Introduction
Cardiovascular-diseases are becoming more prevalent in the United States, affecting the quality of life and increased the risk of adverse events. Hypertension is commonly associated with a range of co-morbidities. Certain populations may be more affected by race, age, and lifestyle, which impact health management practices. This report discusses the disease processes and produces a treatment plan for a 59-year old Hispanic male with type 2 diabetes and high blood pressure.
Disease Processes
The patient has type 2 diabetes (diabetes mellitus) which is a metabolic disease that is characterized by hyperglycemia that is a result of inconsistencies in insulin secretion or its effects on the body. The disease consists of several pathogenic processes. The autoimmune system attacks pancreatic β-cells, which leads to insulin deficiency or resistance to insulin activity in the tissue response. The metabolism of carbohydrates, fats, and proteins is abnormal. The disease process can range from normoglycemia to impaired tolerance to full diabetes mellitus requiring insulin for control (American Diabetes Association, 2014).
The patient’s urine microalbumin levels suggest the presence of microalbuminuria, a condition characterized by increased permeability of albumin in the kidney. It is considered a diagnostic marker for diabetes mellitus, particularly in combination with hypertension. Individuals with obesity and type-2 diabetes are significantly affected by the prevalence of hypertension. Insulin resistance, hyperglycemia, and dysregulation of the estrogen system lead to a risk of hypertension. The pressure in the blood vessels increases, causing the heart to struggle (DeMarco, Aroor, & Sowers, 2014). Eventually, these issues in combination lead to cardiovascular diseases such as CHF or stroke.
Approach and Optimal Goal
Pharmacological hypertension management should occur within a multimorbidity framework. Both type 2 diabetes and hypertension have related cardiometabolic factors. Therefore, medications should address these risk factors through antihypertensive therapy and management of blood sugar(Alexander, 2018). Aggressive therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may be beneficial. Chlorthalidone (12.5-25mg) would be the diuretic of choice (Whelton et al., 2018).
The optimal goal for the patient would be to lower systolic blood pressure to <120 mmHg and the diastolic measure to <80 mmHg. National guidelines state that adults with confirmed hypertension and known CVD should aim for a BP target of less than 130/80 mmHg. The same target applies to adults with confirmed hypertension but without the risk of CVD. These targets have been associated with increased benefits of lowering the risk of cardiovascular diseases (Whelton et al., 2018).
Pharmacological Interactions
The current diabetes medication of metformin and Amaryl that the patient is taking can be consumed in combination. Both are not metabolized and are not involved in any drug interactions (Maideen, Jumale, &Blasubramaniam, 2017). Lisinopril/Hctz can interact with non-steroidal anti-inflammatorily drugs such as aspirin or indomethacin, as well as diuretics and diabetes medications. Tricor negatively interacts with immunosuppressants, bile acid-binding resins, and colchicine. Introducing Chlorthalidone to the patient may lead to insulin requirements and higher dosages of oral hypoglycemic drugs such as metformin and Amaryl.
Chlorthalidone may interact with any other antihypertensive medications. Furthermore, there may a decreased response to norepinephrine (“Thalitone,” n.d.).Pharmacists and nurses can provide education and regulation to the process for patients regarding medication interactions. A patient may require guidance on dosage, timing, and continuation of medication adherence to ensure there are limited side effects from interactions.
Interdisciplinary Team
The co-morbidities of the patient require a multidisciplinary approach. Nurses are able to provide basic care, diagnosis, and education for the patient. Physicians from multiple disciplines such as cardiologists, endocrinologists, and nephrologists can provide input to patient treatment to address various issues of his conditions. Additional experts such as dieticians, therapists, and education instructors are a viable option for creating meaningful lifestyle changes. Interprofessional collaboration with pharmacists could also be beneficial in the adherence to pharmacologic treatments and managing chronic diseases through medication(Jardim et al., 2018).
Interdisciplinary team collaboration during treatment produces a myriad of positive outcomes for the patient. Such collaboration fostered communication and efficiency amongst the staff that countered the “silo effect” and helped to educate those lacking experience or technical expertise. Meanwhile, patients face better outcomes in treatment, so this is a more attentive approach that improves patient satisfaction. Furthermore, a reduction in the occurrence of adverse events and factors such as length of say is also noticeable (Epstein, 2014).
