Are There Gaps in the Dietary Management of Adults with Coexisting Diabetes and Hypertension?

OBJECTIVES: Diabetes and hypertension frequently co-occur. Hypertension control is critical to prevent diabetes complications. Although certain dietary targets for both are similar (fiber, fat, protein) they also differ in important targets. We evaluated if these differences in recommendations are associated with suboptimal diet among diabetic and non-diabetic patients with hypertension in clinical practice.

METHODS: We analyzed data from hypertensive patients (n=178, 50% had diabetes) enrolled in a trial to improve hypertension treatment. Diet was assessed using Willett Food Frequency Questionnaires. Dietary differences between patients were tested using Wilcoxon rank-sum tests.

RESULTS: Diabetic patients scored lower than nondiabetic patients in the Healthy Eating Index (65.8 vs. 69.1, p<.05); other common-target comparisons were: fiber (16.2 g vs. 18.1 g, p=.15), total fat (33.3% vs. 32.1% of calories, p=.12), total protein (18.7% vs. 17.0 % of calories; p<.01). Hypertension-related diet comparisons between diabetic and nondiabetic patients (in mg) were: sodium (1816.9 vs. 1857.7, p=.59), potassium (2424.7 vs. 2757.7, p<.05), calcium (722.1 vs. 838.2, p <.05), magnesium (285.8 vs. 326.1, p<.05). The corresponding diabetes-specific diet comparisons were: diabetics ate fewer calories (1607.4 kcal vs. 1837.3 kcal, p=.01), and lower glycemic load (102.2 units vs. 120.3 units, p< .01).

IMPLICATIONS: Patients with diabetes and hypertension had lower HEI scores than those with hypertension alone, though their diet was better with respect to factors affecting glycemic control. Diabetic patients are not achieving all goals to control hypertension. Patients with coexisting hypertension and diabetes may require more help in creating and adhering to diets treating both diseases.