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Ace Inhibitor In Diabetes

Angiotensin-converting Enzyme (ace) Inhibitors

Angiotensin-converting Enzyme (ace) Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors treat a variety of conditions, such as high blood pressure, scleroderma and migraines. Find out more about this class of medication. Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that narrows your blood vessels and releases hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder. Many ACE inhibitors are available. Which one is best for you depends on your health and the condition being treated. People with chronic kidney disease may benefit from having an ACE inhibitor as one of their medications. People of African heritage and older people respond less well to ACE inhibitors than do white and younger people. In rare cases but more commonly in people of African heritage and in smokers ACE inhibitors can cause some areas of your tissues to swell (angioedema). If it occurs in the throat, the swelling can be life-threatening. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), decrease the effectiveness of ACE inhibitors. Taking an occasional dose of these medications shouldn't change the effectiveness of your ACE inhibitor, but talk to your doctor if you regularly take NSAIDs. Because ACE inhibitors can cause birth defects, talk to your doctor about other options to treat your blood pressure if you're pregnant or you plan to become pregnant. Continue reading >>

Management Of Diabetic Hypertensives

Management Of Diabetic Hypertensives

Department of Diabetology, M.V. Hospital for Diabetes, Prof. M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Research, Education and Training in Diabetes, No.4, West Mada Church Street, Royapuram, Chennai, India Department of Diabetology, M.V. Hospital for Diabetes, Prof. M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Research, Education and Training in Diabetes, No.4, West Mada Church Street, Royapuram, Chennai, India Department of Diabetology, M.V. Hospital for Diabetes, Prof. M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Research, Education and Training in Diabetes, No.4, West Mada Church Street, Royapuram, Chennai, India Corresponding Author: Dr. Vijay Viswanathan, Managing Director and Head, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Research, Education and Training in Diabetes, No.4, West Mada Church Street, Royapuram, Chennai 13, India. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : Indian Journal of Endocrinology and Metabolism This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Hypertension occurs twice as commonly in diabetics than in comparable nondiabetics. Patients with both disorders have a markedly higher risk for premature microvascular and macrovascular complications. Aggressive control of blood pressure (BP) reduces both micro- and macrovascular complications. In diabetic hypertensives, angiotensin convert Continue reading >>

No Benefit Of Ace Inhibitors/statins For Teens With Type 1 Diabetes

No Benefit Of Ace Inhibitors/statins For Teens With Type 1 Diabetes

Kidney News Features No Benefit of ACE Inhibitors/Statins for Teens with Type 1 Diabetes No Benefit of ACE Inhibitors/Statins for Teens with Type 1 Diabetes Treatment with angiotensin-converting enzyme (ACE) inhibitors, statins, or both does not affect albumin excretion in adolescents with type 1 diabetes, concludes a trial in The New England Journal of Medicine. In a screening study of 4407 adolescents with type 1 diabetes, 1287 had increased albumin excretion, defined as the upper third of the albumin-to-creatinine ratio. Of these, 443 were randomly assigned to treatment with an ACE inhibitor, statin, or matching placebos in a 2-by-2 factorial design. The main outcome of interest was change in albumin excretion, assessed every 6 months over 2 to 4 years. Secondary outcomes included microalbuminuria, retinopathy, lipid levels, and other cardiovascular risk markers. Change in albumin-to-creatinine ratio over time was unaffected by treatment with ACE inhibitor and/or statin. The incidence of microalbuminuria was lower with ACE inhibitor compared to placebo, but this difference was not considered significant. Statin treatment was associated with expected changes in lipid levels. However, there were no between-treatment differences in carotid intima-media thickness, other cardiovascular risk markers, glomerular filtration rate, or retinopathy progression. No serious unexpected adverse reactions occurred. In adolescents with type 1 diabetes, puberty-associated increases in albumin excretion occur before the development of microalbuminuria and macroalbuminuria. This suggests that ACE inhibitors or statins might have beneficial effects for young diabetics with high albumin excretion. However, the randomized, placebo-controlled trial shows no significant difference in albumin Continue reading >>

