Htn & Diabetes1

1. Management of Hypertension in Diabetes Dr. Awadhesh K Sharma ,MD, Senior Resident, Department of Medicine, M.L.B. Medical College, Jhansi, UP

3. Diabetes: The Problem INDIA, the diabetes capital of world in next thirty years can also be the hypertension capital of world. (JAPI 2007)(:55:323-24).

9. Diabetes: History Nobel Prize Banting Macleod Collip Best

12. Complications of Diabetes Retinopathy: 25x End-Stage Kidney Disease: 17x Heart Disease: 2-4x Foot/Leg Amputations: 5x Stroke: 2-6x

16. Definition, screening and diagnosis According to Joint National Committee – 7 (JNC-7) Staging SBP DBP Normal <120 <80 Prehypertensive 120-139 80-89 Stage 1 hypertension 140-159 90-99 Stage 2 hypertension >160 >100

17. In Prehypertensive------- Life style modification Stage 1 & 2 Should be treated But Prehypertensive + diabetes mellitus /CKD Life style modification,if it fails to redude BP to <130/80 mm Hg then--- Start drug therapy

19. Certain special characteristics of hypertension in diabetes mellitus

22. Diabetes ,hypertension and nephropathy--- Increased systolic BP is a significant risk factor for micro albuminuria and rapid progression of nephropathy. Isolated systolic hypertension----- ISH is strongly related to development of micro and macrovascular diseases in patients with DM.

24. Non-pharmacological management of hypertension in diabetes

25. Weight loss Loss of weight by 1kg decreases BP by approx 1mm hg. Sodium restriction Decrease in sodium intake from 4.6 gm to 2.3 gm/day results in reduction of 5mm Hg is SBP and 2-3 mm Hg in DBP. Exercise Diabetic patients who are 35 yrs of age or older and are planning to begin a vigorous exercise programme should have exercise stress testing or other appropriate non-invasive testing. At least 150 min of moderate intensity aerobic physical activity is recommended per week. Smoking cessation Moderation of alcohol intake.

30. Health The second part of the equation is nutrition Your body needs the right fuel to help it work well.

32. Encourage people to change habits . Use the pyramid guide to educate people to eat healthy.

33. Pharmacological therapy

35. Pharmacological therapy Thiazide diuretic and Beta Blockers - There have been concerns among physicians as many studies have shown thiazides and beta blockers promote glucose intolerance. Inspite of this both agents have been recommended for treatment of hypertension in DM, lower doses of shorter acting thiazides- hydrochlorthiazide instead of chlorethalidone are generally well tolerated and not associated with adverse metabolic effects. Recommendations for beta blockers are-- combined alpha and beta blocker should be preferable agents. Carvedilol is the potential agent of choice as it effectively control blood pressure and improves insulin sensitivity and decreases HbA1C.

40. Treatment Program for Patients with Hypertension and Diabetes

41. How Can You Help Reduce Your Risk of Hypertension in Diabetes ? Eat foods low in fat & calories. If overweight, lose weight.  Physical activity Stop smoking! Limit alcohol to 1-2 drinks per day. Take your medications regularly.

42. What are goals to healthy living? Be SMART S pecific M easurable A chievable R elevant T ime