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What are the effects of controlling BP in people with diabetes?
It has been proven by several studies that patients suffering from diabetes run the risk of having various related conditions. More than 75 percent of all patients who die from diabetes die because of having cardiovascular disease. Furthermore, high blood pressure, which usually accompanies diabetes, may lead to diabetic eye disease and cause kidney failure if it is not addressed in due time. The problem is that diabetes often provokes artery damages, which is the major cause of hypertension and heart attacks (Taylor, 2013).
That is why such patients must track blood pressure to prevent hypertension that may be life-threatening in this case. All cardiovascular events in such patients must be controlled: Patients with strict BP control have lower chances to have stroke or any heart complication caused by diabetes.
What is the target BP for patients with diabetes and hypertension?
Since patients with diabetes are unlikely to have normal blood pressure, their general target may vary from 125/75 to 130/80 mmHg. The first target is mostly recommended for patients who have nephropathy while the second is suitable for most other cases if there are no side conditions that may affect it (Taylor, 2013).
Which antihypertensive agents are recommended for patients with diabetes?
It is rather hard to say, which antihypertensive agents are the most effective in the case of patients with diabetes as the treatment must be individualized. It may require more than one drug to achieve the target BP. All classes of drugs have been proven to be more effective in reducing mortality rates and reducing cardiovascular risk than relying on the placebo effect. Furthermore, there is no considerable difference in the treatment outcomes for patients who were treated with ACE inhibitors, ARBs, or ²-blockers. The superiority of one medicine over the other largely depends on the patient and his particular case (Taylor, 2013).
What testing does this woman need ordered due to her change in status both SOB and BP?
Since L.N has a change in status both shortness of breath and blood pressure, she needs to undergo some diagnostic tests that will allow finding out if she has any heart conditions. This may be done with the help of EKG, echocardiography, chest CT scan, and lung function test (Matsuda & Shimomura, 2013).
What is the significance of microalbuminuria in this woman? How does this affect her cardiovascular risk?
Due to the presence of microalbuminuria, BP may be reduced by combining ARBs with ACE inhibitors and slow down the development of diabetic nephropathy. The problem is that the patients condition may be aggravated by microalbuminuria, which implies that her high blood pressure must be controlled using aggressive measures as it is more difficult for the woman to achieve her BP targets. The point is that microalbuminuria, regardless of the status of diabetes, serves as a risk indicator of CVD. Thus, it means that the patient may have a stroke. It has been reported that people having type 2 diabetes and microalbuminuria are also likely to have problems with kidneys, which is another reason for strict control (Marso et al., 2016).
Case Study Summary
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Patient name: L.N.
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Gender: Female
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Age: 49 years old
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Race: Caucasian
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Height: 543
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Weight: Ranging from 165 to 185 lb.
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Diagnosis: Type 2 diabetes, hypertension, obesity, migraine headaches, microalbuminuria, increased exertional SOB.
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Physical examination results: a BP of 154/86 mmHg, a pulse of 78 bpm.
Recommended treatment: It is recommended to the patient to combine ACE inhibitors with ARBs instead of taking dihydropyridine calcium-channel blockers alone. Since the patient suffers from obesity, it is highly important to lose weight, for which purpose diet and physical activity are necessary. In case high blood pressure persists after losing weight, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) can be implemented as it would allow not only dealing with diabetes but also address hypertension (Matsuda & Shimomura, 2013).
References
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A.,& & Steinberg, W. M. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 2016(375), 311-322.
Matsuda, M., & Shimomura, I. (2013). Increased oxidative stress in obesity: Implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Obesity Research & Clinical Practice, 7(5), e330-e341.
Taylor, R. (2013). Type 2 Diabetes. Diabetes Care, 36(4), 1047-1055.
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