Conference Insight: Hypertensive & Diabetic Patients.
Rawalpindi, Pakistan, 24/2/2011
Diabetics with Hypertension should take: A.C.E. inhibitor and Angiotensin receptor blockers
Losartan has more side effects than Candesartan.
A.C.E. inhibitor and Calcium channel blockers combination useful with Diuretics.
A.C.E. inhibitors : Reduce neuropathy in Diabetics (both types) and can be taken prophylactically to prevent complications. If A.C.E. inhibitor combined with Angiotensin receptor blockers, Diabetic nephropathy can be avoided, however if proteinurea occurs, then add Furesemide (Loop diuretic); if blood pressure is normal but proteinurea still occurring give Spironolactone (25mg), if problem still continues then add Renin blocker and Losartin, if problem still persists give selective Vitamin D receptor activator. Only discontinue Angiotensin receptor blocker and A.C.E. inhibitor combination if renal artery stenosis occurring or kidney going in acute failure.
For older Hypertensive patients, give Angiotensin receptor blockers and A.C.E. inhibitors to reduce tissue damage. Similarly in Diabetics with Hypertension, 1 drug is unable to control Hypertension, therefore add Angiotensin receptor blockers and A.C.E. inhibitors with Statin therapy/
Renal denervation can be done to prevent hypertension. It is a non invasive method done by ablasive catheter. Side effect: Renal artery stenosis.
Simvastatin decreases the risk of heart attack in Diabetics.
Complications in Diabetics : (a) Macrovascular complications ( Myocardial infarction, Cardiovascular disease, Angina), (b) Microvascular complications (Nephropathy, neuropathy and retinopathy)
Ferobibrates reduce both macrovascular and microvascular complications.
If C reactive protein level is raised, it is marker of Myocardial infarction.
Treatment of Diabetic dyslipedemia:
Lower L.D.L. cholesterol (by statins)
-Raise H.D.L. cholesterol.
-Exercise, stop smoking, Niacin/ Fibrates/ Omega 3 intake.
- Lower Triglycerides (by Fibrates/ Omega 3)
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