Heart disease and stroke statistics update: What is the proper workup of a patient with hypertension?. Cleve Clin J Med. Hypertension diagnosis and treatment.
The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.
Questions What are the effects of controlling BP in people with diabetes?
What is the target BP for patients with diabetes and hypertension? Which antihypertensive agents are recommended for patients with diabetes? Commentary Diabetes mellitus is a major risk factor for cardiovascular disease CVD.
Approximately two-thirds of people with diabetes die from complications of CVD. Nearly half of middle-aged people with diabetes have evidence of coronary artery disease CADcompared with only one-fourth of people without diabetes in similar populations.
Patients with diabetes are prone to a number of cardiovascular risk factors beyond hyperglycemia. These risk factors, including hypertension, dyslipidemia, and a sedentary lifestyle, are particularly prevalent among patients with diabetes.
To reduce the mortality and morbidity from CVD among patients with diabetes, aggressive treatment of glycemic control as well as other cardiovascular risk factors must be initiated.
Studies that have compared antihypertensive treatment in patients with diabetes versus placebo have shown reduced cardiovascular events. Another trial followed patients for 2 years and compared calcium-channel blockers and angiotensin-converting enzyme ACE inhibitors, with or without hydrochlorothiazide against placebo and found a significant reduction in acute MI, congestive heart failure, and sudden cardiac death in the intervention group compared to placebo.
Studies have shown that there is no lower threshold value for BP and that the risk of morbidity and mortality will continue to decrease well into the normal range.
Many classes of drugs have been used in numerous trials to treat patients with hypertension. All classes of drugs have been shown to be superior to placebo in terms of reducing morbidity and mortality. Often, numerous agents three or more are needed to achieve specific target levels of BP. Use of almost any drug therapy to reduce hypertension in patients with diabetes has been shown to be effective in decreasing cardiovascular risk.
Keeping in mind that numerous agents are often required to achieve the target level of BP control, recommending specific agents becomes a not-so-simple task.
The literature continues to evolve, and individual patient conditions and preferences also must come into play. While lowering BP by any means will help to reduce cardiovascular morbidity, there is evidence that may help guide the selection of an antihypertensive regimen.
In addition, both ACE inhibitors and angiotensin II receptor blockers ARBs have been shown to slow the development and progression of diabetic nephropathy. Her BP control can be improved. Diuretics have been shown to have synergistic effects with ACE inhibitors, and one could be added.
Because of the presence of microalbuminuria, the combination of ARBs and ACE inhibitors could also be considered to help reduce BP as well as retard the progression of diabetic nephropathy.Hypertension affects approximately 75 million adults in the United States and is a major risk factor for stroke, myocardial infarction, vascular disease, and chronic kidney disease.
See the image below. Diabetic nephropathy is a clinical syndrome characterized by albuminuria, hypertension, and progressive renal insufficiency. Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) in Western countries, accounting for ~35% of all new ESRD cases in the United States.
L.N. is a year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between and lb.
Initial treatment . Introduction. Case studies are an invaluable record of the clinical practices of a profession. While case studies cannot provide specific guidance for the management of successive patients, they are a record of clinical interactions which help us to frame questions for more rigorously designed clinical studies.
Clinical case scenarios: Hypertension () 4 Introduction Clinical case scenarios are an educational resource that can be used for individual or group learning. Clinical Management and Treatment Decisions Case study, American Journal of Hypertension, Volume 11, Issue S8, 1 may be different for black American and white individuals.
10–12 Some studies indicate that effective treatment of hypertension in black Americans results in a decrease in the incidence of CVD to a level that is similar to.