High Blood Pressure and High Cholesterol in People with Diabetes

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High Blood Pressure and High Cholesterol in
People with Diabetes

• Presented by
• Midwestern University
• Collaborative Healthcare Advocate Team

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What Is Hypertension

• Persistently high blood pressure - May have no
  known cause- May be associated with other
  diseases

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Hypertension in the United States

• gt 50 million Americans
• Increases with age
• More common in men than women lt 45 years old
• Less of a gender difference in people gt65 years
  old

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Signs of Hypertension

• Silent disease
• Often there are little or no signs to indicate a
  person has hypertension
• Sometimes headache, fast heart rate, dizziness

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Complications of Hypertension

• Hypertension can lead to- Cardiovascular
  Disease (CVD) (i.e. heart attack)- Stroke or
  TIA- Kidney failure or problems

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Risk Factors of Hypertension

• Obesity and Inactivity
• High Cholesterol
• Diabetes or Pre-Diabetes
• Excessive Salt Intake
• Cigarette Smoking
• Alcohol consumption (gt3 drinks per day)

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Target Goals for Blood Pressure

• Normal range is 120/80 mmHg
• For people with Hypertension and Diabetes, their
  goal is lt 130/80 mmHg

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Treatment Options for Hypertension

• Non-Drug Therapy- Weight loss (even just 10
  lbs)- Less salt- Balanced diet - Appropriate
  fat intake- Activity (exercise)- Stop Smoking
  - Stress Management

• Drug Therapy- Diuretics (water pills)- ACE
  inhibitors- ARBs- B-blockers- Calcium Channel
  Blockers- Alpha agents- Miscellaneous

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People with Diabetes and High Blood Pressure

• Angiotension Converting Enzyme (ACE) inhibitors
  are usually the preferred drug
• lowers BP in the kidneys to prevent kidney
  problems.
• Angiotension Receptor Blockers (ARB) are also a
  preferred choice
• Usually given if ACE inhibitors are not working
  or if people have side effects from ACE
  inhibitors

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Healthy Eating with Hypertension

• Choose a variety of nutritious foods
• Eat appropriate amounts of food at regular times
• Avoid skipping meals
• Reduce fat intake
• Limit alcohol and salt intake

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Heart Healthy Choices
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Benefits of Exercise

• Burns calories and fat
• Increases muscle mass, which helps you lose
  weight!
• Strengthens heart, lungs and bones
• Helps you feel better
• Lowers risk of heart disease
• Helps lower blood pressure

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Managing Stress

• Get enough sleep
• Keep taking your medicine, and make sure you eat
  regularly!
• Exercise
• Do things you enjoy
• Laugh regularly
• Learn a stress-reduction technique
• Seek support from family, friends, or a support
  group.

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Caffeine and Hypertension
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Over-the-Counter Medications

• Some Over-the-Counter medications can raise blood
  pressure- Sudafed (psuedoephedrine) - Motrin,
  Ibupropen, Aleve (high doses)- Nicotine
  replacement items

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Tips for Blood Pressure Control

• Check your Blood Pressure Regularly
• Eat a Healthy Balanced Diet
• Stay Active
• Keep Blood Glucose levels as close to normal as
  possible
• Stop Smoking
• Know Your Blood Pressure Medications and Be Aware
  of their Side Effects
• Ask About Over-the-Counter Medications Before
  Taking Them
• Relax, Laugh Often and Enjoy Life

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Cholesterol
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Problems from High Cholesterol

• Coronary heart disease
• angina, heart attack
• Cerebrovascular disease
• Stroke, TIAs
• Peripheral arterial disease
• Pain in legs

American Heart Association, 2000.
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The Good, Bad Ugly Lipids

• The Bad Cholesterol -LDL
• Low density lipoprotein
• Most damaging to the arteries
• The Good Cholesterol HDL
• High density lipoprotein
• Cleans up after the bad cholesterol
• The Ugly Cholesterol - TG
• Triglycerides
• Mainly from diet
• Can damage arteries

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LDL (Bad Cholesterol) Levels in Type 2 Diabetes

• LDL levels are similar to people without diabetes
• LDL particles are smaller and denser compared to
  people without diabetes
• This is due to high TG (Ugly cholesterol) levels

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Small, Dense LDL Particles

• Associated with a 3 x greater risk of heart
  disease
• Damage occurs because the small LDL can enter
  artery walls faster and easier than larger LDL
  particles.
• The get into places they should not be and cause
  damage

Lamarche B, et al. Diabetes Med.
199925199-211. Tribble DL, et al.
Atherosclerosis. 199293189-199.
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Triglycerides and Diabetes

• High TG levels can result from
• Overproduction of VLDL in the liver
• Problems in breakdown of TG

Garg A, et al. Diabetes Care. 199013153-169. Pa
tti L, et al. Diabetologia. 198930530A. Bierman
EL. Arterioscler Thromb. 199212647-656.
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DIABETIC DYSLIPIDEMIAManagement Goals

• LDL cholesterol
• Primary Target
• ? LDL (lt100mg/dl)
• HDL cholesterol
• ? HDL (gt40mg/dl)
• Triglycerides
• ? TG (lt150mg/dl)
• Stabilize small dense LDL

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Treatment Options

• Nonpharmacologic Options
• Diet
• Weight reduction
• Exercise/physical activity

• Pharmacologic Options
• Statins
• Fibrates
• Niacin
• Bile Acid Sequestrants
• Selective Intestinal Absorption Inhibitors
• Others (TZDs, herbs)

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Treatment for High Cholesterol

• Statins are usually the first choice to stabilize
  and lower LDL
• Fibrates can decrease TG
• Niacin can increase HDL

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Tips for Cholesterol Control

• Have your doctor check your Cholesterol regularly
• Eat a Healthy Balanced Diet
• Stay Active
• Keep Blood Glucose levels as close to normal as
  possible
• Stop Smoking
• Know Your Cholesterol Medications and Be Aware of
  their Side Effects
• Ask About Over-the-Counter Medications Before
  Taking Them
• Relax, Laugh Often and Enjoy Life

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Thank You For Your Participation.What Questions
Can We Answer For You?
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