Case Summary
The patient’s profile:
Patient name: L.N.
Age: 49 years old
Gender: Female
Race: White
Occupation: —
Marital status: —
Height: 5’4″
Weight: Ranging from 165 to 185 lb.
Allergies: None
Diagnosis: Type 2 diabetes, obesity, hypertension, migraine headaches, increased exertional SOB, microalbuminuria
Results of tests: a BP of 154/86 mmHg, a pulse of 78 bpm
Treatment recommendations: ACE inhibitors, diet.
What are the effects of controlling BP in people with diabetes?
One of the most pressing problems with patients who have diabetes is that in most cases they inevitably develop several other conditions that are caused by diabetes and aggravate it while developing. One of the most widespread diseases among diabetics is cardiovascular disease. It appears since blood vessels become more rigid and easily get damaged, which brings about hypertension (Emdin et al., 2015).
Many patients (from 55 to 80 percent according to different estimations) die from all kinds of heart diseases while having type 2 diabetes. In its turn, high blood pressure can significantly tell on the patient’s condition causing kidney and other problems. That is why the patient’s blood pressure must be controlled with due regularity. If it goes above the desired target, some measures must be taken to lower it. Otherwise, complications may become irretrievable. Moreover, in the given case, the patient also suffers from shortness of breath that will be exacerbated by escalating blood pressure (Zinman et al., 2015).
What is the target BP for patients with diabetes and hypertension?
It is rather difficult to say what blood pressure is universally normal for diabetic patients as it may vary due to the effect produced by related health conditions. Thus, it may range between 120/80 to 130/80 mmHg. Both indicators are accepted depending on the patient. In most cases, only patients who have nephropathy tend to have a lower blood pressure than other people suffering from diabetes (Emdin et al., 2015).
Which antihypertensive agents are recommended for patients with diabetes?
First and foremost, it is important to understand that blood pressure in patients with diabetes must be lowered by all means since inactivity is mortal in this case. The antihypertensive regimen may differ but generally, the results are quite the same. ACE inhibitors or β-blockers do not show any drastic difference in their effect. Neither does angiotensin II receptor blockers (yet, they usually slow down the development of nephropathy).
According to some studies, ACE inhibitors are preferable for their ability to reduce morbidity and mortality (Emdin et al., 2015). Other researchers claim that both ACE inhibitors and β-blockers are more effective than dihydropyridine calcium-channel blockers but may be used in combination with them with equal success. Thus, the physician should rely on the data obtained from physical tests to make a reasonable decision, which combination of drugs will be the most suitable. Generally, it is not enough to treat the patient with only one type of medicine (Zinman et al., 2015).
What testing does this woman need ordered due to her change in status both SOB and BP?
It is reported in the case study, that the patient has a change in status both SOB and BP. This means that she needs to be examined more thoroughly. The tests that may help understand the reasons for this include: chest MRI, blood tests, chest X-rays, chest CT scan, lung function test, and lung ventilation test. It is recommended to do several of them to compare the results (Zoungas et al., 2014).
What is the significance of microalbuminuria in this woman? How does this affect her cardiovascular risk?
The presence of microalbuminuria in the patient aggravates her disease but is not infrequent for diabetes (although it can also appear separately from it). The problem is that this condition requires regular tight control of all health indicators including blood pressure since microalbuminuria makes it very unstable (Zoungas et al., 2014).
References
Emdin, C. A., Rahimi, K., Neal, B., Callender, T., Perkovic, V., & Patel, A. (2015). Blood pressure lowering in type 2 diabetes: A systematic review and meta-analysis. Jama, 313(6), 603-615.
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S.,… Broedl, U. C. (2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New England Journal of Medicine, 373(22), 2117-2128.
Zoungas, S., Chalmers, J., Neal, B., Billot, L., Li, Q., Hirakawa, Y.,… Cooper, M. E. (2014). Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. New England Journal of Medicine, 371(15), 1392-1406.