Management of Chronic Disease - Hypertension and Diabetes by 3bhrtj


									Free Clinics of the Great Lakes
       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
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
   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

 A1C of <7%

 blood pressure <130/80
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-
 Systolic of 140 or higher or diastolic of
  90 or higher is considered
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
 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
 If needed to achieve blood pressure
  targets, a thiazide diuretic should be
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
 Some drugs can be split-and some
 Med/Food interactions should be
 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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