Diabetes, Race, and Pregnancy
Are there special considerations for women who have diabetes?
The risk of death due to heart disease is 3 to 6 times higher for women with diabetes than women without diabetes. Most people with diabetes also have high blood pressure.13-15 It is especially important to control your blood pressure if you have diabetes. Research shows that diabetics are less likely to die or have a heart attack if their blood pressure is 130/80 mm Hg or less — a little lower than the target for people without diabetes (140/90 mm Hg).16
Diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers have all been shown to reduce the risk of heart disease and stroke in diabetics. ACE inhibitors and ARBs have added kidney-protecting benefits, which are particularly important for people with diabetes. However, no single drug class is clearly better than the others — getting your blood pressure under control is more important than taking a specific drug for its kidney-protecting benefits.
People with diabetes taking high blood pressure medicines may need to monitor their blood sugar more often than normal. Diuretics increase the risk of high blood sugar ( hyperglycemia), and beta blockers may hide symptoms of low blood sugar ( hypoglycemia).
Are there special considerations for African-American women?
When used alone, beta blockers, ACE inhibitors, and ARBs are all less effective at lowering blood pressure in African Americans than in white people. African Americans taking ACE inhibitors are also more likely to experience a dry cough and other side effects than white patients. Thiazide diuretics and calcium channel blockers work equally well in both races.17, 18 When beta blockers, ACE inhibitors, or ARBs are combined with a diuretic, their combination is just as effective in African Americans and whites. The most important thing is to get your blood pressure under control, and this may mean trying a number of different medications. You should not avoid specific types of medications based on your race.3
Is it okay to take high blood pressure medications during pregnancy?
There are two major kinds of high blood pressure that can affect pregnancy.
A woman who already has high blood pressure may become pregnant. If she has severe high blood pressure, she may benefit from drug treatment during pregnancy. It is less clear if drug treatment of mild high blood pressure during pregnancy is any better than no therapy at all.19 If you are pregnant or planning to become pregnant, tell your doctor so your medication can be properly adjusted or slowly phased out before pregnancy.
There are also high blood pressure disorders that first develop during pregnancy (gestational hypertension): either a short-term rise in blood pressure that starts in mid-pregnancy and goes away after birth (transient hypertension of pregnancy), or high blood pressure that is a symptom of a more serious syndrome called preeclampsia. In women with these types of high blood pressure, treatment with high blood pressure drugs is not beneficial unless blood pressure is dangerously high (above 160/100 mm Hg).