By Anthony H. Barnett
Univ. of Birmingham, united kingdom. Pocket-sized guide comprises diabetes and vascular sickness, facts base for remedy of high blood pressure in diabetes, analysis and evaluation, and remedy. Softcover.
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Extra resources for Clinical Management of Hypertension in Diabetes: Pocketbook
005 for trend 25 20 15 10 5 0 <90 <85 <80 BP mmHg Figure 21 Data from the HOT study show 50% reduction in cardiovascular endpoints and mortality in favour of the most tightly controlled blood pressure group compared with the least tightly controlled. 15%, although this was associated with more non-fatal bleeding events. Other studies These data are supported by four other large, randomized prospective trials confirming the benefit of antihypertensive treatment on cardiovascular outcomes in diabetic patients.
There is the tantalizing possibility that in 47 Angiotensinogen Renin Angiotensin I Bradykinin ACE Angiotensin II Breakdown products Site of ACE inhibition AT1-receptor Sympathetic activation Cell growth Sodium + water retention Vasoconstriction Figure 26 The renin angiotensin system and the central role of AII in blood pressure control. Shows site of action of ACE inhibitor drugs which inhibit AII production but also allow a build up of bradykinin (the latter may cause chronic cough and very rarely angio-oedema seen with these drugs).
These drugs are generally recommended for use in low dose and usually as part of combination therapy, rather than as first-line treatment of hypertension in diabetes. Beta-blockers These are efficacious in lowering blood pressure, are relatively cheap, and some can be used once daily. They reduce cardiac output, heart rate and renal blood flow and increase peripheral resistance. 69 Potential side-effects69 include worsening of: ● glycaemia ● lipid profile ● symptoms of peripheral vascular disease, together with ● masking of warning symptoms of hypoglycaemia and increased insulin resistance.
Clinical Management of Hypertension in Diabetes: Pocketbook by Anthony H. Barnett