Having diabetes can put you at greater risk for other health issues such as hypertension or high blood pressure. This week during a diabetes teaching session I treated a patient who weighed over 400 pounds and was upset that he was just diagnosed with elevated blood pressure. We had a discussion about blood pressure that I would like to share with you.

  1. Use the correct cuff size – The reason I mention the patient’s weight is important. When measuring blood pressure it is necessary to use the correct size cuff. He admitted that many times he had been tested with a standard cuff. Most times when you go to the physician’s office the standard cuff is attached to the blood pressure monitor; it is generally suitable for average size patients but in the last decade there are many patients who are no longer considered “average size.” Using a standard size cuff on a tiny elderly woman is no more accurate than using a standard cuff on a large male. It will give you inaccurate results which may lead to a false sense of security or unnecessary anxiety. Often the technicians pay little attention to the cuff size; try to become aware and mention it if you feel the cuff is incorrect. The actual cuff should cover 80% of the upper arm circumference. It should be snug with no gap hanging but not so tight that it makes your arm feel like it will explode. Make sure your arm is elevated to a 90% angle related to your heart and not straight down by your side. Bring your home monitor to the office visit and compare both machines.
  2. White Coat Syndrome does exist – Patients often experience this phenomenon which is increased blood pressure just while in the physician’s office. This is possibly due to anxiety about learning the unknown, not following thru with doctor’s orders or just being in the office setting. It may be temporary but could be a sign of future consistent hypertension. The best way to document white coat syndrome is to purchase a home blood pressure monitoring system and check at different times of the day throughout the week. Use a log book for documentation to look for patterns. The reverse may be true as well; you may have normal readings at the doctor’s office, health fair or pharmacy and high readings at home. This too can lead to hypertension in the future.
  3. Caffeine is a factor – Caffeine can influence your blood pressure even if it usually runs normal. The theory is caffeine causes your adrenal glands to secrete an increased level of adrenaline (stress hormone) which can raise blood pressure. Each person reacts differently to caffeine but people who are overweight or older than 70 are more at risk. Try to limit caffeine to no more than 200mg a day or 2 mugs full of coffee or caffeinated drinks. Avoid caffeine after 3 P.M. and before strenuous exercise or physical labor. Try to test your blood pressure about one hour after ingesting caffeine and if you pressure jumps 10 points think about reducing your caffeine intake. Never stop suddenly since it can produce jitters and headaches.
  4. Alcohol and cigarettes too – Drinking more then 3 drinks at a time or nicotine from cigarettes can elevate your heart rate and blood pressure temporarily which can become permanent. Alcohol supplies empty calories which turn to fat as well as interfering with blood pressure medications. Think about sticking to one serving of alcohol (wine: 5 oz, beer: 12 oz, or hard liquor: 1.5 oz). Smoking constricts blood vessels which increases blood pressure instantly. Avoid tobacco completely.
  5. Weather plays a part – Blood pressure elevates in the winter since your vessels vasoconstrict (close up) to help your internal organs achieve proper blood flow. Blood pressure can change with the barometric pressure during storms and change in weather. Warm weather can vasodilate vessels to help you cool down and lower blood pressure. Weather related issues tend to affect those over age 65.
  6. Hormone changes – After menopause, blood pressure tends to rise due to a reduction of the hormone estrogen and an increase of body weight. As we age hormonal changes can affect men and women in how they tolerate sodium intake. Taking birth control pills may also impact blood pressure values in certain women.
  7. Look for patterns – Usually your blood pressure is lowest during the night time when you are in your REM or deep sleep. The pressure starts to rise after 3 A.M. due to hormones preparing you to wake up. It rises progressively during the day with the peak in late afternoon to evening and then drops off again. If this pattern does not exist it could be due to sleep apnea, an adrenal tumor or kidney problems. Always consult your health care provider if you find abnormal patterns. Night shift workers also have changes in blood pressure patterns due to disrupting circadian rhythms.

Bottom line – Blood pressure readings can vary from day to day. If you have diagnosed hypertension make sure you are taking your medication correctly, exercising regularly, and avoiding tobacco, practicing stress reduction, limiting alcohol and caffeine. Controlling your blood pressure is an important step in reducing your risk of future cardiovascular disease – especially when you have diabetes!

NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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