The Clinical Significance And Health Implications Of Blood Pressure Control In Diabetics

Funom MakamaStarred Page By Funom Makama, 21st Mar 2014 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Diseases & Infections

The aggressive approach to control blood pressure has just been endorsed by the National Kidney Foundation (NFK) in USA with regards to diabetics. The current recommendation is to lower the BP of diabetic patient to <130/80 mmHg- a reduction from the goal of <130/85 mmHg recommended in the JNC VI-report.

Recent Clinical Successes

Results of recently published Heart outcomes prevention evaluation (HOPE) and micro HOPE study suggest a benefit of ramipril (an ACE inhibitor) in reducing morbidity and mortality in type 2 diabetics. Lisinopril can also be used. All diabetics should be on ACE inhibitor as initial therapy unless contraindicated or intolerable side effects develop.

Angiontensin receptor blockers (ARBs) have been shown to reduce the rate of progression of nephropathy in patients with type 2 diabetes. There is the need to emphasize Dietary approach to stop Hypertension (DASH). The DASH study shows that diet rich in fruits and vegetables and in which saturated fat was replaced by low fat dietary products produced a greater reduction of blood pressure. Renal function and serum potassium levels should be monitored. Also patient should be taught self measurement of blood pressure at home.

Blood Sugar Control

Diet: There is no longer a diabetic diet. It is a healthy way of eating that matters. The focus is on an evenly spread of carbohydrate in meals throughout the day. Medical Nutrition Therapy (MNT) focuses on reduction of saturated fat and cholesterol intake, weight loss and increase in physical activity. The goal is to attain and maintain optimal metabolic outcome. Patients should avoid artificial sugar preparations, but increase the intake of fruits and vegetables.

Aerobic exercise should be encouraged on a daily basis but special attention must be paid to the shoes and care of the feet. Exercise should be of mild to moderate intensity.

Drugs: Metformin primarily works on the liver, reducing endogenous glucose production. It has dramatic effect on cardiovascular outcome especially in overweight patients.

Troglitasone (TDZ) has effect on peripheral glucose disposal. They are both insulin sensitizers and complement each other thereby bringing down fatty acid levels. There is the need to adopt St. Vincent declaration (a joint WHO-IDF initiative in 1989) which calls for targets for improving the outlook for diabetic patients.

Lipid Management

Since hypertensive diabetics have a propensity towards developing cardiovascular disease, it is important to treat their dyslipidemia. Desirable total cholesterol is <200 mg/dL and optimal LDL is <100 mg/dL. All diabetics should be on HMG-Co Reductase inhibitor (“strain”) with addition of a fibrate if necessary to reach the LDL goal. Limit foods that are high in cholesterol and take more of those that contain high soluble fibers. Recommended dietary intake for calcium, potassium and magnesium is necessary.

Aspirin therapy: Aspirin blocks thromboxanes synthesis by acetylating platelest cyclo-oxygenase. It prevents cardiovascular events. Daily dosage is recommended stating from 75 to 325 mg/day. Aspirin should be avoided in cases of allergy or gastrointestinal bleeding.

For more interesting and very important health related and medical articles, click on the links below
1. General Considerations, Clinical And Medical Classifications Of Anemia
2. Heart Failure: Definition, Detailed Causes And Precipitating Factors Of Cardiac Failure
3. Special Investigations In Cardiology II: The Significance Of Echocardiography
4. Clinical Significance And Health Importance On The Actions Of Adrenocorticotropic Hormone (ACTH) On The Adrenal Cortex

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22nd Mar 2014 (#)

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author avatar Lambasted
25th Mar 2014 (#)

As usual, one of your excellent stuff you have shown to us.. Keep it up Dr. Funom

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9th Apr 2014 (#)

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