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What Is The Drug Class Of Choice To Treat Elevated Blood Pressure In A Diabetic

High Blood Pressure Drugs (hypertension)

High Blood Pressure Drugs (hypertension)

How to choose a high blood pressure (hypertension) medicine There are a number of types and classes of drugs available for the management and treatment of high blood pressure (hypertension). Your doctor or other health care professional will prescribe a drug that fits your specific needs based on your medical condition, and any other existing health problems you may have, for example, kidney disease, heart disease, or diabetes. Your doctor also may recommend other therapies and lifestyle changes like getting more exercise, managing stress, and eating a healthy diet. This information will provide a list of high blood pressure medication generic and brand names, their uses (treatment, management, or prevention of health problems, how they work (mechanism of action), and common side effects. Angiotensin converting enzyme (ACE) inhibitors Angiotensin converting enzyme (ACE) inhibitors are blood pressure medications that inhibit the activity of the enzyme angiotensin converting enzyme (ACE), which is important for controlling blood pressure. Angiotensin II is a very potent chemical formed in the blood by ACE from, angiotensin I. When formed, angiotensin II causes the muscles surrounding blood vessels to contract, thus narrowing the vessels and increasing blood pressure. ACE inhibitors are medications that inhibit the activity of ACE which decreases the production of angiotensin II. As a result, these medications cause the blood vessels to enlarge or dilate, and this reduces blood pressure. 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. Increased blood potassium levels This list is not does not include all sid Continue reading >>

Management Of Hypertension In Elderly Diabetic Patients - Em|consulte

Management Of Hypertension In Elderly Diabetic Patients - Em|consulte

Management of hypertension in elderly diabetic patients [1]Service de Mdecine Interne, Diabte et Maladies Mtaboliques, Hpitaux Universitaires de Strasbourg, Strasbourg, France. [2]Service de Mdecine Interne, Clinique Mdicale B - Hpital Civil, F-67091 Strasbourg Cedex, France. Prise en charge de lhypertension artrielle du diabtique g Lhypertension artrielle (HTA) reprsente un facteur de risque vasculaire majeur chez le diabtique g. Les bnfices lis sa prise en charge ne sont plus discuts, mme si le traitement est sans influence sur la mortalit totale, voire tend laugmenter lgrement chez les sujets trs gs. Globalement, lefficacit des principales classes danti-hypertenseurs, diurtiques, -bloquants, inhibiteurs calciques, inhibiteurs de lenzyme de conversion ou antagonistes des rcepteurs de langiotensine 2 apparat identique, le choix thrapeutique sexerant en fonction du type dHTA, systolique isole ou systolo-diastolique, de la rapidit de leffet recherch, des pathologies associes, en particulier coronariennes ou rnales, ou du profil de tolrance des mdicaments. Les objectifs tensionnels rejoignent ceux des diabtiques dge moyen, sauf peut-tre chez les sujets trs gs, les patients fragiles ou en mauvaise sant. Hypertension is a major vascular risk factor in the elderly diabetic. The benefit of proper management is well recognized, even if treatment has no influence on overall mortality or might even tend to increase it in very elderly subjects. Globally, the efficacy of the major classes of antihypertensive drugs, diuretics, beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin II receptor antagonists appears to be equivalent so that the therapeutic choice depends on the type of hypertension, systolic or systolic-diastolic, and the rap Continue reading >>

Hypertension: Drugs Used To Treat Hypertension

Hypertension: Drugs Used To Treat Hypertension

Diuretics There are three classes of diuretic drugs that are used to treat hypertension. Most commonly used are thiazide diuretics such as hydrochlorothiazide or chlorthalidone. There is not usually an increased urine flow after the first one or two days of taking these medications. Nevertheless, it is best to take them in the morning to prevent annoying urine production overnight. They are effective in lowering blood pressure in the great majority of patients, especially those over 60, African Americans, and those with diabetes. Diuretics increase the effectiveness of all other categories of antihypertensives. That is why they are an essential part of almost any multidrug regimen for hypertension. Special Points: Diuretics are the original antihypertensives. Therefore, their efficacy and adverse effects are very well understood. No drug is more effective overall in reducing blood pressure than a diuretic when given with dietary salt restrictions. Adverse effects are usually slight, and can often be anticipated and prevented (see below). The recent large scale clinical trial, ALLHAT, compared outcomes amongst hypertensive subjects with cardiovascular risk factors who were randomized to receive either a diuretic (chlorthalidone), an angiotensin converting enzyme inhibitor (ACEI; ramipril) or an calcium channel blocker (CCB; amlodipine) reported that the more modern drugs were no more effective overall in preventing cardiovascular disease than the diuretic and no more effective in lowering blood pressure. For this reason, the Joint National Commission on Hypertension Detection Evaluation and Treatment (JNCVII) recommended thiazide diuretics as first line therapy for patients with hypertension, unless there were special reasons to select another type of drug. Thiazide diur Continue reading >>

