What are the effects of controlling BP in people with diabetes?
Diabetes is a disease that may affect any part of the body and change the work of any system. The researchers from the Centers for Disease Control and Prevention (2018) underline that the majority of complications associated with diabetes can be prevented by keeping the level of blood glucose under control and following simple rules like healthy eating, physical activities, and taking tests regularly. Diabetes may affect the heart and lead to a stroke. High blood pressure is one of the main risk factors for heart diseases. Therefore, the main effect of controlling BP in diabetic patients is the possibility to avoid heart complications, as well as predict kidney problems and nerve damage.
What is the target BP for patients with diabetes and hypertension?
One of the main tasks of doctors and nurses is to lower BP targets for diabetic and hypertonic patients and improve mortality outcomes. For example, according to Emdin et al. (2015), the reduction of the BP level below 130 mm Hg can be associated with a decreased risk of stroke and albuminuria. However, in some cases, 140 mm Hg may be a target. A diastolic BP less than 80 mm Hg introduces certain benefits in the intention to reduce the risk of cardiovascular diseases. Therefore, it is hard to give one definite answer using 130/80 as the target BP for the majority of patients who have diabetes and hypertension.
Which antihypertensive agents are recommended for patients with diabetes?
There are several antihypertensive agents that can be offered to patients with diabetes to reduce clinical side effects. Though antihypertensives can predict heart attacks, patients should carefully use this type of drug due to its contraindications, including pregnancy, COPD, and asthma (Youngkin, Davis, Schadewalk, & Juve, 2013). ACE inhibitors can be recommended to reduce BP, b-blockers may help to deal with migraine headaches, and ARBs aim at restoring kidney function. In fact, multiple drug therapy is usually required for patients who have to live with diabetes and control their BP level all the time.
What testing does this woman need to be ordered due to her change in status both SOB and BP?
Tests play an important role in diabetes treatment. A1C tests, well as the tests to check the cholesterol level and BP, are obligatory for diabetic patients. In addition to these regular tests with the help of which it is possible to monitor diabetes and investigate its progress and impact on patients, it is also necessary to check the condition of the heart (Centers for Disease Control and Prevention, 2018). An electrocardiogram may be recommended to observe if there are any changes in the heart’s structure. To predict such a complication as diabetic ketoacidosis, patients should check the level of ketones in the blood.
What is the significance of microalbuminuria in this woman? How does this affect her cardiovascular risk?
In patients like L. N., the significance of microalbuminuria cannot be ignored. Emdin et al. (2015) state that patients have to be careful in taking metformin and other drugs to control diabetes and hypertension because of the possible development of microvascular outcomes like renal failure, retinopathy, and microalbuminuria or worsening albuminuria. This condition is explained by a poorly developed hydration level and the excretion of urinary albumin from 30 to 300 mg within 24-hour urine that leads to diabetic kidney disease (Centers for Disease Control and Prevention, 2018). Frequent urination, back pain, and temperature change can be observed. The connection between microalbuminuria and cardiovascular risk lies in the necessity to develop new behavioral therapies and pharmacologic treatment. As soon as microalbuminuria is diagnosed, the whole body should be checked for organ damage.
References
Centers for Disease Control and Prevention. (2018). Diabetes home: Prevent complications. Web.
Emdin, C. A., Rahimi, K., Neal, B., Callender, T., Perkovic, V., & Patel, A. (2015). Blood pressure lowering in type 2 diabetes: A systematic review and meta-analysis. Jama, 313(6), 603-615. Web.
Youngkin, E. A., Davis, M. S., Schadewalk, D., & Juve, C. (Eds.). (2013). Women’s health: A primary care (4th ed.). New Jersey, NJ: Pearson Education.