Why Ace Inhibitors Are Necessary For All Patients With Type 2 Diabetes

Why Ace Inhibitors Are Necessary For All Patients With Type 2 Diabetes

Numerous scientific studies have demonstrated that ACE inhibitors such as Vasotec, Altace and lisinopril are the antihypertensive drugs of choice in all patients with diabetes and high blood pressure. Furthermore, the American Diabetes Association’s Standards of Care recommend these medications for all patients with type 2 diabetes. In addition to treating blood pressure this class of medication also protects against diabetic renal (kidney) disease, also known as nephropathy. It is important to note that this class of medications should not be used during pregnancy. Lifetime therapy with the drug is required. However, not all patients can tolerate ACE inhibitors because of side effects. The most important side effects include: Persistent dry cough (in about 10 percent of all patients) Hyperkalemia (high potassium level). Urticaria (swelling of the face and/or trunk and extremities). Once begun, the dosage of the ACE inhibitor should be increased to the maximum tolerable dose for the greatest efficacy. Possible reasons that ACE inhibitors reduce microalbumin include: Inadequate dose Excess of salt (sodium) in the diet Another cause of renal disease (in addition to diabetes) Advanced renal disease (serum creatinine over 3 mg/dl) If ACE inhibitors cannot be tolerated, ARB drugs such as Cozaar and Diovan should be substituted. ARBs also treat hypertension and protect against renal disease. Like ACE inhibitors, ARBs should not be taken during pregnancy. In certain cases, physicians may prescribe both classes of drugs for patients with diabetic nephropathy or hypertension. Other antihypertensive agents may be useful, but none have yet been shown to be equivalent to the ACE inhibitors or the ARB drugs in preventing or reducing diabetic nephropathy. Although ACE inhibitor use Continue reading >>

Effects Of Ras Inhibitors On Diabetic Retinopathy: A Systematic Review And Meta-analysis

Effects Of Ras Inhibitors On Diabetic Retinopathy: A Systematic Review And Meta-analysis

Summary Results of several studies have shown a possible beneficial effect of renin-angiotensin system (RAS) inhibitors on diabetic retinopathy, but the findings were contradictory. We did a systematic review and meta-analysis to assess the effect of RAS inhibitors on diabetic retinopathy. We identified relevant publications in PubMed, Embase, Cochrane Library Central Register of Controlled Trials, and abstracts from main annual meetings. Only randomised controlled trials comparing angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) monotherapy with other antihypertensive drugs or placebo in type 1 or type 2 diabetes were eligible for inclusion in the analysis. The primary outcomes were progression and regression of diabetic retinopathy in all patients and several subgroups. Risk ratios (RRs) with corresponding 95% CIs were pooled. We also did a network meta-analysis to assess the effect of different antihypertensive drugs on diabetic retinopathy by ranking order. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42013004548. 21 randomised clinical trials with 13 823 participants were included in the meta-analysis. RAS inhibitors were associated with reduced risk of progression (absolute risk difference −3%, 95% CI −5 to −1; pooled RR 0·87, 95% CI 0·80–0·95; p=0·002) and increased possibility of regression of diabetic retinopathy (8%, 1–16; RR 1·39, 95% CI 1·19–1·61; p=0·00002). In normotensive patients, RAS inhibitors decreased risk of diabetic retinopathy progression (0·81, 0·69–0·94; p=0·007) and increased possibility of regression (1·43, 1·14–1·79; p=0·002). In hypertensive patients, RAS inhibitors were not associated with difference in risk Continue reading >>

