Wednesday, June 2, 2010

Monitoring and Managing Diabetes and High Blood Pressure

People with diabetes should have their blood pressure monitored and managed aggressively, a leading nephrologist told a group of Sinai Hospital physicians last week.

George Bakris, M.D. presented on “Updates in Treatment Goals for the Diabetic Hypertensive” at Sinai Hospital’s Grand Rounds. Dr. Bakris is the Director of Hypertension Center and a professor at the University of Chicago Medical Center. The presentation was dedicated to the numerous accomplishments of longtime Sinai Hospital physician Leon Kassel, M.D.

There is a significant increase in mortality rates for patients in a hospital who have both diabetes and hypertension. Untreated high blood pressure increases the likelihood of a heart attack or stroke. That’s one of the reasons why physicians need to get patients’ blood pressure controlled, which can be accomplished through medication, Dr. Bakris says.

According to the American Heart Association, 77 percent of first-time stroke victims have a blood pressure of over 140/90. The recommendations for blood pressure levels in those with diabetes and chronic kidney disease (without proteinuria) should be less than 140/90, Dr. Bakris says.

“If your patient doesn’t have proteinuria, treat the blood pressure and lipids with the simplest medications and get it below 140/90,” he says.

Diabetes and high blood pressure are risk factors for kidney disease. Those with diabetes should be monitored for microalbuminuria, or small amounts of a protein called albumin in the urine, although physicians should be careful to not jump to conclusions.

“Microalbuminuria does not by itself indicase kidney disease,” Dr. Bakris says. “It is a risk marker, not a risk factor. If you take care of the heart and the brain the kidneys will come along for the ride.”

Both patients and health care providers also need to remember to take blood pressure accurately.

“The patients’ back should be support with both feet on the floor,” Dr. Bakris reminded the physicians. He’s a believer in letting patients use home blood pressure kits.

“Taking blood pressure at home empowers the patient with information,” he says.

To learn more about assessing your high blood pressure, visit the American Heart Association's High Blood Pressure Health Risk Calculator. You can also visit Know Your Health Baltimore to do a heart assessment test.

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