Insulin Resistance and Prediabetes


Insulin resistance is among the most widespread chronic conditions in the country, and it leads to high blood sugar levels, prediabetes, and type 2 diabetes. The health consequences can include hospitalizations, cardiac events and stroke, kidney disease, neuropathy, and amputations. Insulin resistance is also linked to other health conditions, and the Centers for Disease Control and Prevention (CDC) estimate the medical and indirect costs of diabetes at well over $2 billion annually.[1]

Prediabetes and diabetes may affect nearly half of adults, and far more adults may have early stages of insulin resistance.[2] This may include you! Still, you can take charge of your insulin resistance and lower blood sugar levels. Lifestyle changes may be enough to restore insulin sensitivity without medication, but if your doctor says medications are necessary, your healthy behaviors can still make medications more effective.

 

What Is Insulin Resistance?


Insulin resistance occurs when certain cells in your body are no longer fully sensitive, or responsive, to the effects of insulin.[3] Insulin is a hormone that is produced by beta cells of your pancreas. It is necessary for your liver, muscle, and fat cells to process sugar, or glucose, that is in your blood. 

When insulin resistance is low or absent, your body processes carbohydrates normally. Your body breaks down carbohydrates (including sugars and starches) in the foods you eat into a type of sugar called glucose. Glucose goes into your bloodstream. Cells such as muscle, liver, and fat cells take it from the bloodstream and use it for fuel and for energy storage for later use when you have not just eaten a meal.

The trick is that these cells need insulin to remove glucose from the blood. With insulin resistance, your cells are less able to respond to insulin. That means your cells have difficulty taking glucose from the blood, which means blood sugar stays high after a meal. You could develop prediabetes or diabetes.

Insulin Resistance What Happens Result
None/normal
Insulin works well and blood sugar levels are controlled.
Normal blood sugar levels
Slight
Pancreas produce more insulin to compensate for insulin resistance.
Normal blood sugar levels
Moderate
Pancreas produce more insulin to compensate for insulin resistance, but may not be able to keep up with demand.
Slightly elevated blood sugar levels – prediabetes and a high risk of developing diabetes within 1 to 10 years if measures are not taken.
High
Pancreas produce high levels of insulin but are unable to keep up with demand. Pancreatic exhaustion may occur, and insulin production may plummet.
Elevated blood sugar levels – diabetes and risk for complications such as neuropathy, kidney disease, stroke, hypertension, and more if blood sugar is not controlled.
 

Insulin Resistance Syndrome


Insulin resistance is a metabolic disorder that does not happen in a vacuum. Instead, insulin resistance syndrome one of several metabolic abnormalities that tend to occur together and Sometimes, the term, “insulin resistance syndrome,” is used in place of “metabolic syndrome.” These syndromes raise your risk of heart disease and, according to an article published in the journal, “American Family Physician” can include these symptoms.[4]

  • Insulin resistance

  • Diabetes

  • Hypertension (high blood pressure)

  • Hyperlipidemia (high cholesterol and/or triglycerides)

  • Obesity

  • Central adiposity, or too much fat around your waist

The International Code-10 (ICD-10) for metabolic syndrome is E88.81. This code is also used for similar conditions, such as insulin resistance, dysmetabolic syndrome x, and metabolic syndrome x.

 
 
 

Insulin Resistance Symptoms


You are unlikely to have insulin resistance symptoms during early stages or when you have prediabetes, according to the National Institute of Digestive and Kidney Diseases.[5] You could discover skin tags or darkened, velvety patches of skin called acanthosis nigricans on your neck or armpits. 

More symptoms of insulin resistance could appear if insulin resistance progresses and you develop diabetes. 

  • Blurred vision.

  • Neuropathy, including pain, tingling, or numbness on hands or feet.

  • Increased thirst and urination.

  • Unexplained hunger and weight loss.

  • More infections or slower-to-heal wounds.

