Case Study HTN DM

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

  1. What are the effects of controlling BP in people with diabetes?
  2. What is the target BP for patients with diabetes and hypertension?
  3. Which antihypertensive agents are recommended for patients with diabetes?

Answer:

The effects of controlling blood pressure (BP) in people with diabetes are numerous and significant. Controlling BP can reduce the risk of developing complications related to diabetes, such as heart disease, stroke, kidney disease, and peripheral neuropathy. In addition, good BP control can help to maintain good blood sugar control, reducing the risk of long-term complications of diabetes such as blindness, amputation, and kidney failure.

The target BP for patients with diabetes and hypertension is usually lower than for patients without diabetes. The American Diabetes Association recommends a target BP of less than 130/80 mmHg for most people with diabetes. However, individual target BP levels may vary based on factors such as the patient’s age, overall health, and the presence of other medical conditions.

As for antihypertensive agents, there are several classes of drugs that are recommended for patients with diabetes, including:

  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
  • Calcium channel blockers
  • Thiazide diuretics
  • Direct renin inhibitors

It’s important to note that the choice of antihypertensive agent will depend on the patient’s specific medical history and the presence of other risk factors. For example, ACE inhibitors and ARBs are often preferred for patients with diabetes and microalbuminuria, as they have been shown to slow the progression of diabetic nephropathy.

In conclusion, controlling BP is essential for patients with diabetes in order to reduce the risk of developing complications related to the condition. The target BP for these patients is usually lower than for those without diabetes, and several classes of antihypertensive agents are recommended for their treatment.

 

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