Free Clinics of the Great Lakes Region 2007 Conference Chronic Disease Management Hypertension & Diabetes: Invisible Danger Andrea Lee Witt RN CDE Mercy Medical Center-Clinton Education Specialist Mercy Medical Diabetes Center Gateway Free Clinic email@example.com Participants who complete this session should be able to: 1. list the diagnostic & treatment targets for blood pressure and blood sugar 2.describe the cell damage that occurs from elevations. 3. list possible approaches people can take to improve BP and BG other than medication. 4. list standard medication use for hypertension in diabetes. 5. discuss approaches to better BGs/BPs for people with limited resources. ADA Clinical Practice Recommendations: A1C of <7% blood pressure <130/80 mmHg AHA Clinical Standards Blood Glucose <100 Blood Pressure <120/80 mmHg American Heart Association Lower than 120/80 mm Hg is the most desirable reading 120–139/80–89 is considered pre- hypertension. Systolic of 140 or higher or diastolic of 90 or higher is considered hypertension ADA Clinical Standards <130 systolic <80 diastolic BP measured each visit any BP >130/80 verified on a separate visit BP>130/80 begins treatment Diabetes Causes Trouble Increased glycosolation Abnormal lipid metabolism Increased inflammation Hypercoagulation Renal damage Hypertension Causes Trouble Increased vessel permeability Damage to vessel walls Increased insulin resistance Inflammation Renal damage Diabetes cannot be ignored Aggressive treatment of the blood sugar control is equal in importance to hypertension control Evaluate BGs each visit Always seek to achieve A1c<7% Evaluate every 3 months Clinical Significance Hypertension is common, affecting the majority of people with diabetes. Hypertension is a major risk factor for heart disease,and vascular complications that may cause vision and kidney damage. Hypertension can be caused by kidney disease. Studies show that BPs >115/75 mmHg are associated with more cardiovascular events and death in people with diabetes Clinical significance In 90 to 95 %: hypertension the cause is unknown. You can have it for years without knowing it. That's why it's called the “silent killer” African Americans are at higher risk for this serious disease Salt/sodium sensitivity may be high in some people. Treatment Recommendations 130–139 mmHg or a diastolic blood pressure of 80–89 mmHg should be given lifestyle and behavioral therapy alone for a maximum of 3 months If targets are not achieved, medication therapy is added. Hey Wait a Minute…. ….what was that about lifestyle and behavioral therapy????? AHA tips Body Mass Index (BMI) <25 Kg/m² Waist Circumference <35 inches Exercise Minimum of 30 minutes most days, if not all days of the week Free Clinic realities Do you find that free clinic patients : are depressed do not “do” exercise eat salty food because it is cheap do not believe that diet and exercise can work ?? Lifestyle: Food DASH Diet Caveman foods Less salt and salty foods like: Pop Cold cuts/hotdogs/breakfast meats Cheese/ pizza Frozen entrees Canned veggies/soups DASH DIET Servings for Servings on 1600 - 3100 a 2000 Calorie diets Calorie diet Grains and grain products (include at least 3 whole grain foods each day) 6 - 12 7-8 Fruits 4-6 4-5 Vegetables 4-6 4-5 Low fat or non fat dairy foods 2-4 2-3 Lean meats, fish, poultry 1.5 - 2.5 2 or less Nuts, seeds, and legumes 3 - 6 / wk 4 - 5 / wk Fats and sweets 2-4 limited Lifestyle: Activity Moving a little at a time Moving something Moving >30 mins a day 3-5 times a week no more than 1 day off Lifestyle: Stress Reduction Hoo weeee Encourage good choices that de-stress Encourage positive motion Encourage hobbies Encourage good friends Be not the stressor today Treatment Recommendations ACE inhibitor or an ARB. If one class is not tolerated, the other should be substituted. If needed to achieve blood pressure targets, a thiazide diuretic should be added. Treatment Recommendations If ACE inhibitors, ARBs, or diuretics are used, watch kidney function and potassium levels. In patients with Type 1 diabetes, with hypertension and any degree of albuminuria, ACE inhibitors have been shown to delay the progression of kidney disease. In those with Type 2 diabetes, hypertension, macroalbuminuria, and renal insufficiency, ARBs have been shown to delay the progression of kidney disease. Free Clinic Thinkers: Cheap can be effective. Once a day is easier to remember to take. Some drugs can be split-and some can’t. Med/Food interactions should be posted. When drug companies compete-we win! Your Mission Be a good example Accept my thanks for the work you do. Thank you!
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