It is important to keep blood sugar levels at target levels because higher-than-normal blood sugar levels for a long period of time put you at risk for complications. Complications of diabetes can include the following:

Insulin resistance is more likely if you have weight gain or obesity. In addition, weight gain is more likely among patients who are treated with insulin. That is probably because the increase in insulin allows for the “proper” use of glucose, which includes storing excess glucose as fat – which increases body weight.

 

Causes of Insulin Resistance


The causes of insulin resistance can be complicated and can include chronic inflammatory processes as well as dysregulation and hormone imbalance. Genes can influence your risk, and older adults are more prone to insulin resistance. However, obesity is the major cause of insulin resistance in many cases. Other lifestyle factors that can increase insulin resistance include:

  • Low physical activity levels.

  • Use of tobacco.

  • Diet high in sugar and unhealthy fats.

  • Diet low in vegetables and dietary fiber.

  • Too much stress.

  • Not enough sleep.

  • Excessive alcohol consumption.

A cause of insulin resistance in females can be polycystic ovarian syndrome (PCOS). Although PCOS is an imbalance affecting the balance of sex hormones in the body, it also is closely related to insulin resistance and diabetes. About 2 in 3 women with PCOS have insulin resistance, including up to 4 in 5 women with PCOS who are obese.[6] Other symptoms include tendency to gain weight, infertility, irregular menstrual cycles, hair loss, and headaches.

 

An Insulin Resistance Test


An insulin resistance test can be simple, quick, and life-saving. You can ask your doctor to order a test for insulin resistance at the lab where you get your regular blood tests. The three tests that are used to diagnose prediabetes and diabetes are fasting glucose, glycated hemoglobin (A1C), and oral glucose tolerance test (OGTT).[7]

Test Normal Prediabetes Diabetes
Fasting glucose – fasting blood draw to see your at-this-moment blood sugar level.
Under 100 mg/dl
100 to 125 mg/dL
Over 125 mg/dl
Glycated hemoglobin (A1C) – blood draw to see your body’s 3-month control over blood sugar levels.
Under 5.7%
5.7 to 6.4%
Over 6.4%
Oral glucose tolerance test (OGTT) – Fast for 8 hours, drink a high-sugar solution (75 grams of glucose), get blood drawn 2 hours later to see how your body responds.
Under 140 mg/dl
140 to 199 mg/dL
Over 199 mg/dL

These tests detect insulin resistance only after it has progressed for a while and your blood sugar levels have started to rise. Some research suggests that other tests for insulin resistance may be able to detect it earlier.[8] You might want to ask your doctor if you have risk factors for insulin resistance.

 

How to Reverse Insulin Resistance


You might have heard about reversing insulin resistance, but can it be reversed? So many people have insulin resistance, and so many of those patients progress to diabetes, that you may think it is not possible to reverse insulin resistance. But…you would be wrong!

In most cases, reversing insulin resistance is possible, and often without medications. Study after study has shown that insulin resistance treatment with lifestyle changes can:

  • Delay diabetes,

  • Stop the progression of insulin resistance, or

  • Completely reverse insulin resistance.

Keep reading if you want to know how to fix insulin resistance! 

 

Insulin Resistance and Weight Loss


Weight loss may be top on the list when you are thinking about how to treat insulin resistance. Your weight may be the cause of your insulin resistance or be increasing your risk if:

  • You have a body mass index over 30 kg/m2. To put that into perspective, that is a weight of 169 lb. if your height is 5’3”, 197 lb. if your height is 5’8”, and 213 lb. for a height of 6’0”.

  • You have gained unwanted weight as an adult.

  • You have a waist-to-hip ratio over 1.0 (men) or 0.8 (women).

How important is weight loss for insulin resistance treatment? It is very significant, even if you lose what seems like only a little bit of weight. 

  • A loss of 7% of your body weight (12 lb. if you weigh 180 lb. or 14 lb. if you weigh 200 lb.) can lower diabetes risk by over 50%.

  • Each kilogram (2.2 lb.) of excess weight that you lose lowers your risk by 16%.

  • Each pound of excess weight that you gain raises your risk by 2%.[9]

Since you may be able to reverse insulin resistance with long-term, moderate weight loss, your best bet for weight loss is a sustainable plan that may include the components in the following table.

