Treating Hypertension in Patients With Diabetes

Treating Hypertension in Patients With Diabetes

When treating diabetic patients who have developed hypertension, a number of outcomes are expected. Risks in these patients include cerebrovascular disease, sexual dysfunction, hypotension, renal disease, and eye disease, which health professionals strive to reduce. Pharmacological and lifestyle change interventions are highly recommended for these patients in order to control blood pressure and stabilize renal function (Turan & Turan, 2017). Furthermore, the medications aim to improve insulin sensitivity in these patients, which reduces the likelihood of complications. Patients are advised to limit their salt intake, exercise regularly, and maintain a healthy body weight in order to reduce the risks associated with the condition. Pharmacological interventions, such as the use of ACE inhibitors, play an important role in improving endothelial dysfunction and fibrinolysis (Turan & Turan, 2017). The end result of the patients’ lifestyle changes and pharmacological interventions is a reduction in all death risks.

Health professionals who work with diabetes and hypertension patients strive to achieve an optimal blood pressure level for these patients. The American Diabetes Association proposed a blood pressure of 130/80mmHg (Rabkin, 2016). However, a meta-analysis was carried out in order to arrive at a unified figure, as various bodies had their own recommendations. Following the analysis, it was recommended that health professionals keep these patients’ blood pressure levels at 130-135mmHg (Rabkin, 2016). In order to achieve the recommended level, health professionals should also consider individual health risks.

There are several anti-hypertensive medications available for diabetics who have developed hypertension. Renin-angiotensin system (RAS) blockers produce the best results by preventing adverse cardiovascular and renal outcomes (Bangalore, Fakheri, Toklu & Messerli, 2016). According to the American Diabetes Association, they are primarily used as first-line treatments for these patients.

References

Bangalore, S., Fakheri, R., Toklu, B., & Messerli, F. H. (2016). Diabetes mellitus as a compelling indication for the use of renin-angiotensin system blockers: a systematic review and meta-analysis of randomized trials. BMJ, i438. doi:10.1136/bmj.i438

Rabkin, S. W. (2016). Target blood pressure for patients with hypertension: lower blood pressure is not better. Journal of the American Society of Hypertension, 10(8), 623- 624. doi:10.1016/j.jash.2016.06.034

Turan, Y., & Turan, E. (2017). Association between hypertension and type 2 diabetes mellitus. Journal of Hypertension, 35, e48. doi:10.1097/01.hjh.0000523101.46266.61

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L.N. 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 5′4″ and has always been on the large side, fluctuating between 165 and 185 lb.

Treating Hypertension in Patients With Diabetes

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 7.4%.

Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. 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. L.N. 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?