What should my target blood pressure level be if I have diabetes?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
Diabetes and high blood pressure are both major risk factors for heart disease and stroke, so it is critical to keep your blood pressure in a proper range if you have diabetes. But it can be a little difficult to know exactly what that range should be given that recommendations vary in different settings.

The guiding principle of blood pressure management is that the lower the blood pressure the better, unless the pressure is so low as to cause symptoms of dizziness or lightheadedness, especially with getting up quickly from lying or sitting. Blood pressures of 120 to 130 on the top (“systolic”) number and under 80 on the bottom (“diastolic”) number are the goal, and if a person comes in with a blood pressure of 94/50, but never has any dizziness or other symptoms, that’s great. Adolescents, young adults and petite individuals often have very low pressures like these and they are fine. 

Blood pressures vary over time, and they are often higher than normal when taken in the doctor’s office at the beginning of a visit because there is often alot of anxiety about what’s going to happen at the visit. After a person has had the chance to get comfortable, provided no terrible news is delivered, the blood pressure will often fall. If there is some uncertainty about whether a person has high blood pressure or not, then getting a home monitor and testing regularly is very helpful. There are also ambulatory blood pressure monitors that people can wear for 24 hours or more which can help uncover episodic high blood pressure or reassure us that outside  of the medical office the blood pressure is OK. 

One very important point is that lower blood pressures are often dangerous for older individuals, including those with diabetes. There is no exact age cut-off, but over age 80 in most people it’s probably safer to have the blood pressures be a bit higher. The problem is that in order to keep blood flowing to your brain when you get up from sitting or lying, your blood vessels have to constrict and raise your blood pressure somewhat. This constriction happens quickly in most young and middle-aged adults, but it may be slow to occur or may not occur completely in older individuals. These people have “orthostatic hypotension,” meaning that their blood pressure levels fall when they change posture. This is a common cause of falling or fainting in older people, especially those who are on too much blood pressure lowering medication. In fact, a physician often has to accept relatively high blood readings in such individuals in order to prevent them from falling because of lightheadedness.  
Blood pressure is shown by two numbers, like 130/80. This is read as 130 over 80. The first number is the pressure when the heart pushes blood through the body. The second number is the pressure when the heart rests. Goal blood pressure for most people with diabetes is to have the first number less than 130 and the second number less than 80. Have your blood pressure checked at every diabetes visit. If your blood pressure numbers aren't on target, work with your health care team to reach your target.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.