Basic Weight Loss Tips

Eat more “healthy-weight” foods.

  • Eat vegetables frequently at meals and for snacks.
  • Serve yourself large portions of raw and steamed vegetables.
  • Try a variety of healthy foods that are new to you, and experiment with recipes.
  • Eat lean proteins, such as skinless chicken, reduced-fat yogurt and cottage cheese, seafood, beans, tofu, and eggs.
  • Eat more fiber from vegetables, fruit, nuts, whole grains, beans, and lentils.

Limit “unhealthy-weight” foods.

  • Choose added sugars, refined carbs, saturated fats, and trans fats less often.
  • Limit sugary foods, such as candy, cake, cookies, ice cream, pies, brownies, and jam.
  • Avoid extra calories from fatty foods such as fatty meat or poultry with skin, fried foods, and foods with creamy or buttery sauces or spreads.
  • Take smaller portions of foods that you know are low-nutrient and high-calorie.

Lose weight at restaurants.

  • Before you start eating, pack up half of your meal to take home.
  • Ask if you can swap fruit, salads, or steamed vegetables for sides instead of potatoes, rice, or pasta.
  • Ask to get sauces and dressings on the side.
  • Look for lean proteins such as chicken and fish for your main course instead of pasta dishes or fatty meats.
  • Order water instead of calorie-laden beverages, and share appetizers and desserts if you order the at all.

Drink more and smarter.

  • Drink at least 8 8-ounce glasses of water each day. More is better!
  • Choose water and other calorie-free or low-calorie beverages, such as decaf tea and coffee.
  • Limit or avoid sugar-sweetened beverages such as soft drinks, sports drinks, energy drinks, sweet tea, and flavored coffee beverages.

Make small swaps.

  • Cook and prepare foods with fewer calories by grilling, steaming baking, or roasting instead of frying.
  • Swap applesauce or yogurt for butter in baked goods.
  • Choose whole grains such as whole-wheat bread or pasta instead of white, whole-grain cereal instead of regular, and oatmeal instead of refined cream of wheat.
  • Have a piece of fruit instead of a full serving of dessert a few times per week.

Lose weight all day.

  • Track your food to stay on track and aware of what you are eating.
  • Exercise regularly if your doctor allows it.
  • Get enough sleep each night to prevent metabolic imbalances from sleep deprivation.
 

Insulin Resistance Diet Plan


Aside from affecting your weight, what you eat can affect insulin resistance. More nutritious foods tend to increase insulin sensitivity, while less nutritious foods tend to lower it. The best diet for insulin resistance is generally:

  • High in dietary fiber from foods such as vegetables, whole grains, nuts, fruit, and beans.

  • Higher in whole grains (such as whole grain bread, pasta, and cereal, oatmeal, brown rice) than refined (such as white bread, pasta, and rice).

  • Low in fried foods, such as French fries, fried chicken, doughnuts, and onion rings.

  • Low in fatty red meats and processed meats such as ham, bacon, bologna, pepperoni, sausage, and hot dogs.

  • Low in added sugars from foods such as candy, cakes, cookies, pies, and other baked goods, ice cream, other desserts, and sweetened flavored foods such as flavored oatmeal and yogurt.

  • Low in sugar-sweetened beverages such as soft drinks, sports drinks, energy drinks, and sweetened coffee and tea beverages.

  • Moderate in carbohydrates, with small servings spread throughout the day.

An insulin resistance meal plan can include vegetables and a source of lean protein at most meals and snacks. It should have plenty of whole grains, fruit, reduced-fat dairy products, and healthy fats. You can consider filling half your plate with vegetables at most meals, adding a serving of lean protein or low-fat dairy, adding a whole grain, fruit, or starchy vegetable, and adding the occasional healthy fat.

A sample insulin resistance diet menu could look something like this. (Add plenty of water and check with your doctor before starting a new meal plan).

