Blood Pressure Insight
High blood pressure in Diabetic Patients
Blood pressure should be less than 130/85 mm Hg in a diabetic
patient.
Any Blood pressure value above 130/85 is causing damage to
the body and must be treated effectively.
Hypertension occurs much more frequently in patients with
diabetes.
Hypertension, diabetes, obesity and high cholesterol usually
occur together in the same patient or in the same family and
are manifestations of basically one disease process called
"Insulin Resistance Syndrome" or IRS.
Uncontrolled diabetes, uncontrolled hypertension and a high
cholesterol level are major causes for the following complications:
Heart attack
Kidney failure requiring dialysis
Stroke
Poor circulation in the legs which can lead to amputation
of legs.
Narrowing of the arteries throughout the body, causing symptoms
such as
impotence, heart failure and dementia
Hypertension in a diabetic patient must be treated aggressively,
with medication in addition to dietary salt reduction and
weight reduction.
Drugs to control Hypertension
ACE-inhibitors
First line medications to treat hypertension in a diabetic
patient are a class of drugs called ACE- inhibitors (angiotensin
converting enzyme inhibitors). In addition to lowering blood
pressure, these drugs have other beneficial effects, such
as preserving kidney function and helping a weak heart.
There are two main side-effects of ACE-inhibitors: dry cough
and high blood potassium level. Patients should be closely
monitored for these side-effects.
Patients who develop a cough on ACE-inhibitors should be
treated with a new class of drugs known as ARB ( angiotensin
2 receptor blockers ).
Angiotensin 2 receptor blockers (ARB)
ARBs, like ACE-inhibitors, appear to provide protection against
diabetic nephropathy.
ARBs should be used in place of an ACE- inhibitor if the
patient develops side-effects on an ACE-inhibitor agent such
as dry cough.
ARBs may also be used as the first line drug.
High potassium level in the blood is a shared side-effect
between ACE-inhibitors and ARBs.
ARBs must not be used in pregnant, diabetic patients as these
agents can be detrimental to the health of the fetus.
Calcium Channel Blockers:
Calcium channel blockers are sometimes required to control
high blood pressure in resistant cases or in cases where ACE-inhibitor
agents or ARBs cannot be used.
Diuretics
Diuretics are sometimes needed in combination therapy in
order to achieve target blood pressure values.
Diuretics should be used in low doses ( Hydrochlorthiazide
6.25-12.5 mg / day , Indapamide 1.25 mg / day ) as higher
doses ( 50-100mg / d ) may increase the risk of sudden death
in diabetic patients.
Hydrochlorthiazide diuretics can adversely affect blood glucose
and cholesterol values.
Indapamide , however does not worsen blood glucose or cholesterol
values.
Alphablockers
Alphablockers are an useful add-on therapy in controlling
high blood pressure in diabetic patients.
These agents do not worsen glucose or cholesterol values.
These drugs also have beneficial effects on the symptoms
of an enlarged prostate.
Clonidine ( Catapres )
Clonidine is sometimes used in resistant cases of high blood
pressure.
Catapres skin patches:
Catapres skin patches are preferred for their convenience
and smoother blood pressure control.
Methyldopa
Methyldopa is primarily used to control hypertension in pregnant,
diabetic patients as this drug appears to be safer for the
fetus.
Peripheral Vasodilators
Peripheral vasodilators such as Minoxidil and Hydralazine
are occasionally needed in severely resistant cases, especially
in patients on dialysis.
Beta blockers
Beta blockers should be avoided in most diabetic patients
as these drugs may cause hypoglycemia unawareness.
Beta blockers, however may be used cautiously if the patient
needs a beta blocker for some other reason such as in victims
of heart attack.
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