What are the effects of controlling BP in people with diabetes|Course hero helper
Posted: February 12th, 2023
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, 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 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
- What are the effects of controlling BP in people with diabetes?
- What is the target BP for patients with diabetes and hypertension?
- Which antihypertensive agents are recommended for patients with diabetes?
SOLUTION
L.N. also has a history of hypertension, which has been treated with a combination of an ACE inhibitor and a diuretic for the past 7 years. Despite optimal pharmacotherapy, her blood pressure remains elevated and uncontrolled, with a recent reading of 145/85 mmHg. L.N.’s obesity and uncontrolled blood pressure increase her risk for diabetic microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease.
L.N. also experiences migraine headaches, which are often associated with a fluctuation of blood glucose levels in patients with diabetes. Proper glucose control, lifestyle modifications, and preventive pharmacotherapy can help reduce the frequency and severity of migraine headaches in such patients.
In order to better manage her medical conditions, L.N. will benefit from a multidisciplinary approach that involves her primary care physician, a diabetes educator, a dietitian, and a specialist such as an endocrinologist or a cardiologist. This team can work together to develop a comprehensive treatment plan that addresses her diabetes, hypertension, obesity, and migraines. Lifestyle modifications, such as a healthy diet, regular physical activity, stress management, and smoking cessation, will also play a crucial role in improving L.N.’s overall health and well-being.
L.N. also has a history of hypertension, which has been treated with a combination of an ACE inhibitor and a diuretic for the past 7 years. Despite optimal pharmacotherapy, her blood pressure remains elevated and uncontrolled, with a recent reading of 145/85 mmHg. L.N.’s obesity and uncontrolled blood pressure increase her risk for diabetic microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease.
L.N. also experiences migraine headaches, which are often associated with a fluctuation of blood glucose levels in patients with diabetes. Proper glucose control, lifestyle modifications, and preventive pharmacotherapy can help reduce the frequency and severity of migraine headaches in such patients.
In order to better manage her medical conditions, L.N. will benefit from a multidisciplinary approach that involves her primary care physician, a diabetes educator, a dietitian, and a specialist such as an endocrinologist or a cardiologist. This team can work together to develop a comprehensive treatment plan that addresses her diabetes, hypertension, obesity, and migraines. Lifestyle modifications, such as a healthy diet, regular physical activity, stress management, and smoking cessation, will also play a crucial role in improving L.N.’s overall health and well-being.
L.N. also has a history of hypertension, which has been treated with a combination of an ACE inhibitor and a diuretic for the past 7 years. Despite optimal pharmacotherapy, her blood pressure remains elevated and uncontrolled, with a recent reading of 145/85 mmHg. L.N.’s obesity and uncontrolled blood pressure increase her risk for diabetic microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease.
L.N. also experiences migraine headaches, which are often associated with a fluctuation of blood glucose levels in patients with diabetes. Proper glucose control, lifestyle modifications, and preventive pharmacotherapy can help reduce the frequency and severity of migraine headaches in such patients.
In order to better manage her medical conditions, L.N. will benefit from a multidisciplinary approach that involves her primary care physician, a diabetes educator, a dietitian, and a specialist such as an endocrinologist or a cardiologist. This team can work together to develop a comprehensive treatment plan that addresses her diabetes, hypertension, obesity, and migraines. Lifestyle modifications, such as a healthy diet, regular physical activity, stress management, and smoking cessation, will also play a crucial role in improving L.N.’s overall health and well-being.
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