Meal/Snack Food(s)
Breakfast
Egg white or tofu scramble with spinach and tomatoes on a high-fiber tortilla/wrap
Snack
Apple and peanut butter
Lunch
Greek salad with lettuce, cucumbers, tomatoes, olives, feta, chicken breast or garbanzo beans, and vinaigrette
Snack
Fat-free refried beans with melted low-fat cheddar cheese
Dinner
Salmon with citrus salsa, steamed broccoli, and brown rice
 

Natural Remedies for Insulin Resistance


A healthy lifestyle can go a long way toward reducing insulin resistance without medications or, if you are on blood sugar-lowering medications, healthy life choices can make them more effective. They are simple and include:

  • Achieving 150 minutes per week of moderate-intensity aerobic exercise, such as brisk walking, stationary or road cycling, aerobics, kickboxing, dancing, gardening, playing tennis, and swimming. Exercise directly increases insulin sensitivity.

  • Strength training each major muscle group at least twice per week. You can use weight machines, body weight, barbells, resistance bands, or dumbbells. Aim to hit the shoulders, chest, back, front and backs of the arms, stomach and core, hips, and upper and lower legs.

  • Getting enough sleep. Most adults need 7 to 9 hours each night, but fall short regularly. Sleep deprivation, even for a single night, alters hormone levels, including raising levels of a hormone called ghrelin that makes you hungry. Insulin resistance also increases, while your ability to resist carb and sugar cravings decreases when you are short on shuteye.

  • Manage stress. You may not be able to eliminate stress – and nor should you, since it is a healthy and natural response. Too much stress, poorly managed, though, can raise insulin resistance. After you identify negative stresses in your life, such as having too much to do or feeling pressure to be perfect, identify and then practice stress management techniques. These can include changing your attitude (“I’ll only worry about what I can change and not about what I cannot change”) and using in-the-moment strategies when you feel yourself getting anxious. You can try deep breathing, meditating, walking, phoning a friend, blogging or journaling, and listening to music, for starters. See what works for you!

There are many other natural remedies for insulin resistance along with losing excess weight and eating healthier. Many people take supplements for insulin resistance, and there is some evidence that they can make your other efforts more effective. According to research presented in the journals, “Frontiers in Bioscience”[10] and “Canadian Family Physician,”[11] the following natural insulin resistance supplements may support healthier blood sugar control and levels in prediabetes or diabetes.

  • Cinnamon may increase the activity at insulin receptors and may help store glucose. Cinnamon appears to lower blood sugar levels in patients with diabetes.

  • Chromium is an essential mineral for proper insulin action. Deficiency causes diabetes. Chromium picolinate supplements could lower blood glucose and A1C levels in people with diabetes, but there is mixed evidence on this.

  • Fenugreek is an herb that has been used since ancient times in traditional medicine systems, including Ayurvedic medicine. It may lower cholesterol levels and increase insulin secretion by the pancreas, but it does not appear to lower A1C or blood sugar levels consistently.

  • Bitter melon may increase insulin release from the pancreas, but it does not appear to reduce insulin resistance.

  • Gymnema sylvestre is another ancient herb used in Ayurvedic medicine for purposes such as weight loss and cholesterol and diabetes management. It could lower fasting blood glucose and A1C levels slightly.

  • Green tea has caffeine and phytonutrients, including epigallocatechin gallate, that may improve insulin sensitivity. It could lower fasting blood glucose, but research is mixed, and green tea does not appear to lower A1C.

  • Vanadium is another mineral linked to proper insulin function and carbohydrate metabolism, but supplementation is not certain to be safe or effective for improving insulin sensitivity.

Always talk to your doctor before taking dietary supplements. Even natural supplements can pose health risks or interfere with medications. They are not suitable for everyone, especially if you are pregnant, are taking some medications, or have certain health conditions.

Since weight loss can be challenging, but it is so healthy, a perfect weight loss pill would be wonderful. Wouldn’t it be nice if you could pop a pill, lose a few pounds, and lower blood sugar levels? It does not appear to be that simple. Here are some points to consider from the American Diabetes Association.[12]

  • Some blood sugar-lowering medications support weight loss or management. These include metformin, which is the most likely medication for early insulin resistance.

