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Yesterday we reported that the American Diabetes Association released updated guidelines for patients with both diabetes and hypertension, two major areas of focus for any well-run workplace wellness program. The Association last published a Position Statement on this topic in 2003.

In “Diabetes and Hypertension: A Position Statement by the American Diabetes Association,” the Association writes: “Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors. Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications.” And ASCVD is “the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes.”

The ADA's conclusion: “Hypertension is a strong, modifiable risk factor for the macrovascular and microvascular complications of diabetes. Robust literature demonstrates the clinical efficacy of lowering blood pressure, with cardiovascular and microvascular benefits demonstrated for multiple classes of antihypertensive medications. Strong evidence from clinical trials and meta-analyses supports targeting blood pressure reduction to at least <140/90 mmHg in most adults with diabetes.”

Today we provide more details on the ADA's guidance around lifestyle management. Many of these tactics can be part of a well-run workplace wellness program:

• “Lifestyle management is an important component of hypertension treatment because it lowers blood pressure, enhances the effectiveness of some antihypertensive medications, promotes other aspects of metabolic and vascular health, and generally leads to few adverse effects.”
• “Lifestyle therapy consists of reducing excess body weight through caloric restriction, restricting sodium intake (<2,300 mg/day), increasing consumption of fruits and vegetables (8–10 servings per day) and low-fat dairy products (2–3 servings per day), avoiding excessive alcohol consumption (no more than 2 servings per day in men and no more than 1 serving per day in women), smoking cessation, reducing sedentary time (54), and increasing physical activity levels.”

Deeper guidance came in specific areas:

• Sodium: “Sodium reduction has not been tested in controlled clinical trials in people with diabetes. However, results from trials in primary hypertension have shown a reduction in systolic blood pressure of ∼5 mmHg and diastolic blood pressure of 2–3 mmHg with moderate sodium reduction (from a daily intake of 200 mmol [4,600 mg] to 100 mmol [2,300 mg] of sodium per day).” Note: We reported here on the CDC's report: ““Estimated Effects of Sodium Reduction on Hypertension Prevalence and Related Costs: Reducing average population intake to 2300 mg per day (current recommended maximum) may — Reduce cases of hypertension by 11 million; Save $18 billion in health care costs.”
• Physical Activity: “Moderately intense physical activity, such as 30–45 min of brisk walking most days of the week, has been shown to lower blood pressure.”
• Weight Loss: “Weight reduction should be considered in the management of blood pressure. The loss of 1 kg in body weight has been associated with a decrease in blood pressure of ∼1 mmHg.” As we reported here, BMC Public Health Journal had a study titled “Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants.”