Ace-inhibitors And New-onset Diabetes

Ace-inhibitors And New-onset Diabetes

1 - Epidemiology Type 2 diabetes is a major risk factor for cardiovascular mortality and morbidity. The prevalence of diabetes is increasing worldwide causing tremendous social economic burden to patients and health care providers. Effective strategies for the prevention of diabetes include diet and exercise in order to reduce insulin-resistant fatty tissue and improve insulin sensitivity 1. Randomised trials have convincingly demonstrated that lifestyle changes are associated with a convincing reduction in the progression to diabetes 1. However, the implementation of lifestyle modifications is challenging and therefore, new strategies for the prevention of diabetes are warranted. 2 - Preventive Treatment Peroxisome-proliferator-activated receptor (PPAR) agonists which are known to improve insulin sensitivity and metformin have been shown to reduce the incidence of diabetes 2. In addition, various clinical trials in more than 66,608 patients with coronary artery disease, hypertension, or heart failure have demonstrated a delay and/or prevention of new-onset diabetes with substances directed to inhibit the renin-angiotensin system (RAS) 3-6. However, in all these studies, the incidence of diabetes was not the primary endpoint and in most of the studies results were obtained from post-hoc analyses. In addition, glucose levels were not systematically reviewed. Since inhibition of the RAS is an effective and widely used method for reducing mortality and morbidity in patients with cardiovascular disease, additional positive effects on plasma glucose levels would be intriguing. 3 - The Dream Trial In order to further elucidate the effect of inhibitors of the RAS and the incidence of diabetes the Diabetes Reduction Assessment of Ramipril and Rosiglitazone Medications (DREAM) t Continue reading >>

Angiotensin Converting Enzyme Gene Polymorphism And Ace Inhibition In Diabetic Nephropathy - Sciencedirect

Angiotensin Converting Enzyme Gene Polymorphism And Ace Inhibition In Diabetic Nephropathy - Sciencedirect

Volume 53, Issue 4 , April 1998, Pages 1002-1006 Clinical Nephrology Epidemiology Clinical Trials Angiotensin converting enzyme gene polymorphism and ACE inhibition in diabetic nephropathy Angiotensin converting enzyme gene polymorphism and ACE inhibition in diabetic nephropathy. The antiproteinuric effect of angiotensin converting enzyme (ACE) inhibition in insulin-dependent diabetes mellitus (IDDM) patients with diabetic nephropathy varies considerably. Therefore, we tested the potential role of an insertion (I)/deletion (D) polymorphism of the ACE gene on this early antiproteinuric responsiveness in an observational follow-up study. Sixty (II, N = 13; ID, N = 26 and DD, N = 21) young hypertensive IDDM patients suffering from diabetic nephropathy were investigated during three months before and for the initial six month period during ACE inhibition [captopril 44 (SD 22) mg/24 hr, no differences in drug dose between groups]. Blood pressure (MABP) and albuminuria (ELISA) were measured three (1 to 6) times before and three (1 to 13) times during ACE inhibition. At baseline the groups (II/ID/DD) had comparable (1) mean arterial blood pressure (MABP mm Hg) of 113 10/108 9/114 8, (2) albuminuria (geometric mean with 95% CI) 1394 (747 to 2608)/1176 (844 to 1797) and 1261 (827 to 2017) mg/24 hr, and (3) serum creatinine (geometric mean with 95% CI), 80 (68 to 93)/85 (76 to 97)/103 (85 to 119) mol/liter, respectively. Angiotensin converting enzyme inhibition induced a significant reduction in MABP, albuminuria and kidney function in all three groups (II/ID/DD; P < 0.05): (1) MABP (mean SD) 12 7/5 7/8 9 mm Hg (ANOVA, P = 0.02); (2) albuminuria [mean (95%CI)] 61 (34 to 77)/22 (3 to 37)/31 (13 to 46) %, (ANOVA, P < 0.01); and (3) increasing serum creatinine [mean (95%CI)] 8 (4 t Continue reading >>

Population Implementation Of Ace Inhibitor Therapy In Patients With Diabetes And Coronary Artery Disease

Population Implementation Of Ace Inhibitor Therapy In Patients With Diabetes And Coronary Artery Disease