Medications For Treating Hypertension

Medications For Treating Hypertension

Doctors once hesitated to prescribe medication until a patient's blood pressure reached 160/100. Anything below that level was deemed "mild hypertension" and not considered dangerous, so many doctors worried that the drugs' potential side effects might outweigh their benefits. These perceptions turned out to be false. Research has firmly established the value of treating stage 1 hypertension (140/90 to 159/99 mm Hg) with drugs, if necessary. For those with diabetes or kidney disease, medications may be necessary at pressures as low as 130/80. And today, blood pressure can be controlled with lower doses of medications, meaning there is less chance of side effects. Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School. Continue reading >>

Pharmacologic Management Of Hypertension In Patients With Diabetes

Pharmacologic Management Of Hypertension In Patients With Diabetes

KAREN L. WHALEN, PharmD, University of Florida College of Pharmacy–St. Petersburg Campus, Seminole, Florida ROBERT D. STEWART, PharmD, Bay Pines Veterans Affairs Healthcare System, Bay Pines, Florida Am Fam Physician. 2008 Dec 1;78(11):1277-1282. Hypertension is a common comorbidity in patients with diabetes, and adequate control of blood pressure significantly reduces the risk of macrovascular and microvascular complications. Patients with diabetes should achieve a target blood pressure of less than 130/80 mm Hg. The use of angiotensin-converting enzyme inhibitors may slow progression to kidney failure and cardiovascular mortality; these agents are the preferred therapy for managing coexisting diabetes and hypertension. Angiotensin receptor blockers can prevent progression of diabetic kidney disease and are a first-line alternative for patients intolerant of angiotensin-converting enzyme inhibitors. Thiazide diuretics provide additional antihypertensive effects when combined with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. With lower doses of these drugs, the risk of clinically significant metabolic alterations is minimal. Beta blockers and calcium channel blockers also have beneficial effects in managing hypertension in patients with diabetes. Beta blockers reduce cardiovascular events and are useful in a multidrug regimen. Dihydropyridine calcium channel blockers should be reserved for patients intolerant of preferred agents or those who need additional therapy to achieve target blood pressure. Many patients with diabetes require combination therapy with multiple antihypertensive agents. Approximately 23.6 million adults in the United States have diabetes.1 Hypertension is a common comorbidity in these patients; it is 1.5 to three tim Continue reading >>

Management Of Blood Pressure In Patients With Diabetes

Management Of Blood Pressure In Patients With Diabetes

Management of Blood Pressure in Patients With Diabetes Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, affiliated to Sackler Faculty of Medicine, Tel-Aviv University Division of Cardiology, Luke's-Roosevelt Hospital and Columbia University American Journal of Hypertension, Volume 24, Issue 8, 1 August 2011, Pages 863875, Ehud Grossman, Franz H. Messerli; Management of Blood Pressure in Patients With Diabetes, American Journal of Hypertension, Volume 24, Issue 8, 1 August 2011, Pages 863875, Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality in patients with diabetes. Lowering blood pressure (BP) to 135/85 mmHg is the main goal of treatment. A nonpharmcologic approach is recommended in all patients. If BP levels remain above the target despite nonpharmacologic treatment, drug therapy should be initiated. Blockers of the reninangiotensinaldosterone system (RAAS) represent the cornerstone of the antihypertensive drug arsenal; however, in most patients, combination therapy is required. For many patients, a combination of RAAS blocker and calcium antagonist is the combination preferred by the treating physician. Often three or even four drugs are needed. Treatment should be individualized according to concomitant risk factors and diseases and depending on the age and hemodynamic and laboratory parameters of the patient. In order to maximally reduce cardio renal risk, control of lipid and glycemic levels should also be ensured. American Journal of Hypertension, advance online publication 28 April 2011; doi:10.1038/ajh.2011.77 blood pressure , diabetes mellitus , hypertension , treatment Hypertension is a powerful risk factor for cardiovascular morbidity and mortality, 1 particuarly Continue reading >>

