By Anthony H. Barnett
Univ. of Birmingham, united kingdom. Pocket-sized instruction manual contains diabetes and vascular sickness, facts base for remedy of high blood pressure in diabetes, analysis and overview, and remedy. Softcover.
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Extra resources for Clinical Management of Hypertension in Diabetes: Pocketbook
The results were also clearly better at the higher dose of irbesartan. Side effect profile was excellent with adverse events actually less than placebo. 105 The Reduction of Endpoints in NIDDM with Angiotensin II Antagonists Losartan (RENAAL) study compared losartan 50–100 mg versus placebo in hypertensive type 2 diabetic patients with proteinuria above 500 mg/day, with a target blood pressure of <140/90 mm Hg. 02). 002). 001). There was no significant difference in cardiovascular events or death.
In type 1 diabetes, however, there is little evidence for an excess of hypertension in the absence of diabetic nephropathy. Indeed, the presence of hypertension and proteinuria is an extremely bad prognostic sign in both type 1 and type 2 diabetic patients, most of whom die of cardiovascular disease many years prematurely. The aetiology of hypertension in association with diabetic nephropathy is incompletely understood, but appears to have genetic, haemodynamic and metabolic correlates. 32,33 This is in turn associated with basement membrane abnormalities and urinary protein loss.
In addition, Framingham does not take into account the presence or absence of micro or macroalbuminuria, which again is associated with greatly increased cardiovascular risk. In the author’s opinion, treatment of such patients should be based on secondary prevention recommendations. 39 Implications of the National Service Framework for diabetes This is due to be published after publication of this book, but will almost certainly place emphasis on: ● A primary care led service but with strong collaborative links with secondary care ● Organization of care through multidisciplinary working ● Emphasis on cardiovascular risk reduction through: — lifestyle changes (weight loss, increased activity, cessation of cigarette smoking, etc) — aggressive screening for and management of hypertension, dyslipidaemia and glycaemia ● Reduction in: — amputation rates — blindness — renal failure ● Pregnancy outcomes close to those expected in the nondiabetic population ● Patient empowerment and a more holistic approach to diabetes management These will be all great challenges to health professionals, and none will be greater than cardiovascular risk assessment and treatment.