Behavioural Changes in Patients with Hypertension and Diabetes with the Introduction of a Healthy Lifestyle
Hypertension and diabetes are two common chronic conditions that often occur together and increase the risk of cardiovascular disease, the leading cause of death for people with diabetes. However, these conditions can be prevented and managed by adopting a healthy lifestyle that includes dietary modifications, physical activity, weight management, stress reduction, and smoking cessation. This article will discuss how these lifestyle factors can affect blood pressure and blood glucose levels, and how patients with hypertension and diabetes can benefit from behavioural changes that promote a healthy lifestyle.
Dietary Modifications
One of the most important aspects of a healthy lifestyle for patients with hypertension and diabetes is to follow a balanced diet that provides adequate nutrients, limits sodium, sugar, saturated fat, trans fat, and cholesterol intake, and promotes weight control. Some dietary patterns that have been shown to lower blood pressure and blood glucose levels are the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the vegetarian diet. These diets emphasize the consumption of fruits, vegetables, whole grains, legumes, nuts, seeds, lean meats, fish, low-fat dairy products, and healthy oils, while reducing the intake of processed foods, sweets, red meat, cheese, butter, and fried foods. A meta-analysis of 37 studies found that following a DASH diet reduced systolic blood pressure by 5.5 mmHg and diastolic blood pressure by 3.0 mmHg in hypertensive patients (Soltani et al., 2016). Another meta-analysis of 32 studies found that following a Mediterranean diet lowered fasting blood glucose by 0.47 mmol/L and glycated hemoglobin (HbA1c) by 0.30% in diabetic patients (Schwingshackl et al., 2018). A systematic review of 27 studies found that following a vegetarian diet decreased systolic blood pressure by 6.9 mmHg and diastolic blood pressure by 4.7 mmHg in hypertensive patients, and lowered fasting blood glucose by 0.36 mmol/L and HbA1c by 0.32% in diabetic patients (Yokoyama et al., 2014).
Physical Activity
Another key component of a healthy lifestyle for patients with hypertension and diabetes is to engage in regular physical activity that improves cardiovascular fitness, muscle strength, flexibility, and balance. Physical activity can lower blood pressure and blood glucose levels by improving blood circulation, insulin sensitivity, glucose uptake, endothelial function, inflammation, oxidative stress, and body composition. The American Diabetes Association (ADA) recommends that patients with diabetes perform at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, spread over at least three days with no more than two consecutive days without exercise (ADA, 2021). The ADA also recommends that patients with diabetes perform resistance training at least twice per week on nonconsecutive days, involving all major muscle groups (ADA, 2021). The American Heart Association (AHA) recommends that patients with hypertension perform at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week (AHA, n.d.). A meta-analysis of 23 studies found that aerobic exercise reduced systolic blood pressure by 4.6 mmHg and diastolic blood pressure by 3.2 mmHg in hypertensive patients (Cornelissen & Smart, 2013). Another meta-analysis of 23 studies found that resistance training reduced systolic blood pressure by 3.2 mmHg and diastolic blood pressure by 1.8 mmHg in hypertensive patients (Cornelissen & Smart,
2013). A systematic review of 14 studies found that aerobic exercise lowered fasting blood glucose by 0.67 mmol/L and HbA1c by 0.43% in diabetic patients (Umpierre et al., 2011). Another systematic review of 12 studies found that resistance training lowered fasting blood glucose by 0.40 mmol/L and HbA1c by 0.34% in diabetic patients (Umpierre et al., 2011).
Weight Management
A third essential element of a healthy lifestyle for patients with hypertension and diabetes is to achieve and maintain a healthy weight that reduces the risk of obesity-related complications such as heart disease,
stroke, kidney disease, nerve damage, eye damage, foot problems, and amputation. Weight management can lower blood pressure and blood glucose levels by decreasing body fat mass, visceral fat accumulation,
insulin resistance, inflammation, oxidative stress, and hormonal imbalance. The ADA recommends that patients with diabetes who are overweight or obese lose at least 5% of their initial body weight and aim for a body mass index (BMI) of 18.5-24.9 kg/m2 (ADA, 2021). The AHA recommends that patients with hypertension who are overweight or obese lose at least 3-5% of their initial body weight and aim for a BMI of 18.5-24.9 kg/m2 (AHA, n.d.). A meta-analysis of 54 studies found that weight loss reduced systolic blood pressure by 4.5 mmHg and diastolic blood pressure by 3.2 mmHg in hypertensive patients (Aucott et al., 2009). Another meta-analysis of 20 studies found that weight loss lowered fasting blood glucose by 0.50 mmol/L and HbA1c by 0.50% in diabetic patients (Wing et al., 2011).