Blood Pressure Medications Have Extra Health Benefits For Diabetes

Blood Pressure Medications Have Extra Health Benefits For Diabetes

Blood Pressure Medication Information Two classes of medications--angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)--often are used to treat high blood pressure, also called hypertension. They also help reduce the risk of stroke and heart attack in high-risk people, including those with diabetes. ACE inhibitors and ARBs also help decrease diabetes-related kidney and heart complications. They also have little adverse effect on glucose levels and cholesterol. "They are the go-to class of antihypertensives in patients with diabetes, as cardiac [heart] and renal [kidney] protective drugs," says endocrinologist Bob Busch, M.D., of Albany, New York. Complications Protection In addition to their positive effect on blood pressure, ACE inhibitors and ARBs have been shown to: Reduce the progression of some diabetes complications that affect the kidneys and eyes. A recent study called the ADVANCE trial demonstrated that blood pressure-lowering therapy with an ACE inhibitor and a water pill reduced the number of kidney events experienced by people with type 2 diabetes by 21 percent, compared with those on a placebo. Protect the heart. The ADVANCE study showed that the relative risk of death from cardiovascular diseases decreased by 18 percent and death from any cause decreased by 14 percent for people with type 2 diabetes taking an ACE inhibitor and water pill. How Blood Pressure Medications Work Here's how ACE inhibitors and ARBs work to lower blood pressure and provide other health benefits. ACE inhibitors: These meds work to widen blood vessels and increase the amount of blood pumped by the heart. They also improve the flow of blood so the heart has less work to do. ARBs: Drugs in this family block a hormone that causes blood vessels to narr Continue reading >>

Types Of Blood Pressure Medications

Types Of Blood Pressure Medications

Prescription blood pressure drugs come in many classes Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs. In the widget below, you will find an overview of the classes of blood pressure medication. To expand the information on a type of medication, simply click on the subject tab. Overviews of the classes of blood pressure medications In the tabs below, youll find summaries of some of the major types of commonly prescribed cardiovascular medications. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association. If your prescription medication isnt on this list, remember that your healthcare provider and pharmacist are your best sources of information. It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your doctor. The classes of blood pressure medications include: Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies. Some noted possible side effects from diuretics: Some of these drugs may decrease your body's supply of the mineral potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. If you Continue reading >>

Treating High Blood Pressure And Diabetes

Treating High Blood Pressure And Diabetes

People with diabetes have an increased chance of developing high blood pressure, also known as hypertension. In fact, hypertension is twice as likely in people with diabetes as it is in people who don’t have diabetes. Almost 24 million people in the United States have diabetes — that’s about 8 percent of the entire population. And up to 60 percent of people with diabetes also have hypertension. Almost one-third of all those with high blood pressure and diabetes are unaware that they have hypertension, and 43 percent of those with diabetes who have high blood pressure go untreated. People with diabetes “are at higher risk for vascular disease, coronary artery disease, and cerebral vascular disease, which results in heart attacks and strokes," says Curtis Rimmerman, MD, staff cardiologist and echocardiographer at the Cleveland Clinic in Cleveland. "Oftentimes high blood pressure has a genetic component. Either way, controlling risk factors is important. There are [people with diabetes] who lead very healthy lifestyles and don't develop high blood pressure. But there's a tendency to be more overweight and more sedentary and have higher cholesterol levels, too." Gaining Control of Both Conditions It's very important to control hypertension because, like diabetes, it can lead to other health complications. If your blood travels through vessels with extra force due to hypertension, your heart must work harder and, as a result, your risks of cardiovascular diseases increase. The American Diabetes Association recommends aiming for blood pressure that's less than 130/80 mmHg (millimeters of mercury) if you have diabetes. “The lower the better," Dr. Rimmerman says. The Best Medicines for High Blood Pressure and Diabetes Having diabetes may also impact which hypertension Continue reading >>

Treatment Of Hypertension In Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice Of Agents, And Setting Priorities In Diabetes Care Free

Treatment Of Hypertension In Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice Of Agents, And Setting Priorities In Diabetes Care Free

Abstract Background: Hypertension in patients with type 2 diabetes mellitus is a prevalent condition that leads to substantial morbidity and mortality. Purpose: To evaluate the goals and optimal agents for treatment of hypertension in type 2 diabetes. Study Selection: Randomized trials that evaluated the pharmacologic treatment of hypertension in patients with diabetes and reported microvascular and macrovascular outcomes. Data Extraction: Studies were identified by using the Cochrane Library, MEDLINE, meta-analyses, review articles, and expert recommendation. The searches of the Cochrane Library and MEDLINE were performed in May 2000 and updated in April 2002. Data were abstracted to standardized forms by a single reviewer and were confirmed by a second reviewer. Data Synthesis: Treatment of hypertension in type 2 diabetes provides dramatic benefit. Target diastolic blood pressures of less than 80 mm Hg appear optimal; systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable. Studies that compare drug classes do not suggest obviously superior agents. However, it is reasonable to conclude that thiazide diuretics, angiotensin-II receptor blockers, and perhaps angiotensin-converting enzyme (ACE) inhibitors may be the preferred first-line agents for treatment of hypertension in diabetes. -Blockers and calcium-channel blockers are more effective than placebo, but they may not be as effective as diuretics, angiotensin-II receptor blockers, or ACE inhibitors; however, study results are inconsistent in this regard. Conclusions: Treatment of hypertension in type 2 diabetes, with blood pressure goals of 135/80 mm Hg, provides dramatic benefits. Thiazide diuretics, angiotensin II receptor blockers, and ACE inhibitors may be the best Continue reading >>