Population Implementation of ACE Inhibitor Therapy in Patients with Diabetes and Coronary Artery Disease Patients with diabetes commonl Patients with diabetes commonly die of coronary artery disease (CAD). Studies suggest ACE inhibitors (ACEI) at appropriate doses can delay or prevent cardiovascular outcomes. The purpose of this study was to use a population management strategy to increase the proportion of patients with diabetes and CAD on target dose ACEI and to assess the safety and tolerability of the initiative. Patients with diabetes and CAD were eligible for enrollment if not on or receiving target dose ACEI. Clinical pharmacy specialists were responsible for initiation, titration, and appropriate follow-up of ACEI therapy. The proportion of patients achieving target ACEI dose, changes in blood pressure, serum creatinine, and serum potassium, and reasons why target dose was not achieved were evaluated. At baseline, 30.9% (n=140) of eligible patients were on no ACEI therapy and no patients were at the target dose. Of the 453 subjects enrolled, the mean age was 67.9 years and 77% were male. The mean systolic blood pressure, serum creatinine and serum potassium were 128.0 mmHg, 1.0 mg/dL and 4.4 mEq/dL, respectively. At follow-up, 8.2% (n=37) (p[lt]0.001) were on no ACEI therapy and 68.7% (n=311) (p[lt]0.001) of patients achieved target dose. From baseline to follow-up, mean systolic blood pressure decreased 4.4 mmHg (p[lt]0.001). There were no clinically significant changes in serum potassium or creatinine. Of the 142 subjects unable to achieve target dose, 21.8% (n=31) experienced hypotension, 20.4% (n=29) did not have the dose advanced due to potential for hypotension, and 16.2% (n=23) experienced cough. A population management approach to patients with diabetes Continue reading >>

Benefits Of Arbs Not The Same As Ace Inhibitors

Benefits Of Arbs Not The Same As Ace Inhibitors

The effects of ACEIs and ARBs on multiple outcomes in type 2 diabetes patients…. Angiotensin-converting enzyme inhibitors (ACEIs) are a mainstay class of antihypertensive medications with proven benefits in not only hypertensive patients but also in conditions such as diabetes. Some patients taking ACEIs may experience a chronic, dry, nonproductive cough, prompting the switch to a similar class of medications which don’t cause this side effect; Angiotension II receptor blockers (ARBs). While both of these drug classes are closely related, their effects on preventing secondary complications in patients with diabetes may be much different. In a recent meta-analysis, researchers evaluated the effects of ACEIs and ARBs on multiple outcomes, in type 2 diabetes patients, including; all-cause mortality, cardiovascular deaths and major cardiovascular events. Data sources for this study included; EMBASE (1988 to 2012), MEDLINE (1966 to 2012) and Cochrane Controlled trial register. Of the trials evaluated, 23 evaluated ACE inhibitors against placebo or active drugs (32,827 patients) and 13 trials compared Angiotensin II receptor blockers against controls (23,867 patients). Using risk ratios with 95% confidence intervals, random-effects models were analyzed. Further, meta-regression analysis was performed to identify sources of heterogeneity. Researchers found that ACEIs displayed a 13% reduced risk of all-cause mortality (RR= 0.87, CI 95%, 0.78 to 0.98). ACEIs also reduced cardiovascular death rate by 17% (RR=0.83, CI 95%, 0.70-0.99), and major CV events by 14% (RR=0.86, CI 95%, 0.77 to 0.95). Further, ACEIs lowered myocardial infarction by 21% (RR=0.79, CI 95%, 0.65 to 0.95) and heart failure by 19% (RR=0.81, CI 95%, 0.71 to 0.93). Similar findings were not seen with ARBs. T Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Diabetic nephropathy (diabetic kidney disease) is kidney damage that results from having diabetes. Having high blood glucose levels due to diabetes can damage the part of the kidneys that filters your blood. The damaged filter becomes 'leaky' and lets protein into your urine. For some people, diabetic nephropathy can progress to kidney failure. However, most people with diabetes do not develop kidney disease that progresses to kidney failure. How common is diabetic nephropathy? Diabetic nephropathy is common. One in 4 women and one in 5 men with type 2 diabetes develops diabetic nephropathy. It is even more common in type 1 diabetes. Diabetic kidney disease is the leading cause of kidney failure in Australia. Symptoms Diabetic nephropathy usually has no symptoms early on. You can't tell that there is protein in your urine – it's something that is detected with a urine test. It can take many years for the kidney damage to progress. Symptoms usually only appear when kidney damage has deteriorated significantly. Even then, the symptoms tend to be vague. If the kidney damage becomes severe, you may notice: weight loss; a poor appetite or feeling sick; swollen ankles and feet (due to retaining fluid); puffiness around the eyes; dry, itchy skin; muscle cramps; needing to pass urine more often; feeling tired; and having difficulty concentrating. What happens to the kidneys in diabetes? The main function of the kidneys is to filter waste products and excess water from the bloodstream so that they can be excreted in the form of urine. This is carried out by a system of tubes and blood vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny urine-collecting tubes. One of the major structures in the nephron is a group of blood vessels kn Continue reading >>