  • Some blood sugar-lowering medications lead to weight gain.

  • All medications have side effects and risks. 

  • They should not be used during pregnancy.

  • Weight loss medications should be used to enhance results from diet and physical activity, and not as a replacement for healthy behaviors.

  • Costs can range from $5 to over $1,000 per month.

FDA-approved weight loss drugs include the following.

  • Phentermine.

  • Contrave.

  • Saxenda (liraglutide).

  • Orlistat (Alli).

These medications can cause side effects ranging from uncomfortable to life-threatening. Examples include diarrhea, constipation, and nausea; vomiting; headaches; fatigue; renal failure; pancreatitis; and thyroid tumors.

 

How Lark Can Help with Reversing Insulin Resistance and Prediabetes


It is great that a healthy lifestyle can often reverse insulin resistance, but where can you get the help you need to make those healthy changes? Where can you go to track your food intake and physical activity? Who will provide you with instant feedback on what you ate and how much you slept? Where will you find a nurse who is ready to chat anytime, day or night, weekends included, with no appointment necessary and no extra fees?

It can all be available to you through your smartphone with Lark DPP. This digital health coach offers CDC-approved educational lessons with a program that has been shown to lower diabetes risk by over 50%. Your Lark nurse is powered by AI (artificial intelligence), allowing every patient to experience a unique and personalized program.

Lark can help you with diet and reversing insulin resistance and prediabetes by acting as your personal nurse. Lark acts as a health educator, cheerleader, and conscience. For those times when you just need a friend, Lark is at your side. 

Lark helps with the daily healthy lifestyle choices that are the core of your insulin resistance reversal plan. With the app, you can:

  • Log and track your food and physical activity.

  • Set and track weight and physical activity goals.

  • Get instant feedback on food choices.

  • Learn strategies for making healthy choices easier and more natural.

  • Walk through stress management techniques when you need them.

  • Monitor sleep and improve sleep quality and quantity to help normalize hormones.

Insulin resistance is common and it can be progressive, but you do not need to take it lying down. Natural remedies for insulin resistance and prediabetes can be surprisingly effective. Lark DPP helps you with learning your options and making good choices, so find out if you may be eligible!

 


Reference

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Reviewed March 6, 2018. Accessed December 5, 2018.

  2. Fonseca VA. Defining and Characterizing the Progression of Type 2 Diabetes. Diabetes Care Nov 2009, 32 (suppl 2) S151-S156; DOI: 10.2337/dc09-S301. http://care.diabetesjournals.org/content/32/suppl_2/S151/

  3.  Insulin Resistance and Prediabetes. NIDDK. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. Updated May 2018. Accessed December 5, 2018.

  4.  Rao GM. Insulin Resistance Syndrome. Am Fam Physician. 2001 Mar 15;63(6):1159-1164. https://www.aafp.org/afp/2001/0315/p1159.html

  5. Insulin Resistance and Prediabetes. NIDDK. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance Updated May 2018. Accessed December 6, 2018.

  6.  Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22.

  7.  American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(Suppl 1).

  8.  Cobb J, Gall W, Adam KP, et al. A novel fasting blood test for insulin resistance and prediabetes. J Diabetes Sci Technol. 2013;7(1):100-10. Published 2013 Jan 1. doi:10.1177/193229681300700112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692221/

  9.  Fonseca VA. Defining and Characterizing the Progression of Type 2 Diabetes. Diabetes Care Nov 2009, 32 (suppl 2) S151-S156; DOI: 10.2337/dc09-S301. http://care.diabetesjournals.org/content/32/suppl_2/S151/

  10.  Kouzi SA, Yang S, Nuzum DS, Dirks-Naylor AJ. Natural supplements for improving insulin sensitivity and glucose uptake in skeletal muscle. Front Biosci (Elite Ed). 2015 Jan 1;7:94-106. https://www.ncbi.nlm.nih.gov/pubmed/25553366

  11.  Nahas R, Moher M. Complementary and alternative medicine for the treatment of type 2 diabetes. Can Fam Physician. 2009;55(6):591-6.