Treatment Of Hypertension In Patients With Diabetes Mellitus

Treatment Of Hypertension In Patients With Diabetes Mellitus

INTRODUCTION AND PREVALENCE Hypertension is a common problem in patients with both type 1 and type 2 diabetes, but the time course in relation to the duration of diabetes is different [1-3]. Among those with type 1 diabetes, the incidence of hypertension rises from 5 percent at 10 years, to 33 percent at 20 years, and 70 percent at 40 years [1]. There is a close relation between the prevalence of hypertension and increasing albuminuria. The blood pressure typically begins to rise within the normal range at or within a few years after the onset of moderately increased albuminuria (the new term for what was previously called "microalbuminuria") [2] and increases progressively as the renal disease progresses. (See "Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus", section on 'Risk factors'.) These features were illustrated in a study of 981 patients who had type 1 diabetes for five or more years [3]. Hypertension was present in 19 percent of patients with normoalbuminuria, 30 percent with moderately increased albuminuria, and 65 percent with severely increased albuminuria (the new term for what was previously called "macroalbuminuria") [2]. The incidence of hypertension eventually reaches 75 to 85 percent in patients with progressive diabetic nephropathy [4]. The risk of hypertension is highest in blacks, who are also at much greater risk for renal failure due to diabetic nephropathy. (See "Overview of diabetic nephropathy".) The findings are different in patients with type 2 diabetes. In a series of over 3500 newly diagnosed patients, 39 percent were already hypertensive [5]. In approximately one-half of these patients, the elevation in blood pressure occurred before the onset of moderately increased albuminuria. Hypertension was strongly a 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 >>

Antihypertensive Drug

Antihypertensive Drug

Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure).[1] Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.[2] There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used drugs are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers. Which type of medication to use initially for hypertension has been the subject of several large studies and resulting national guidelines. The fundamental goal of treatment should be the prevention of the important endpoints of hypertension, such as heart attack, stroke and heart failure. Patient age, associated clinical conditions and end-organ damage also play a part in determining dosage and type of medication administered.[3] The several classes of antihypertensives differ in side effect profiles, ability to prevent endpoints, and cost. The choice of more expensive agents, where cheaper ones would be equally effective, may have negative impacts on national healthcare budgets.[4] As of 2009, the best available evidence favors the thiazide diuretics as the first-line treatment of choice for high blood pressure when drugs are necessary.[5] Although clinical evidence shows calcium channel blockers and thiazide-type diuretics are preferred first-line treatments for most people (from both efficacy and cost points of view), an ACE inhibitor is re Continue reading >>

Choosing Blood Pressure Medications

Choosing Blood Pressure Medications

Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you. Dozens of high blood pressure medications (anti-hypertensives) are available, each with pros and cons. Your doctor might prescribe more than one high blood pressure medication to treat your condition. If you have high blood pressure or are at risk of developing it, lifestyle changes can help keep your numbers under control. But you might need medication, as well. Having an effective medication regimen, taking drugs as prescribed, monitoring your blood pressure and making lifestyle changes can help you keep your blood pressure under control. Lifestyle changes Whether you're beginning to develop high blood pressure (prehypertension) or you already have it (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. Eat a healthy diet, focusing on fruits and vegetables and, especially, reduce the sodium in your diet. Maintain a healthy weight. Exercise. Get 30 minutes of moderate activity on most days of the week. It's OK to break up your activity into three 10-minute sessions a day. Limit the amount of alcohol you drink. For healthy adults, that means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men 65 and younger. Don't smoke. Manage stress. Medication options If a trial of making lifestyle changes isn't enough to control your blood pressure, you'll likely receive a prescription for one or more of these medications in addition to maintaining your lifestyle measures. Diuretics (water pills). Your doctor might first suggest diuretics, which remove excess water and Continue reading >>

Blood Pressure Control In Type 2 Diabetic Patients

Blood Pressure Control In Type 2 Diabetic Patients

Abstract Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature. In recent years, new medications were introduced for the treatment of DM, some of which also affect BP and the clinician treating hypertensive and diabetic patients should be familiar with these medications and their effect on BP. In this manuscript, we discuss the evidence supporting different BP targets in diabetics and review the various guidelines on this topic. In addition, we discuss the various options available for the treatment of hypertension in diabetics and the recommendations for a specific treatment over the other. Finally we briefly discuss the new diabetic drug classes and their influence on BP. Continue reading >>

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