Nonpharmacological Education
The American Heart Association and other similar expert organizations on hypertension recommend lifestyle modifications as the primary and most efficient manner of a nonpharmacological approach to disease management. It is recommended that a diet is adopted that incorporates vegetables, fruits, and whole grains while limiting sodium intake to less than 2,400 mg per day. Furthermore, exercise should be done at the rate of 3-4 times per week for at least 40 minutes. Meanwhile, other factors such as decreasing alcohol and tobacco consumption are also necessary (Oza&Garcellano, 2015).
It is likely that the patient will face educational needs when using the nonpharmacological approach. This may require the need for a dietician to create a balanced meal plan and educate the patient on how to keep track of micronutrients as well as daily blood glucose levels. A physical therapy professional may be required to teach the patient appropriate exercise routines for his age and abilities. Finally, a lifestyle education coach and appropriate supporting material may be helpful as well. Considering that the patient is Hispanic, culturally-appropriate education may be beneficial.
Health Maintenance Needs
The health maintenance needs of a patient with hypertension and diabetes are facilitated by lifelong behavioral and lifestyle changes. It is necessary to conduct regular screenings of blood pressure and blood sugar using at-home devices. However, more in-depth and comprehensive laboratory tests should also be done on at least an annual basis. Maintaining a level of blood pressure of at least at prehypertension levels of 120-130/80-90 mm Hg, and if possible, at the optimal level of <120/80 mm Hg. Screenings should include blood pressure, cholesterol, heart disease prevention, and diabetes screening. Since this patient has severe measurements for both blood pressure and blood sugar, it is critical to strictly adhere to the pharmacological treatment plan.
Furthermore, applying strategies learned in nonpharmacological education is viable. That includes reducing risk factors for heart disease, including avoiding tobacco use, implementing diet and exercise, and engage in regular health service utilization (Riley, Dobson, Jones, & Kirst, 2013).
Conclusion
Chronic non-communicable diseases are becoming more common and affecting all segments of the population. Cardiovascular conditions are a significant risk factor, particularly with the presence of hypertension and type 2 diabetes. This report examined a patient with these conditions and developed a treatment plan. Pharmacologic interventions focusing on antihypertensive therapy and blood glucose management are critical. The treatment can be approached competently through a multidisciplinary approach and patient education. In conclusion, the patient must commit to lifelong lifestyle changes and adherence to treatment in order to promote health maintenance.
References
Alexander, M. R. (2018). Hypertension treatment and management. Web.
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(S1). Web.
DeMarco, V. G., Aroor, A. R., & Sowers, J. R. (2014). The pathophysiology of hypertension in patients with obesity. Nature Reviews Endocrinology, 10(1), 364-376.
Epstein, N. (2014). Multidisciplinary in-hospital teams improve patient outcomes: A review. Surgical Neurology International, 5(8), 295. Web.
Jardim, T. V., Inuzuka, S., GalvĂŁo, L., Negretto, L. A., Oliveira, R. O., Sá, W. F.,… Jardim, P. C. (2018). Multidisciplinary treatment of patients with diabetes and hypertension: Experience of a Brazilian center. Diabetology & Metabolic Syndrome, 10(1). Web.
Maideen, N. M., Jumale, A., &Balasubramaniam, R. (2017). Drug interactions of metformin involving drug transporter proteins. Advanced Pharmaceutical Bulletin, 7(4), 501-505. Web.
Oza, R., &Garcellano, M. (2015). Nonpharmacologic management of hypertension: What works? American Family Physician, 91(11), 772-776. Web.
Riley, M., Dobson, M., Jones, E., & Kirst, N. (2013). Health maintenance in women. American Family Physician, 87(1), 30-37. Web.
Thalitone. (n.d.). Web.
Whelton, P.K., Carey, R. M., Aronow, W.S., Casey, Jr., D.E., Collins, K. J., …Wright Jr. J. T. (2018). 2017ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), 127-148. Web.