  12.  American Diabetes Association Standards of Medical Care in Diabetes—2018. American Diabetes Association. Diabetes Care. 2018 Jan; 41(Supplement 1). https://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf

Hypertension Medications

Hypertension, or high blood pressure, is a chronic condition. It happens when the force of your blood against the walls of your blood vessels is higher than normal. Blood pressure can increase because there is too much volume in your blood vessels, which increases the force against them, or because there is not enough elasticity in your blood vessel walls, which increases the pounding against them and increases blood pressure.

Hypertension is a dangerous condition known as “the silent killer” because it can have no symptoms, but can cause heart attacks, stroke, and kidney disease. Hypertension is related to over 1,000 deaths per day in the U.S., 

Nearly one-third of American adults have hypertension. According to the Centers for Disease Control and Prevention (CDC), diabetes is one of the major causes.[1] Hypertension can also be the result of poor lifestyle behaviors, such as being obese, having a high-sodium diet, getting low amounts of physical activity, and smoking. You are also at increased risk if you are an older adult or of are of African-American descent.

American Heart Association (AHA) and American College of Cardiologists (ACC)[2] have published guidelines on what hypertension is and the best medications for controlling it. These are the classifications for normal, elevated, and high blood pressure.

Category of Blood Pressure Systolic Blood Pressure Diastolic Blood Pressure
Normal
< 120 mm Hg
and
< 80 mm Hg
Elevated (at risk for hypertension)
120-129 mm Hg
and
< 80 mm Hg
Stage 1 hypertension
120-129 mm Hg
or
80-89 mm Hg
Stage 2 hypertension
≥ 90 mm Hg
or
≥ 90 mm Hg

Hypertension can lead to serious health problems if it is not controlled, but you can control it, in most cases, with a combination of lifestyle changes and medications. These are some of the most common types of medications used for hypertension, along with their possible side effects, as well as some strategies for making them work for you as well as possible.

 

Hypertension Medication Overview


You can try different types of treatments for hypertension. The AHA and ACC suggest starting with lifestyle therapies if you have elevated blood pressure or stage 1 hypertension without other serious risk factors. Your doctor may recommend hypertension medication if lifestyle changes do not work within 3 to 6 months, or if you have stage 1 hypertension with other risk factors for heart disease, or if you have stage 2 hypertension.

When you start taking blood pressure-lowering medications, your doctor will probably prescribe a low dose of a single type of drug. You may increase the dose, add another hypertensive medication, or switch medications if your first prescription does not work.

 

Range of drugs used for hypertension


There is a range of drugs used for hypertension. They have different strategies for lowering blood pressure.[3]


Diuretics (“Water Pills”)

Diuretics are often the first type of medication your doctor will prescribe. They increase the elimination of water from your body, which reduces the volume of your blood, which lowers blood pressure. Diuretics are also known as “water pills” because you are likely to notice the excretion of excess water from your body in the form of increased urination. 

Thiazide diuretics include chlorothiazide, hydrochlorothiazide, metolazone, and spironolactone. They can lead to side effects including fatigue and weakness, cramps, and low potassium levels.


Calcium Channel Blockers

Muscle contraction depends on calcium moving through calcium channels. Calcium channel blockers prevent calcium from entering smooth muscle tissue, which is the type of muscle in blood vessels. The result is that calcium channel blockers prevent strong contractions in blood vessels and they may lower heart rates. Examples include diltiazem and amlodipine. Side effects can include weakness, constipation and diarrhea, and headaches. Calcium channel blockers are also famous for interacting with grapefruit juice, which can lead to greater side effects and low blood pressure.


Angiotensin-Converting Enzyme (ACE) Inhibitors

Angiotensin-converting enzyme (ACE) is a natural compound that helps narrow your blood vessels. Angiotensin-Converting Enzyme (ACE) inhibitors are medications that block this chemical’s action so your blood vessels are not narrowed as much. Examples include lisinopril, benazepril, and captopril. Side effects can include a persistent dry cough, fatigue, diarrhea, and a rash.


