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Hypertension and Diabetes Management

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Hypertension is a major risk factor for cardiovascular disease. Hypertension is more difficult to control in patients with diabetes due to various pathophysiological factors. This document discusses hypertension in diabetes in depth, including definitions, types, causes, management goals, refractory hypertension, and treatment approaches. Treatment involves optimizing drug regimens, addressing medication non-adherence, and considering secondary causes of hypertension such as kidney disease or obstructive sleep apnea.

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Hypertension in Diabetes Mellitus
Hypertension: The Silent Killer Facts & Figures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Top Three Countries for Diabetes Data from King H et al. Diabetes Care . 1998;21:1414-1431.
What is Hypertension? JNC 7 Definition Hypertension 2003;42:1206-52 Blood Pressure (mm Hg) Category Systolic Diastolic <120 and <80 Normal 120-139 or 80-89 Prehypertension 140-159 or 90-99 Stage 1 hypertension ≥ 160 or ≥100 Stage 2 hypertension
Types of Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Secondary Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertension: Predisposing factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypertension: A Significant CV and Renal Disease Risk Factor National High Blood Pressure Education Program Working Group. Arch Intern Med. 1993;153:186-208.
CV Mortality Risk Doubles with Each 20/10 mm Hg BP Increment* *Individuals aged 40-69 years, starting at BP 115/75 mm Hg. CV, cardiovascular; SBP, systolic blood pressure; DBP, diastolic blood pressure Lewington S, et al. Lancet . 2002; 60:1903-1913. JNC VII. JAMA. 2003. CV mortality risk SBP/DBP (mm Hg) 0 1 2 3 4 5 6 7 8 115/75 135/85 155/95 175/105
Pathophysiology of hypertension in DM ,[object Object],[object Object],[object Object],[object Object],[object Object]
Vasoactive substances ,[object Object],[object Object],[object Object],[object Object]
Processes important in the development or perpetuation of hypertension in diabetics ,[object Object],[object Object],[object Object],[object Object]
Reactive oxygen species (ROS) ,[object Object],[object Object],[object Object]
Management: JNC 7 GUIDELINES
What are the goals of therapy? ,[object Object],[object Object],[object Object],[object Object]
But… There are Reasons for Inadequate BP Control ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],JNC VI. Arch Intern Med. 1997
And that leads to… ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Refractory Hypertension leads to
Causes of Refractory Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Resistant Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Accurate BP Measurement ,[object Object],[object Object],[object Object],[object Object]
Approach to Resistant Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
White Coat Hypertension ,[object Object],[object Object],[object Object]
Approach to Resistant Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pseudoresistance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Resistant Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Importance of Adherence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Techniques to Improve Adherence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Resistant Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Causes of Hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of Refractory Hypertension
Management of Refractory Hypertension - 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med. 2001;344(1):3-10, Med. 2000;107(5):57-70.
Management of Refractory Hypertension - II ,[object Object],[object Object],[object Object]
Management of Refractory Hypertension - III ,[object Object],[object Object]
Study performed at Mayo Clinics with Refractory Hypertensive patients ,[object Object],[object Object]
Thank You

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Hypertension and Diabetes Management

  • 2.
  • 3. Top Three Countries for Diabetes Data from King H et al. Diabetes Care . 1998;21:1414-1431.
  • 4. What is Hypertension? JNC 7 Definition Hypertension 2003;42:1206-52 Blood Pressure (mm Hg) Category Systolic Diastolic <120 and <80 Normal 120-139 or 80-89 Prehypertension 140-159 or 90-99 Stage 1 hypertension ≥ 160 or ≥100 Stage 2 hypertension
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  • 8. Hypertension: A Significant CV and Renal Disease Risk Factor National High Blood Pressure Education Program Working Group. Arch Intern Med. 1993;153:186-208.
  • 9. CV Mortality Risk Doubles with Each 20/10 mm Hg BP Increment* *Individuals aged 40-69 years, starting at BP 115/75 mm Hg. CV, cardiovascular; SBP, systolic blood pressure; DBP, diastolic blood pressure Lewington S, et al. Lancet . 2002; 60:1903-1913. JNC VII. JAMA. 2003. CV mortality risk SBP/DBP (mm Hg) 0 1 2 3 4 5 6 7 8 115/75 135/85 155/95 175/105
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  • 14. Management: JNC 7 GUIDELINES
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  • 31. Management of Refractory Hypertension
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Hinweis der Redaktion

  1. 2 nd most common reason for visit All family physicians should be experts at HTN.
  2. Hypertension is an important contributing risk factor for morbidity and mortality from both cardiovascular (CV) and renal disease. Hypertension is one of the most significant contributing factors to the development of CV and renal disease. Complications of hypertension include coronary artery disease, congestive heart failure, stroke, renal disease (including end-stage renal disease), and peripheral vascular disease. These diseases account for significant disability, loss of productivity, and decreased quality of life for many Americans. National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med. 1993;153:186-208.