Diabetes mellitus blood pressure control

The clinical manifestations of PAD are associated with reduction in functional capacity and quality of life, but because of the systemic nature of the atherosclerotic process there is a strong association with coronary and carotid artery disease. Consequently, patients with PAD have an increased risk of cardiovascular and cerebrovascular ischemic events [myocardial infarction (Ml), ischemic stroke, and death] compared to the general population (4,5). In addition, these cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity PAD cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia (6). Therefore, aggressive treatment of known risk factors for progression of atherosclerosis is warranted. In addition to tobacco cessation, encouragement of daily exercise and use of a low cholesterol, low salt diet, PAD patients should be offered therapies to reduce lipid levels, control blood pressure, control blood glucose in patients with diabetes mellitus, and offer other effective antiatherosclerotic strategies. A recent position paper... 

ESKD (see Chap. 44), necessitating dialysis or transplantation for survival (see Chaps. 45 and 87). The rate of progression can be slowed and in some cases halted through dietary modification and blood pressure control, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker therapy, and improved glucose control in patients with type I diabetes mellitus (see Chap. 43). The efficacy of these interventions is optimally assessed with serial measurements of accurate and sensitive indices of GFR such as iohexol, iothalamate, or radioisotope clearances. ... 

Cushman WC, Evans GW, Byington RP et al. For the ACCORD study group. Effects of intensive blood pressure control in type 2 diabetes mellitus. The New England Journal of Medicine. 2010 362 1575-1585. doi 10.1056/NEJMoa1001286. 

Gerber P, Liibben G, Heusler S, Dodo A. Effects of pioglitazone on metabolic control and blood pressure a randomized study in patients with type 2 diabetes mellitus. Curr Med Res Opin 2003 6 532-9. 

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