Angiotensin Receptor Blockers

Angiotensin receptor blockers (ARBs) affect receptors on your cells that respond to the hormone angiotensin II. This hormone constricts your blood vessels and increases blood pressure. Blocking angiotensin with ARBs can lower blood pressure, and ARBs are often used in patients with kidney disease. Examples of ARBs include candesartan and losartan. Side effects can include high potassium levels (hyperkalemia), dizziness, fatigue, and headaches.


Alpha Blockers

Alpha blockers block the normal action on alpha receptors so that they cannot narrow. This allows them to dilate, or relax, which lowers blood pressure. They are among the oldest blood pressure medications, and they can be the medication of choice for hypertension during pregnancy. Examples include prazosin, terazosin, and doxazosin. Side effects can include postural hypertension, which is a sudden drop in blood pressure when you stand up. Other side effects include increased heart rate, weakness, nausea and headache, tremors, a rash, swollen ankles and legs, and trouble with sleep. They can lead to a sudden drop in blood pressure the first time you take them.


Beta Blockers

Your doctor may prescribe beta blockers as a second blood pressure-lowering medication if you need it, but they are not necessarily a great option if you have diabetes. These medications are also used for cardiac patients, especially when trying to prevent a second heart attack. Beta blockers lower your heart rate and open your blood vessels so that your blood pressure decreases and you heart does not need to work as hard. Examples include acebutolol and atenolol. Side effects can include fatigue and weakness, constipation and diarrhea, and headaches.


Central Agonists

Central agonists act on your central nervous system to prevent strong contractions of your blood vessels. Examples include guanfacine, methyldopa, and clonidine. Side effects include drowsiness, dry mouth, sleepiness, constipation, headache, depression, and nightmares.


Vasodilators

Vasodilators prevent your blood vessels from constricting too much so that your blood pressure does not rise too much. Examples include hydralazine and minoxidil, and they are most used with other blood pressure-lowering medications. Side effects can include fluid retention and swelling around the eyes, pain in the joints, heart palpitations, rapid heartbeat, and chest pain, flushing, dizziness, and hair growth on the body.


Peripheral Adrenergic Inhibitors

Peripheral adrenergic inhibitors work in the brain and help block signals that cause constriction of blood vessels. Examples include guanadrel and reserpine. They are not the first choice for most hypertensive patients because of their side effects. You are more likely to be prescribed them if other medications haven’t worked for you. Side effects can include dizziness, diarrhea, erectile dysfunction, stuffy nose, and heartburn. 

 

Can Hypertension Medication Be Taken during Pregnancy?


Uncontrolled hypertension during pregnancy can be linked to a serious condition called pre-eclampsia, which threatens the mother with heart failure and stroke, and threatens the fetus with premature birth and low birthweight.[4]

As important as it is to prevent uncontrolled high blood pressure during pregnancy, though, pregnant women should never take medications without first consulting their doctors. ACE inhibitors and angiotensin II receptor blockers are among the common blood pressure medications that should not be taken during pregnancy or while breastfeeding. Be extra careful if you have diabetes, since blood pressure-lowering medications can also be tricky.

 

Does Everyone Take the Same Kind of Medication for Blood Pressure?


Not everyone ends up taking the same kind of medication for blood pressure. The drug or combination of drugs that works for you can be different than what works for another person. You may start with a single medication, which is often a diuretic. If that does not work, your doctor might increase the dose, add another medication, or switch the type of blood pressure medication that you take.

Lifestyle factors can affect the effectiveness of your medications. For example, you are more likely to get your blood pressure under control with one drug if you eat well, maintain a healthy body weight, exercise, and avoid tobacco and excessive alcohol consumption.

The effectiveness can depend on genetic factors, too. African-Americans and older adults tend to respond better to calcium channel blockers and diuretics than to ACE inhibitors on their own. Furthermore, the National Heart, Lung, and Blood Institute (NHLBI) reports that ACE inhibitors tend to have angioedema, or dangerous water retention.[5] Individuals with chronic kidney disease are likely to use ACE inhibitors and ARBs.

