Treating Diabetic Hypertension

" Hello and welcome to our webcast I'm -- John. For diabetes patients changes in blood sugar levels can mean the difference between well being and serious danger. So controlling these mobile is a crucial part of daily life. But a large percentage of people with diabetes also develop high blood pressure or hypertension. Which is equally dangerous. Joining me today to discuss the treatment of hypertension and diabetes patients are doctored dominate cica. From the Medical College of Virginia campus of Virginia Commonwealth University. And also doctor William White. From the University of Connecticut school of medicine what you found out that you have both hypertension and diabetes what are your treatment goals."

" When you have both high blood pressure diabetes it's kind of like a double whammy to tell you the truth because you are now at enhanced risk for coronary disease. Vascular disease kidney disease and so forth so we become more aggressive in recent years because results of large studies suggest normalization. Is more important than ever before. So we now find a cure for blood pressures that are normal IE less than 130. For the systolic pressure which is the top number and less than eighty. If you have significant real or kidney disease -- looking for lower values than that it's possible. I US one point five over seventy it is taking -- you have to keep that under control we're now looking for blood sugars that are in the normal range we're now looking for lectures that are around a 10010. Milligrams percent. It's at one point 5150 like we used to accept in the old days. And in addition that we use this test called lookalike -- hemoglobin or. Hemoglobin a one C which kind of looks at the pattern of control of blood sugar for the last two or three months. These that's a percentage and so we look at that now as the value that we try to get down to around 6% of possible. What's the first step in achieving some of those levels it's gonna require the non drug options such as exercise diet watching your salt intake and so forth but. In that case we've we've learned that you really need to have multiple drugs. Used in a thoughtful combinations so that you can take most of the stuff in the in the first part of the day of work that night and -- not having it take medication throughout the day we adopted -- which you agree that you would go right for the medications first or should he tried diet and exercise first."

" You always try it but it may be simultaneous. Our first so even though you may start to medicine -- almost always implement it lifestyle management plan. That incorporates into it appropriate dietary modifications. In excess pattern but those are key issues sign -- that we separate them."

" So basically Lucerne lifestyle and diet modifications to the sounds like these are diseases that you can control."

" As opposed to something like cancer this is a good way to think of this it's not a curable disorder but it treatable disorder that is in fact a big difference. In many cases though it's a serious problem because the end result of having. Under control diabetes and under control hypertension is just as bad as having uncontrollable or untreated cancer do we know doctor cica what's more important."

" To control blood sugar or blood pressure. "

" We probably should never separate those two. Although some information suggests there's in attendance greater benefit. In a -- the blood pressure reduction for certain complications. In for others a benefit from type blood sugar control. When she never argue the point. To trying prefer one versus the other are all people who have both. Conditions being treated with blood pressure medicine it is very uncommon for eight hypertensive diabetic. Being treated for their high blood sugar is not to be receiving. Blood pressure medication. For the hypertension."

" How many different types of medications are people with both hypertension. And diabetes typically on. I would say on average that you would beyond two or three book actually lowering drugs and approximately two agents which lower the blood sugar. If you're if you're not on -- And so that's probably about five drugs for patient if the condition is relatively controllable. And relatively mild -- moderate. In some of our more severe patients you can almost double. And either side effects like. Dean drowsy at certain times of the day won't hurt every class of anti hypertensive drugs has some of its own distinct little side effects. Fortunately. The medications have gotten so much better during the last twenty years that we actually see me in new drugs having no more side effects than placebo pills or sugar pills."

" I would also may be in out yet but the problem -- pharmacy or multiple prescriptions. Is such now that most physicians knowledge of how to give a drunk. End the wide range of drugs within a specific drug class. Allow things to be given in a way we're side effects are really minimized can you outline some success. Rates from using these drugs start to see all these successes both in the media. -- realized long term the immediate gain is by blood pressure coming under control the long term gain. -- never really be identified any specific patient. But will be identified in a population sense so being exposed to these medicines means a lesser risk of developing coronary artery disease. Congestive heart failure. And likely a lesser progression on to various elements of chronic renal failure."

" Closing comments like what we've learned an awful lot just in the last couple of years about the management of the paper consultation with diabetes. People are specific to information about certain classes of drugs. And therefore we are able just provide to patients and more refined drug treatment plan. Even though it's a lot of drugs that will actually reduce their morbidity and that's a very positive thing considering what we knew a few years ago. The last word from the doctors -- can I think."

" The more information we can get to patients about these diseases. So we self empower them to become active participants in their own health care plan. Is the best way we're gonna solve this problem if you educate the patient you very importantly create the basis for future success with that if -- that you buy."

" Doctor cica doctor white. Thanks for joining us today and thank you for watching our webcast I'm -- John."