Stress Reduction
A fourth important factor of a healthy lifestyle for patients with hypertension and diabetes is to reduce stress levels that can trigger or worsen blood pressure and blood glucose fluctuations. Stress can increase blood pressure and blood glucose levels by stimulating the sympathetic nervous system, the hypothalamic-pituitary-adrenal axis, the renin-angiotensin-aldosterone system, and the release of cortisol, adrenaline, noradrenaline, and glucose. Stress can also impair the regulation of blood pressure and blood glucose levels by affecting sleep quality, mood, appetite, coping skills, and adherence to medication and lifestyle recommendations. The ADA and the AHA suggest that patients with diabetes and hypertension practice stress management techniques such as relaxation, meditation, breathing exercises, yoga, tai chi, biofeedback, cognitive-behavioral therapy, counseling, support groups, hobbies, music, humor, and spirituality (ADA, 2021; AHA, n.d.). A meta-analysis of 25 studies found that relaxation techniques reduced systolic blood pressure by 5.5 mmHg and diastolic blood pressure by 3.5 mmHg in hypertensive patients (Brook et al., 2013). Another meta-analysis of 14 studies found that mindfulness-based interventions lowered fasting blood glucose by 0.55 mmol/L and HbA1c by 0.60% in diabetic patients (Hartmann et al., 2019).
Smoking Cessation
A fifth crucial aspect of a healthy lifestyle for patients with hypertension and diabetes is to quit smoking or avoid exposure to secondhand smoke that can damage the blood vessels, heart, lungs, kidneys,
and other organs. Smoking can increase blood pressure and blood glucose levels by constricting the arteries, reducing the oxygen-carrying capacity of the blood, impairing the function of insulin-producing cells,
increasing insulin resistance, stimulating the release of catecholamines and cortisol, and promoting inflammation and oxidative stress. Smoking can also worsen the complications of hypertension and diabetes such as cardiovascular disease, stroke, kidney disease, nerve damage, eye damage, foot problems,
and amputation. The ADA and the AHA recommend that patients with diabetes and hypertension stop smoking or using tobacco products and avoid exposure to secondhand smoke (ADA, 2021; AHA,
n.d.). A meta-analysis of 17 studies found that smoking cessation reduced systolic blood pressure by 2.8 mmHg and diastolic blood pressure by 1.6 mmHg in hypertensive patients (Linneberg et al., 2010). Another meta-analysis of nine studies found that smoking cessation lowered fasting blood glucose by
0.21 mmol/L and HbA1c by 0.26% in diabetic patients (Chen et al., 2015).
Conclusion
Hypertension and diabetes are two interrelated conditions that can increase the risk of cardiovascular disease and other complications. However, these conditions can be prevented and managed by adopting a healthy lifestyle that includes dietary modifications, physical activity, weight management,
stress reduction, and smoking cessation. These lifestyle factors can lower blood pressure and blood glucose levels by improving various physiological mechanisms that affect the cardiovascular system,
the endocrine system, the immune system, and the nervous system. Patients with hypertension and diabetes should consult their health care providers for individualized guidance on how to implement
behavioural changes that promote a healthy lifestyle.
Works Cited
ADA. (2021). Standards of medical care in diabetes—2021 abridged for primary care providers.
Clinical Diabetes: A Publication of the American Diabetes Association ,39(1),8–38.
https://doi.org/10.2337/cd20-as01
AHA.(n.d.). Living healthy with diabetes.Retrieved from https://www.heart.org/en/health-topics/diabetes/prevention–treatment-of-diabetes/living-healthy-with-diabetes
Aucott,L.,Poobalan,A.,Smith,W.C.S.,Avenell,A.,Jung,R.,&Broom,J.(2009).Weight loss in obese diabetic
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