Posted: February 26th, 2023
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.
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.
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.
The case of L.N. is like most patients that medical practitioners experience daily in their line of work. In most cases, patients with diabetes are vulnerable to developing other health complications like hypertension. Patients with uncontrolled diabetes are at a higher risk of gaining weight hence developing obesity. Controlling B.P. in diabetic patients is vital; however, it brings effects; therefore, the patient and the physician should be aware of them. The effects are reducing the risk of microvascular and macrovascular problems and stroke. Brumstrom (2016) concluded that controlling hypertension in patients with SBP of more than 140 mmHg would cause reduced cardiovascular morbidity and mortality. If the SBP were less than 140 mmHg, it would increase cardiovascular death.
Meta-analyses produce different results, which bring a lot of confusion on which is the target B.P. for patients with diabetes and hypertension. However, medical guidelines provide the levels to which they target B.P. should range, which is what most physicians work with. According to Passarella et al. (2018), the American Diabetes Association guideline recommends that the target goal that all physicians should use should be a systolic blood pressure lower than 140 mmHg and a diastolic blood pressure lower than 90 mmHg.
The first line of antihypertensive agents for patients with diabetes are angiotensin-converting enzymes (ACE) inhibitors. When the ACEI is not tolerated, an angiotensin receptor blocker (ARB) should be applied. Also, diuretics as combination regimens or monotherapy, beta-blockers, and calcium channel blockers are considered a treatment for these patients (Grossman & Grossman, 2017). The treatment options of the antihypertension agents are applied depending on the B.P. levels, both diastolic and systolic, the patient's age, and the patient's underlying health conditions. An appropriate combination regimen is necessary if one agent does not work well, and changing the agents is not tolerated.
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