Question

LN. is a 49-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 54" and has always been on the large side, with her weight fluctuating between 165 and 185 lb. 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 Ate of 24%. Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office wats noted to be consistently elevated in the range of 160/90 mmHg on three occasions. LN. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. LN. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm. Questions 1. What are the effects of controlling BP in people with diabetes? 2. What is the target BP for patients with diabetes and hypertension? 3. Which antihypertensive agents are recommended for patients with diabetes?

Answer 1

1.The effects of controlling BP in patients with diabetes are

• They help in prevention of microvascular complications like retinopathy, nephropathy, neuropathy and macrovascular complications like CAD,Stroke,Cardiac conditions,peripheral vascular diseases
• Reduces the aggravation of other diseases

2.According to The Action to Control Cardiovascular Risk in Diabetes (ACCORD) the target BP for a patient with DM and HTN is a systolic BP ranging 130 to 135 mmHg and a Diastolic BP of 80mmHg

3. The first line of choice for treating hypertension in patients with diabetes are with ACE (angiotensin converting enzyme)inhibitors or ARB (angiotensin receptor blocker ) inhibitors. This medicine slows down any cardiovascular problems and renal complications .