercise? - at least 30 minutes of aerobic/day. I remember from a course in the second year of my undergrad the reduction in blood pressure from exercise being somewhere around 7/3 mmHg (meaning, if I wasn't exercising I might come down to 118/67 from 125/70), but since I'm going off memory don't hold me to it.

high potassium? - Generally speaking, potassium is found in high amounts in fruits, vegetables, and legumes. At the top of each category are banana's, potatoes, and soybeans, respectfully. How much? The experts recommend 4700 mg/day, or the equivalent you'd get in either 5 potatoes, 10 bannanas, or 5 cups of cooked soybeans. You can check out an entire diet plan that provides lots of great potassium information (on page 21 specifically) and has been studied and proven conclusively lower blood pressure here:
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

low sodium? - Canada's most recent guidelines recommend no more than 1500 mg/day. The largest sources of sodium in our diet are processed foods with high amounts added. For example, I looked at a can of chickpeas the other day that contained about 900 mg of sodium per cup of chickpeas. Needless to say I now buy presidents choice blue menu legumes with no salt added, or make them myself without adding any. Check out this link for more info:
http://www.nhlbi.nih.gov/hbp/prevent/sodium/tips.htm


So, after doing this research I've realized I can try to incorporate more servings of potassium rich foods into my diet everyday, which for me will likely come in the form of fruits & vegetables. I'll also try to cut out sodium from processed foods - for me that's in terms of beans, peanut butter, nuts, and pretty much anytime I eat out (I'll have to eat out less often). However, as I've said I'm already doing  nearly all of this stuff and I'm not sure doing it to a further degree will provide much additional benefit. I think I'll have to consult my endo about BP lowering medications (which, essentially kick sodium out of your body). It's pretty scary to think at 22 I need hypertension medication, but it's better than doing nothing.








1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/
2. http://www.diabetes.org/living-with-diabetes/complications/high-blood-pressure-hypertension.html?__utma=1.1450893926.1327370431.1327370431.1327370431.1&__utmb=1.1.10.1327370431&__utmc=1&__utmx=-&__utmz=1.1327370431.1.1.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=blood%20pressure%20targets%20for%20diabetes&__utmv=-&__utmk=204364816
3. http://www.mayoclinic.com/health/pulse-pressure/AN00968
4. http://circ.ahajournals.org/content/110/9/1076.full

Introduction

Hi, my names Dylan and I've had type 1 for about 19 years now, since I was three and a half. At the moment I'm a first year medical student at the University of Toronto

***!!!!Important disclaimer!!!!!!*** - I am not a licensed healthcare professional and all the suggestions and ideas I provide are personal opinions and should not be replaced by that of a licensed healthcare professional. Please feel free to discuss these ideas with your healthcare team, but don't try them before then.

I've decided to create this blog because I'm pretty vigilant about managing diabetes and feel like I have tons of information about managing it running around my head that might be quite helpful for us (people with type 1, or in some instances type 2) but that is otherwise pretty stagnant at the moment. I hope you can find something useful here to live healthier, and hopefully add to the information I post to help people further.

Dylan