Hector Ruiz
Case Study Paper
Question 1
Controlling BP in people with diabetes can help reduce the risk of mounting serious problems, such as heart attack, stroke, kidney disease, and peripheral neuropathy. By keeping BP within recommended levels, people with diabetes can reduce their risk of these complications and enjoy a better quality of life (Cheon et al., 2022). Lowering BP can also help to lower blood sugar levels, which can advance diabetes control and decrease the risk of hypoglycemia.
Question 2
The target BP for patients with diabetes and hypertension is less than 130/80 mmHg. The ADA endorses that people with type 2 diabetes should strive to maintain a BP between 130/80 mmHg and 140/90 mmHg. People with type 1 diabetes should strive to maintain a BP between 140/90 mmHg and 150/90 mmHg (Westgate et al., 2021). The target BP for patients with diabetes and hypertension is lower than that for those without diabetes due to the increased risk of complications associated with having both conditions. Controlling BP helps to reduce the risk of rising serious problems, such as heart attack, stroke, kidney disease, and peripheral neuropathy. Keeping BP within the recommended range can also help to lower blood sugar levels and advance diabetes control, reducing the risk of hypoglycemia. In order to maintain the target BP, lifestyle modifications, such as diet and physical activity, are recommended. Additionally, medications may be prescribed to help lower BP. It is important to adhere to prescribed medications and lifestyle modifications to help reduce the risk of complications associated with diabetes and hypertension (Cheon et al., 2022). Blood pressure should be monitored regularly to ensure it is within the recommended range.
Question 3
Several antihypertensive agents are recommended for patients with diabetes, including ACEIs, ARBs, thiazide diuretics, and calcium channel blockers. ACEIs and ARBs are often prescribed first-line for people with diabetes and hypertension as they can help to reduce the risk of developing complications (Westgate et al., 2021). Thiazide diuretics and calcium channel blockers may also be used in combination with other medications for optimal BP control. Beta-blockers may also be used but are not recommended as a first-line treatment for people with diabetes and hypertension due to their potential to worsen glucose control.
Fariany Pino Blanco
Discussion week 5
28 mins ago
Answer The Reflective Questions
What are the effects of controlling BP in people with diabetes?
Hypertension and diabetes mellitus commonly coexist and are associated with high insulin resistance. Blood pressure is increased by hyperinsulinemia due to increased renal sodium reabsorption, change in transport of ions, activation of the sympathetic nervous system, and increase in vascular resistance. Hypertension is a risk factor for cardiovascular complications, particularly in individuals with diabetes. The incidence of diabetes is 2 to 3 times higher in hypertension patients. The cardiovascular system has devastating effects due to the presence of diabetes and hypertension, and it eventually leads to end-stage renal disease (Kim et al., 2022). There is a 2 to 4 times greater mortality risk with cardiovascular complications in type 2 diabetic patients than in nondiabetic individuals.
Hyperinsulinemia is influenced by the control of hypertension. Hypertensive medications such as angiotensin-converting enzyme inhibitors and angiotensin two receptor blockers are associated with degrees for the development of diabetes type-2, while diuretics are associated with increased risk for the development of diabetes type-2. In diabetic patients, a level of BP greater than 130/80 mmHg is considered hypertensive. If the BP is maintained in diabetic patients, it reduces cardiovascular risks and stroke risks by 44% (Yamazaki et al, 2018). Moreover, the development of ESRD is also slowed in diabetic patients, and the expansion of diabetic retinopathy will not be accelerated. Lowering or managing blood pressure in diabetic patients decreases vascular complications.
What is the target BP for patients with diabetes and hypertension?
In some cases, the risk of patients having a future cardiovascular event along with diabetes and hypertension determines the target blood pressure. In most diabetic patients, the target of lowering blood pressure in patients with high-risk clinical features is that the blood pressure should be less than 130/80 mmHg, while in other cases, it should be lower than 140/90 mmHg. Research determined that in hypertensive patients with type 2 diabetes if the diastolic blood pressure is lower than its lowest target level, i.e., 80mmHg, 51% of the cardiovascular events are reduced compared to the group in which the target was set as 90 mmHg (Sun et al., 2019). The UKPDS analyzed that the complications related to diabetes are reduced by 12% with each 10 mmHg reduction in systolic blood pressure.
Which antihypertensive agents are recommended for patients with diabetes?
For initiation and maintenance of hypertensive treatment, the following classes are used as a monotherapy or combination.
Angiotensin-converting enzyme inhibitors (ACEIs):
To manage coexisting hypertension and diabetes, these agents are considered first-line therapy. ACE inhibitors decrease the progression of cardiovascular mortality and kidney failure. Enalapril, Lisinopril, and benazepril are examples of ACE inhibitors. Lisinopril 5mg once daily is recommended initially, but depending on the condition, the dose can be increased to 10mg once daily or 5 mg twice daily.
Angiotensin 2 receptor blockers ARBs:
If the patients are intolerant to ACE inhibitors, then ARB is prescribed. These agents do not affect the level of blood sugar. ARBs are first-line therapy for patients that are intolerant to ACE inhibitors because the progression of diabetic kidney disease is prevented by these agents (Przezak et al., 2022). For example, losartan 50mg once daily.
Calcium channel blockers:
To manage hypertension in diabetic patients, calcium channel blockers also show beneficial effects, and these are reserved for patients needing additional therapy so that target blood pressure can be achieved. A combination of multiple antihypertensive agents is required in many diabetic patients. For example, amlodipine 5 mg once daily.
B-Blockers
Beta-blockers also manage hypertension, but these are not recommended in diabetic patients because the symptoms of hypoglycemia are altered in diabetic patients, and beta-blockers also enhance and prolong hypoglycemia. The action of oral hypoglycemic drugs is usually antagonized by these beta blockers, so blood glucose concentration eventually increases.
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