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

OBJECTIVE—Chemokines play an important role in the pathogenesis of diabetic nephropathy. Angiotensin II induces several fibrogenic chemokines, namely monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 1 and type 2 diabetes. We examined if blockade of the renin-angiotensin system lowered urinary levels of the chemokine MCP-1 and correlated urinary MCP-1 (uMCP-1) with parameters of renal function and glucose and lipid metabolism before and after 1 year of treatment with an ACE inhibitor. RESEARCH DESIGN AND METHODS—In 22 patients with type 2 diabetes and diabetic nephropathy in stages 3–5, treatment with the ACEI lisinopril was initiated. Before treatment and after 12 months of continuous therapy, proteinuria, creatinine clearance, uMCP-1 levels, BMI, HbA1c, and serum cholesterol were assessed. RESULTS—Lisinopril treatment improved renal function. Proteinuria decreased from 410 ± 662 mg per 24 h to 270 ± 389 mg per 24 h. Creatinine clearance rose from 61 ± 26 to 77 ± 41 ml/min. Urinary MCP-1 levels decreased from 0.456 ± 0.22 ng/mg creatinine to 0.08 ± 0.096 ng/mg creatinine. The change in uMCP-1 correlated significantly (r = 0.61, P < 0.001) with the change in proteinuria. No other parameter correlated with the improvement in renal function. CONCLUSIONS—Blockade of the renin-angiotensin system in type 2 diabetic patients with diabetic nephropathy reduces uMCP-1 levels and improves renal function. Because MCP-1 induces monocyte immigration and differentiation to macrophages, which augment extracellular matrix production and tubulointerstitial fibrosis, pharmacological reduction of angiotensin II may also exert its beneficial ef Continue reading >>

Ace Inhibitors (side Effects, List Of Names, Uses, And Dosage)

Ace Inhibitors (side Effects, List Of Names, Uses, And Dosage)

What are ACE inhibitors, and how do they work (mechanism of action)? Angiotensin II is a very potent chemical produced by the body that primarily circulates in the blood. It causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing increases in blood pressure (hypertension). Angiotensin II is formed from angiotensin I in the blood by the enzyme angiotensin converting enzyme (ACE). (Angiotensin I in the blood is itself formed from angiotensinogen, a protein produced by the liver and released into the blood.) Angiotensin converting enzyme inhibitors (ACE inhibitors) are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed. Why are ACE inhibitors prescribed (uses)? ACE inhibitors are used for: ACE inhibitors also improve survival after heart attacks. In studies, individuals with hypertension, heart failure, or prior heart attacks who were treated with an ACE inhibitor lived longer than patients who did not take an ACE inhibitor. ACE inhibitors are an important group of drugs because they prevent early death resulting from hypertension, heart failure or heart attacks. Some individuals with hypertension do not respond sufficiently to ACE inhibitors alone. In these cases, other drugs often are used in combination with ACE inhibitors. List of examples of brand and generic drug names for ACE inhibitors The following is a li Continue reading >>

