The diabetic patient is subject to many complications in the event of poor control of blood glucose or blood pressure. Diabetic nephropathy is the leading cause of kidney dialysis in the developed world. Diabetic retinopathy is one of the leading causes of blindness in the United States. Cardiovascular diseases are the leading cause of morbidity in the United States. There are many different factors that predispose people to developing these conditions. Among these factors in a diabetic patient, hypertension has been shown to be strongly correlated with progression of micro and macrovascular complications. There are several antihypertensive treatment options for lowering blood pressure including angiotensin receptor blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, beta adrenergic receptor blockers, and diuretics among others. By lowering blood pressure in diabetic patients comorbid with hypertension, complications arising from either condition have been shown to be reduced to a greater extent than can be explained with either normal blood pressure or blood glucose levels. However, there is mounting evidence that certain beta-adrenergic receptor blockers cause insulin desensitization, adverse lipid metabolism, and poor carbohydrate metabolism. Furthermore, hypertension is a complex disease process especially when considered from the perspective of the patient with diabetes. There are many possible underlying mechanisms for the hypertension and resulting complications, so it may be important for the prescribing physician to employ a combination of different classes of antihypertensive pharmaceuticals when treating their patients. Although some antihypertensive agents may cause some adverse effects in patients, they are usually very well tolerated, and attempts should be made to incorporate them into a treatment plan for preventing the onset of diabetic complications.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/36583 |
| Date | 13 June 2019 |
| Creators | MacKenzie, James |
| Contributors | Atkinson, David, Levy, Simon |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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