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The American Diabetes Association (ADA) released standards of medical care in diabetes for 2014.
A Controlling Hypertension in Patients with DiabetesA  This is a corrected version of the article that appeared in print.
Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39.
DASH (Dietary Approaches to Stop Hypertension) diet is effective treatment for stage 1 isolated systolic hypertension.
Effects of sodium intake on albumin excretion in patients with diabetic nephropathy treated with long-acting calcium antagonists. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy.
Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Therapeutic benefits of ACE inhibitors and other antihypertensive drugs in patients with type 2 diabetes. Effects of ramipril on plasma fibrinolytic balance in patients with acute anterior myocardial infarction.
Early captopril treatment reduces plasma endothelin concentrations in the acute and subacute phases of myocardial infarction: a pilot study.
Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial.
Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension.
Randomised controlled trial of dual blockade of reninangiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect.


Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. Influence of the angiotensin converting enzyme inhibitor cilazapril, the beta-blocker propranolol and their combination on haemodynamics in hypertension. Previous: Caregiver Support for Women During Childbirth: Does the Presence of a Labor-Support Person Affect Maternal-Child Outcomes? This entry was posted in Cardiovascular, Cardiovascular Disease, Diabetes, Non-Communicable Disease, Pharmacology, Primary Care and tagged cardiovascular disease, clinical guidelines, diabetes, gylcemic control, HbA1c, hyperglycemia, hypoglycemia, metformin, NCDs, pharmacology, primary care.
Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. The JNC VI guidelines recommend that patients with diabetes be started on both antihypertensive medication and lifestyle modifications when hypertension is diagnosed. The one exception was the United Kingdom Prospective Diabetes Study (UKPDS), which compared captopril with atenolol and found the two agents to be similar in terms of reduction in microvascular and macrovascular complications.8 [Evidence level A, RCT]ACE inhibitors may provide additional benefits in patients with diabetes.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Type 2 diabetes can be due to increased peripheral resistance to insulin or to reduced secretion of insulin.
Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. These patients may have impaired fibrinolysis and endothelial dysfunction, which increase their risk of cardiovascular disease.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. In many patients, a combination of two or more of these agents is necessary to reach blood pressure goals. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. However, in patients with bilateral renal artery stenosis, ACE inhibitors can cause renal insufficiency. Glucose is then stored as glycogen in liver and muscle.Insulin also inhibits the release of glucagon and so blocks fat being used as an energy source. To help detect the presence of undiagnosed bilateral renal artery stenosis, physicians should monitor the serum creatinine level at baseline and one week after initiation of ACE inhibitor therapy.DIURETICSThiazide diuretics have been shown to benefit patients with diabetes and systolic hypertension. There are one million to three million islets of Langerhans (pancreatic islets) and beta cells constitute 60-80% of all the cells.


Insulin is synthesised from the proinsulin precursor molecule by the action of proteolytic enzymes, known as prohormone convertases, as well as the exoprotease carboxypeptidase E.
There are a family of four specialised transporter proteins that carry glucose across the membrane. GLUT4 carries glucose into muscle and adipose tissue after the insulin receptor has been stimulated - see diagram above. This treats insulin resistance.Sulfonylureas (gliclazide) bind to an ATP-dependent potassium channel on the cell membrane of pancreatic beta cells. This depolarisation opens voltage-gated calcium channels which leads to increased fusion of insulin granulae with the cell membrane, and increased secretion of (pro)insulin.Glitazones also treat insulin resistance.
They bind to peroxisome proliferator-activated receptor gamma (a nuclear regulatory protein) which influences insulin-sensitive genes, which enhance production of mRNAs of insulin-dependent enzymes. It should be remembered that there is a temporary increased risk of lactic acidosis in situations where increased tissue hypoxia occurs, e.g. This is increased in older age groups, mild-to-moderate hepatic impairment, and renal impairment. The trials that have been done indicate that the incidence of hypoglycaemia is equivalent to that of the older sulphonylureas.18ThiazolidinedionesThiazolidinediones (TDZs) or 'glitazones' - pioglitazone19 is the only one currently licensed in the UK. Its mechanism of action is still subject to debate but is thought to act in a similar manner to metformin, increasing hepatic sensitivity to insulin, and enhancing glucose clearance. They also slow the rate of absorption of nutrients into the bloodstream by reducing gastric emptying, and may directly reduce food intake. Both are rapidly deactivated by dipeptydyl peptidase-4 (DPP4) GLP1 is not useful in diabetes treatment, as it has a very short half-life and must be given as a continuous subcutaneous (SC) injection. Inhibiting the enzyme that inactivates GLP1 is more successful and several oral DPP4 inhibitors are available for type 2 diabetes management, e.g. Updated 3rd November 2008, accessed 29 Dec 2009Klip A, Leiter LA; Cellular mechanism of action of metformin.
Updated September 2005, accessed 29 Dec 2009Landgraf R, Bilo HJ, Muller PG; A comparison of repaglinide and glibenclamide in the treatment of type 2 diabetic patients previously treated with sulphonylureas. Updated 24 Feb 2009, accessed 29 Dec 2009Wada K, Nakajima A, Katayama K, et al; Peroxisome proliferator-activated receptor gamma-mediated regulation of neural stem cell proliferation and differentiation. Updated 10 November 2009, accessed 29 Dec 2009Sitagliptin, New Drug Evaluation No 45, Regional Drug and Therapeutic Centre, (Aug 2007)Summary of Product Characteristics (SPC) - Galvus® 50 mg tablets (vildagliptin), Novartis Pharmaceuticals UK Ltd, electronic Medicines Compendium. Updated Aug 2009, accessed 29 Dec 2009Summary of Product Characteristics (SPC) - Byetta® (exenatide), (5 micrograms and 10 micrograms solution for injection, prefilled pens), Eli Lilly and Company Limited, electronic Medicines Compendium.



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