Ace Inhibitors: Blood Pressure Control In Diabetes

Ace Inhibitors: Blood Pressure Control In Diabetes

Angiotensin converting enzyme (ACE) inhibitors are oral medications that lower blood pressure. ACE inhibitors are used to treat hypertension (high blood pressure), coronary artery disease and heart failure, and to help to control the progression of diabetes and kidney disease. Overview These disease processes tend to go hand in hand; high blood pressure is very common among people with diabetes. High blood pressure also contributes to the development of diabetic nephropathy (kidney disease). Furthermore, those with diabetes tend to have worse outcomes (longer hospitalizations, longer recovery times and higher risks of infection) from major heart problems. Therefore, health-care providers treat hypertension in concert with diabetes. While ACE inhibitors don't directly lower blood sugar, they can contribute to blood sugar control by increasing the body’s sensitivity to insulin. Insulin helps the body metabolize glucose (sugar) and move it from the bloodstream into cells, where it acts as a source of energy. Many ACE inhibitors are available in the United States, including Capoten (captopril), Prinivil and Zestril (lisinopril), Vasotec (enalapril), Lotensin (benazepril), Altace (ramipril), Accupril (quinapril), Monopril (fosinopril), Mavik (trandolapril), Aceon (perindopril) and Univasc (moexipril). How They Work ACE inhibitors lower blood pressure by preventing the body from producing the hormone angiotensin II. Angiotensin II causes vasoconstriction (narrowing of blood vessels) and fluid retention, resulting in hypertension. By reducing blood pressure and fluid retention, ACE inhibitors help to control heart failure. ACE inhibitors may also prevent and control diabetic nephropathy (kidney disease) and help control diabetic retinopathy (eye problems). ACE inhibitors do Continue reading >>

Ace Inhibitors And Statins In Adolescents With Type 1 Diabetes

Ace Inhibitors And Statins In Adolescents With Type 1 Diabetes

Among adolescents with type 1 diabetes, rapid increases in albumin excretion during puberty precede the development of microalbuminuria and macroalbuminuria, long-term risk factors for renal and cardiovascular disease. We hypothesized that adolescents with high levels of albumin excretion might benefit from angiotensin-converting–enzyme (ACE) inhibitors and statins, drugs that have not been fully evaluated in adolescents. We screened 4407 adolescents with type 1 diabetes between the ages of 10 and 16 years of age and identified 1287 with values in the upper third of the albumin-to-creatinine ratios; 443 were randomly assigned in a placebo-controlled trial of an ACE inhibitor and a statin with the use of a 2-by-2 factorial design minimizing differences in baseline characteristics such as age, sex, and duration of diabetes. The primary outcome for both interventions was the change in albumin excretion, assessed according to the albumin-to-creatinine ratio calculated from three early-morning urine samples obtained every 6 months over 2 to 4 years, and expressed as the area under the curve. Key secondary outcomes included the development of microalbuminuria, progression of retinopathy, changes in the glomerular filtration rate, lipid levels, and measures of cardiovascular risk (carotid intima–media thickness and levels of high-sensitivity C-reactive protein and asymmetric dimethylarginine). The primary outcome was not affected by ACE inhibitor therapy, statin therapy, or the combination of the two. The use of an ACE inhibitor was associated with a lower incidence of microalbuminuria than the use of placebo; in the context of negative findings for the primary outcome and statistical analysis plan, this lower incidence was not considered significant (hazard ratio, 0.57; 9 Continue reading >>

Diabetes With Hypertension

Diabetes With Hypertension

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Home and Ambulatory Blood Pressure Recording article more useful, or one of our other health articles. This article aims to provide a simple management plan for the management of people with diabetes mellitus who also have raised blood pressure (BP). It is based mainly on the current National Institute for Health and Care Excellence (NICE) recommendations. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients.[1, 2]Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes.[3] Early intervention and targeting multiple risk factors with both lifestyle and pharmacological strategies give the best chance of reducing macrovascular complications in the long term.[4] Antihypertensive therapies may promote the development of type 2 diabetes mellitus. Studies indicate that the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists (AIIRAs) leads to less new-onset diabetes compared to beta-blockers, diuretics and placebo.[5] Epidemiology Hypertension is more prevalent in patients with type 2 diabetes than in those who don't have diabetes.[4] It is estimated that the prevalence of arterial hypertension (BP greater than 160/95 mm Hg) in patients with type 2 diabetes is in the Continue reading >>

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