 

Alcohol and Hypertension Medication


Alcohol can cause drowsiness and dizziness. These are some of the same symptoms as those caused by some hypertension medications, so it is especially important to avoid alcohol when you start taking medications or you switch or add medications. 

 

How to Take Hypertension Medication


It is important to take your hypertension medication as prescribed. This includes taking all of your doses, taking the proper dose, and, if your doctor says, taking the medication with food rather than on an empty stomach. A nurse coaching app can help if you have trouble remembering to take your medicines.

Taking your medications at the right time of day can be one of the most important ways you can get the most from them. Taking medications at bedtime appears to lower blood pressure better and reduce your risk for cardiovascular disease and damage to blood vessels and kidneys, according to research published in “Blood Pressure Monitoring.”[6] Research in “Journal of American Society of Nephrology” found that this is also true among patients with chronic kidney disease.[7]

Research published in the journal “Diabetes Care” confirms that bedtime administration of hypertensive medications led to better blood pressure control and lower risk of cardiovascular events among individuals who also had diabetes.[8] Medications examined included ACE inhibitors, diuretics, calcium channel blockers, beta blockers, ARBs, and others.

 

Other Treatments for Hypertension


Non-pharmacological treatments, or lifestyle changes, can improve your health and blood pressure whether or not you are also on medications. You can use the AHA and ACC guidelines for motivation, since they provide estimates of how much your lifestyle changes can lower your blood pressure.[9]

 
Behavior Estimated Decrease in Systolic Blood Pressure
Weight loss if overweight
1 mm Hg per pound lost
Healthy diet (high in fruit, vegetables, whole grains, and reduced-fat dairy products, low in saturated and trans fat)
11 mm Hg
Sodium under 1,500 mg/day
5 mm Hg
Potassium 3,500-5,000 mg/day
4 mm Hg
Aerobic exercise at least 150 minutes per week
5 mm Hg
Resistance (strength) training
5 mm Hg
No more than moderate alcohol consumption
4 mm Hg
 

Weight Loss

Healthy Diet

The DASH (Dietary Approaches to Stop Hypertension) is an example of an overall healthy diet to lower blood pressure. It is a common-sense eating pattern that includes plenty of fruits, vegetables, reduced-fat dairy products, and whole grains such as oatmeal, whole grain bread and pasta, brown rice, and whole grain cereal. DASH is low in saturated and trans fats from fatty red meats and fried food, and low in sugar-sweetened foods. Other healthy approaches are similar, and include a Mediterranean-style diet and a diet based on the US Dietary Guidelines.

Regular Exercise

Aerobic exercise includes brisk walking, cycling, swimming, and anything else that gets your heart rate up for longer periods of time. You can lower your blood pressure by upping your aerobic exercise to 150 minutes per week, as long as your doctor approves. 

Strength training or resistance training further helps with blood pressure. A good goal is to aim to work all of the major muscle groups at least two days per week. You can use weight machines or dumbbells, and body weight exercises, resistance bands, and weighted bars can work just as well.

Stress Management

It is not your imagination that stress can sdrive up blood pressure. If you cannot reduce the stress in your life, you can still learn to manage it better so that it does not hurt your blood pressure. These tips can help.

  • Let go of what you cannot control.

  • Breathe deeply five times when you feel yourself getting tense or anxious.

  • Find one or more activities that relax you. Possibilities include walking, blogging, meditating, aromatherapy, listening to music, and taking a hot bath.

Excessive alcohol intake can be a factor in the development of high blood pressure. If you choose to drink, be sure to do so responsibly and only as your medication regimen permits. Reducing alcohol consumption to no more than 1 (females) or 2 (males) drinks per day can lower systolic blood pressure by 4 mm Hg. One drink is 12 oz. (1 can) of beer, 5 oz. (1 glass) of wine, or 1.5 oz. of 80-proof liquor.

Uncontrolled hypertension is dangerous, but you have many opportunities to prevent or control high blood pressure. In addition to managing any contributing conditions, such as diabetes if you have it, you can make healthier lifestyle choices. If your doctor does prescribe medications, taking them properly can lower blood pressure and possibly save your life.