Blood Pressure and Diabetes

Most doctors I spoke with while I did research for this book said virtually the same thing I consider every diabetic patient to be a heart patient. That was confirmed by a 2002 survey done by the American Diabetes Association (ADA) and the American College of Cardiology (ACC). More than 90 percent of physicians surveyed reported that men and women with diabetes are very likely or extremely likely to have a cardiovascular event. 

There s a good reason all those physicians feel that way. Fully 65 percent of diabetic men and women will die from a heart attack or a stroke. Yet diabetic patients are not sufficiently conscious of their risk. In another survey done by the ADA and the ACC that same year, 68 percent of diabetics reported that they were not aware of their increased risk for heart disease and stroke. Indeed, those cardiovascular events strike diabetics more than twice as often as they do other people. 

Prehypertension poses particular hazards for diabetic men and women, as found in a study at the University of Oklahoma Health Sciences Center. Doctors there investigated prehypertension in 2,629 subjects taking part in the Strong Heart Study. Many within that group—42 percent—had diabetes. At the outset, participants had normal blood pressure and were free of heart disease. They were followed for twelve years, during which time 389 people suffered a heart event. 

Researchers examined the data and found that compared with nondiabetic individuals with normal blood pressure, those with diabetes and prehypertension had nearly four times the risk of experiencing a cardiovascular incident such as a heart attack or a stroke. Those with diabetes alone had 2.9 times the average risk and those with prehypertension alone had 1.8 times the average risk. The take-home message here is obvious if you have both diabetes and prehypertension you are at greatly increased risk. 

A diagnosis of diabetes in an adult presents the same degree of risk as someone who has already had a heart attack. Cardiovascular complications happen at earlier ages and often result in premature death. People with diabetes are five times more likely to suffer strokes and, after the first stroke, are two to four times more likely to have a second one. 

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Mogensen CE. Microalbuminuria, blood pressure and diabetic renal disease origin and development of ideas. Diabetologia 1999 42 263-85. 

These are chemicals that are contained in all plant foods. In fact, the word "phyto" means "plant" in Greek. Interestingly, they are not vitamins or minerals. Phytochemicals are not nutritious in the usual sense. Some types are isothiocyanates, polyphenols, flavonoids, monterpenes, and organosulfides. They are credited with the treatment and prevention of the four major causes of death heart disease, cancer, high blood pressure, and diabetes. 

Historically the only melanocortin peptide to be used clinically is the parent hormone from which all these peptides are derived from namely ACTH (see above). It has also been used in the treatment infantile spasms for epilepsy, where it is administered as an intramuscular injection only over a 2-12 weeks period. Obvious side effects include weight gain, puffy face, high blood pressure and an increased risk of infection and should never be administered to patients with diabetics, renal or heart failure. ACTH is also used as a stimulation test to measure adrenal cortex activity, i.e. production of cortisol and is used to ascertain whether someone has Addison s disease. 

Factors that predispose an individual to IHD are listed in Table 4—2. Hypertension, diabetes, dyslipidemia, and cigarette smoking are associated with endothelial dysfunction and potentiate atherosclerosis of the coronary arteries. The risk for IHD increases two-fold for every 20 mm Hg increment in systolic blood pressure and up to eight-fold in the presence of diabetes.5,6 Physical inactivity and obesity independently increase the risk for IHD, in addition to predisposing individuals to other cardiovascular risk factors (e.g., hypertension, dyslipidemia, and diabetes). 

A 73-year-old man with a history of diabetes mellitus, chronic kidney disease, gout, osteoarthritis, and hypertension is hospitalized with possible urosepsis. He recently completed a 10-day course of antibiotics and was ready for discharge when his morning labs showed an increase in BUN and serum creatinine concentration. Upon examination, he was found to have 2+ pitting edema, weight gain, nausea, elevated blood pressure, and rales on chest auscultation. 

Almost no one dies from opioid withdrawal per se however, underlying medical complications (e.g., hypertension or recent myocardial infarction) increase the risk of death. Therefore, it is important to manage and stabilize any medical issues (i.e., uncontrolled blood pressure or diabetes, among others), and then determine if hospitalization is appropriate. Patients with... 

Discuss therapeutic goals for blood glucose, blood pressure, and lipids for a patient with diabetes. 

Frank decided that he would try taking this medicine. Although plagued with multiple side effects that affected mainly his bowels, he lost weight. He knew that if he ate fewer fatty foods, the digestive side effects would lessen. He did this and stuck with the medication. He has lost 15 pounds and would like to lose more. Frank has already seen a change in his blood pressure, and his diabetes medicine dosage is lower. 

It should be mentioned that the inhibition of superoxide overproduction and lipid peroxidation by lipoic acid has been recently shown in animal models of diabetes mellitus. The administration of LA to streptozotocin-diabetic rats suppressed the formation of lipid peroxidation products [213], In another study the supplementation of glucose-fed rats with lipoic acid suppressed aorta superoxide overproduction as well as an increase in blood pressure and insulin resistance [214]. 

As noted above, obesity is a health problem. It is associated with both elevated mortality and morbidity. More specifically, obesity is a risk factor for cardiovascular disease, including heart attack and stroke, and for high blood pressure (hypertension), diabetes, and hyperlipidemia (elevated levels of lipids in the blood, a risk factor for atherosclerosis and its sequelae), and for cancer. 

A number of chronic conditions such as high blood pressure or diabetes bear certain similarities to snbstance use disorders. These illnesses prodnce a variety of physical symptoms that, if left untreated, can resnlt in significant medical complications and even death. Complications of uncontrolled diabetes inclnde blindness, kidney failure, neuropathies, and limb amputation. Similarly, inadeqnately controlled hypertension is a risk factor for stroke, heart attack, and other serions complications. Recognizing that these are diseases does not relieve the patient of responsibility indeed, the knowledge that one has snch an illness imposes significant responsibility. For example, knowing the likely ontcome of nncontrolled diabetes is hopefully an impetus for the diabetic to exercise, take medication, and... 

Changes from baseline blood pressure and plasma renin activity in patients with diabetes and hypertension receiving aliskiren monotherapy (150 mg/d), ramipril monotherapy (5 mg/d) or the combination of aliskiren (50 mg/d) and ramipril (5 mg/d). 

Hodgson JM et al Coenzyme Q10 improves blood pressure and glycaemic control A controlled trial in subjects with type 2 diabetes. Eur J Clin Nutr 2002 56 1137. [PMID 12428181]... 

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