Type II Diabetes shortens lives by causing high blood pressure, strokes and heart attacks (Circulation, 2019;139:2228–2237). Diabetics in the DIRECT study in Scotland, who followed a strict 800-calorie-per-day diet and lost a lot of weight, were also able to lower their high blood pressure (Diabetologia, May 31, 2021:10.1007/s00125-021-05471-x). Many of these patients were able to stop taking all blood pressure medications, as long as they did not regain their lost weight, and their blood pressure and blood tests for diabetes remained normal.

The DIRECT (DIabetes REmission Clinical Trial) program starts with 12 weeks on a nutritionally complete formula diet that strictly limits calories so patients usually lose more than 30 pounds during that period. Many of the patients were able to safely stop taking their diabetes medications as well as their blood pressure medications when their blood sugar and blood pressure numbers dropped towards normal. After the initial 12 weeks on the formula diet, the patients were taught to choose healthful foods and avoid harmful ones to maintain their weight loss. Eighty percent of those who maintained their weight loss were able to stop all of their diabetic medications for the full two year study period.

Everyone Should Keep Their Blood Pressure Under Control
Another recent study shows that very aggressive control of high blood pressure helps to prevent heart attacks, strokes and premature death far more effectively than less stringent control (N Engl J Med, 2021 May 20;384(20):1921-1930). Normal blood pressure is 120/80, and you have high blood pressure if either of your values are higher than that. Doctors followed 9,361 people who had high blood pressure, but did not have diabetes or a previous stroke. One group was treated with medications to lower systolic blood pressure below 120 mm Hg, while the other group was treated with far fewer medications to lower systolic pressure below 140. Those treated with several medications to lower their blood pressures below 120 had fewer heart attacks, strokes and cases of premature death. However, those treated to get their blood pressure below 120 had more side effects from their medications.

The majority of North Americans who have high blood pressure need several blood pressure medications to control their high blood pressure, and the more medications you take to treat high blood pressure, the more likely you are to suffer side effects from these drugs. Side effects can include diarrhea, constipation, lack of energy, headache, nausea, vomiting, dizziness, lightheadedness, erection problems, feeling nervous, tired or weak, and so forth. If you think you are having side effects from your blood pressure medications, discuss them with your doctor, who may be able to adjust the types of drugs or their doses to make you more comfortable.

My Recommendations
Whatever drugs you may be taking for Type II diabetes, high blood pressure or both, realize that these drugs are used to control your condition, not to cure it. You can often get rid of both type II diabetes and high blood pressure with major lifestyle changes. See my report on the High-Plant, Low-Salt DASH diet

Most Type II Diabetics Could Be Cured with Lifestyle Changes