Plain Talk About High Blood Pressure and Diabetes

 

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Millions of Americans suffer from two major chronic diseases: Primary( Essential) High Blood Pressure (Hypertension) and Diabetes type II.  These two diseases are associated with significant morbidity and mortality. However, if treated  and managed appropriately, one could see a rapid decline in the incidence of acute heart attack, stroke, and kidney failure. Although typically asymptomatic during early stage of the disease, these two (2) most prevalent chronic diseases are often mismanaged by primary care providers leading to detrimental complications widely known by the general public and costing billions of dollars for overall medical care.

Even though there are appropriate guidelines which are established by experts in the field of cardiology, endocrinology, and nephrology, among other related medical fields, patients continue to be misguided with recommendation for therapy. And, so after evaluating literally hundreds of patients living with these two prevalent diseases, it became clear that patients continue to be misinformed.  Although the causes of these diseases are multifaceted including genetics, dietary habits, and other risk-prone life-styles, hampering the development of these two devastating diseases is most prominent in Preventative Care Maintenance Programs.  Rather than getting into the pathophysiology i.e. the origin, development, and manifestation of these two diseases, I would rather list what patients MUST know to take control of their health to assist their physicians in managing their high blood pressure and diabetes, reducing the notion of “CLINICAL INERTIA” as described by the above article, and given the fact of those currently on inappropriate medications.  Consider this basic concept as one review the list below: Knowing what ingredients are needed to prepare a dish has major influence on the outcome of the prepared meal. The taste is literally in the pudding, i.e. what you know about or put into your own health-care can have major outcomes in advancing and/or preventing major complicating medical events.

Primary (Essential) HIGH BLOOD PRESSURE:

1. Patients who are forty (40) years are older, either with a personal or family history of early heart disease and/or stroke, should start with an ACE (Angiotensin Converting Enzyme) inhibitor or ARB (Angiotensin II receptor blocker) plus or minus a diuretic. If patients do not achieve control with an ACE inhibitor or Angiotensin II receptor Blocker, a second class of antihypertensive medication is attempted starting with a calcium channel blocker, which after no control, a third class of antihypertensive medication such as a beta blocker is added.  If blood pressure control is not achieved at this point, patients are then referred to expert for further management of their blood pressure control.   ACE inhibitors and ARBs are protective against heart attacks and strokes. The old school of thought of grouping patients into treatment strategy based on two ethnic groupings, White and Black, is outdated (i.e. A-ACE inhibitor for Whites; B-Beta Blocker For Whites; C-Calcium Channel Blocker for Blacks; and D-Diuretic for Blacks).  Because of low expense, we typically start our patients who are above the age of 40 years old, regardless of ethnicity on a combination therapy which includes Lisinopril (an ACE inhibitor) and hydrochlorothiazide (a diuretic), if tolerable and if there are no contraindications for these medications. The goal is to achieve a blood pressure level between 130-140/70-90.

2. Patients who are younger than forty years old, are typically given a trial of a diuretic alone, such as hydrochlorothiazide and/or counsel regarding life-style changes, appropriate dietary habits, and exercise.

3. Patients who are older than sixty-five (65) years old, should be primarily evaluated by hypertension (high blood pressure) specialist(s), prior to being placed on medical therapy, given the complexities that come with age, and that may influence therapeutic and management decisions.  Typically the goal is to achieve a blood pressure level between 140-165/70-90, but again this may be greatly altered based on other underlying complicating diseases, i.e. advanced stages of cardiovascular disease, and/or kidney disease.

4. We recommend that patients monitor blood pressure on a routine basis, by purchasing an automatic blood pressure monitor.  That way, patients may share their numbers with their physician on follow up visits, to assess control.

Controlling Diabetes AlgorithmADA Diabetes Therapy Algorithm

DIABETES TYPE II

1. There are standard guidelines according to American Diabetes Association and the American  Association of Clinical Endocrinologists, both websites are readily available to the public. While there may be some slight differences in recommendations, some basic fundamental principles hold.

2. Patients should know their numbers:

a) Hemoglobin A1c; The ideal number should be less than 6; but aggressive therapy may be delayed until numbers are above 7.2-8.0, or 9.0 depending on which authority one may review.

b) Monitor Glucose level: ideal range should be 80-110, again depending on patients other medical conditions and/or other specific guidelines that patients should discuss with their physician.

3) Follow strict dietary guidelines according to the above indicated Associations, as well as considering appropriate life-style changes and/or exercise.

Lipid ControlLipid Control Page 2

4) Know your numbers for your lipid status:

a) Total cholesterol, recommended 200 or less; but not less than 180

b) High-density lipoproteins (HDL), (cardiac protective) recommended greater than 50; the higher the better, and can be increased by increasing fibers to diet, and exercise.

c) LOW-density lipoproteins (LDL), (Increases risk of cardiovascular disease), recommended less than 100 or less than 70 for those with personal or family history of early heart disease, stroke, and/or diabetes

d) Triglycerides (also known as stored dietary FAT),  recommended less than 180, again depends on patient’s other medical conditions.

Disclaimer: We recognize the revised recommendations from the recent ATP-III panel. However, we, at MDC-Atlanta, believe that certain basic targets, as originally indicated by the previous ATP-III panel, give a level of guidance for patients to achieve a basic control with respect to LDL-cholesterol.  LDL-cholesterol  is the chief component to the development of atherosclerotic cardiovascular disease,  and thus increases risk for early heart attacks and strokes.  Remember, vascular disease is also a natural process of aging, and while we can’t completely eliminate vascular disease, we can responsibly reduce risks of complications from EARLY vascular disease.  Because of side-effects with certain cholesterol lowering medications, such as Statins, our medical practice shall remain selective and vigilant with regards to prudent medical therapy for reducing our patient-population risks of early, and advanced cardiovascular disease.

In General, therapeutic and mangement decisions are made with a goal to reduce patients’ risks for cardiovascular and Cerebro-vascular events, as well as other complicating illnesses,  while maintaining a HEALTHY LIFE STYLE.

We at MDC are committed to KEEPING PATIENTS INFORMED FOR BETTER QUALITY HEALTH CARE, Through Patients Partnership with a DOCTOR!!