Hypertension with diabetes and metabolic syndrome. Best treatment. 2
High blood pressure treatment when diabetes, obesity, and metabolic syndrome are present. It is a great challenge. Leading hypertension expert explains best ways to treat hypertension in complicated patients. Hypertension and diabetes are very common. They often exist together. Often obesity also coexists with them. That is termed the metabolic syndrome. Dr. Anton Titov, MD. You specialize in treatment of hypertension in the setting of diabetes and metabolic syndrome. Dr. Anton Titov, MD. How to treat hypertension in patients who have obesity and metabolic syndrome? Dr. Ehud Grossman, MD. First of all, we have to know that the combination, coexistence of hypertension and diabetes is very dangerous. The risk is much higher in diabetic patients when the blood pressure is elevated. So the first point is that we need to lower the blood pressure much more aggressively in diabetic and in obese patients. They are more resistant to hypertension treatment. It’s more difficult to reach the blood pressure goal. Blood pressure goal is 130 over 80 in diabetic patients. Dr. Ehud Grossman, MD. Sometimes they require four or five medications in order to get to the blood pressure target. You have to also know that you don’t want to give medications that may impair the glucose control. So you prefer to choose a type of angiotensin converting enzyme or angiotensin receptor blocker in combination with calcium channel blockers. You try to avoid a beta-blocker as part of the treatment. Because beta blockers impair the glucose metabolism. They increase the Triglycerides. But overall in most of the diabetes and hypertension patients you need so many medications. You end up using all the anti-hypertension medications to control the blood pressure. Dr. Ehud Grossman, MD. Many patients with obesity also have sleep apnea. Sleep apnea is one of the causes for treatment-resistant hypertension. It may be more difficult to control the blood pressure in obese patients. Sometimes CPAP may help to control the blood pressure in obese patients with hypertension. Dr. Anton Titov, MD. CPAP is Continuous Positive Airway Pressure devices. Yes, correct! This is very interesting. Sleep apnea in patients with obesity. Of course, in normal circumstances the blood pressure dips during the night. So there are dippers and non-dippers. Sometimes someone is “non-dipper”. This patient has a blood pressure that does not become lower during sleep. Dr. Ehud Grossman, MD. The first thing that you have to consider is sleep apnea. Because patients with sleep apnea don’t lower the blood pressure during night. Sometimes you use the CPAP. Then you can improve the blood pressure control. This is one thing that you have to take into consideration in hypertension treatment with diabetes and obesity.
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