Diabetes and Hypertension

Diabetes and hypertension share pathophysiology and risk factors, so management is most effective when coordinated. Begin with baseline risk stratification: assess ASCVD history, albuminuria and eGFR, lipids, smoking, and sleep apnea. Set targets that reflect overall risk and safety: a blood pressure goal <130/80 mmHg for most, and an individualized A1c (often around 7%, relaxed for frailty or hypoglycemia risk). Implement high-yield lifestyle changes first and continuously: Mediterranean or DASH-style eating with sodium <2,300 mg/day (lower if tolerated), structured exercise ≥150 minutes/week plus resistance training, weight reduction, and sleep optimization; encourage home BP monitoring and digital tools for feedback. Select pharmacotherapy for outcomes, not just numbers. If albuminuria or CKD is present, start an ACE inhibitor or ARB; add a thiazide-like diuretic (e.g., chlorthalidone, indapamide) or a dihydropyridine calcium channel blocker to reach target BP. For type 2 diabetes with ASCVD, HF, or CKD, introduce an SGLT2 inhibitor and/or GLP-1 receptor agonist, independent of baseline A1c, to reduce cardiovascular and renal events. In T2D with CKD and persistent albuminuria on ACEi/ARB, consider finerenone with potassium and renal monitoring. Continue statin therapy per risk, and prioritize smoking cessation. Review medications for glycemic effects and interactions, and monitor kidney function, potassium, and retinopathy regularly. Team-based care and home BP logs improve adherence and outcomes. This integrated strategy reduces heart attack, stroke, heart failure, and kidney failure more than treating either disease in isolation.

Traditional East Asian medicine views diabetes (Xiao Ke) and hypertension as related expressions of internal imbalance—often combining yin deficiency and heat with phlegm-damp accumulation and liver yang rising. An integrative plan starts with pattern differentiation, then pairs biomedically proven therapies with adjunctive modalities aimed at autonomic calming, metabolic resilience, and stress reduction. Acupuncture protocols (e.g., LR3, LI11, ST36, SP6, KI3, PC6, GB20) may modestly lower blood pressure and fasting glucose while improving sleep and perceived stress—factors that can indirectly enhance adherence and metabolic control. Herbal formulas are selected for the individual: yin-nourishing formulas such as Liu Wei Di Huang Wan for dryness and thirst; Tian Ma Gou Teng Yin or Zhen Gan Xi Feng Tang when liver yang rising and headaches predominate; and phlegm-resolving strategies for central adiposity and dampness. Where botanicals like berberine are considered for glucose control, coordination with the prescribing clinician is essential to avoid hypoglycemia and to monitor for interactions with RAAS blockers, anticoagulants, or statins. Lifestyle is a core bridge between traditions: whole-food dietary patterns, reduced greasy/sweet foods and excess sodium, mindful eating, and daily movement (tai chi/qigong or brisk walking) address phlegm-damp and improve insulin sensitivity and vascular tone. Eastern modalities should complement—not replace—guideline-based care. Safety measures include sourcing standardized products, monitoring kidney and liver function when using herbs, and pausing herbal therapies during acute illness or surgery. Used judiciously within a collaborative care model, traditional practices can support stress management, sleep, and metabolic balance while Western therapies deliver proven reductions in cardiovascular and renal events.