CVD for CHAT1

High Blood Pressure and High Cholesterol in People with Diabetes: 

High Blood Pressure and High Cholesterol in People with Diabetes Presented by: Midwestern University; Collaborative Healthcare Advocate Team

What Is Hypertension: 

What Is Hypertension Persistently high blood pressure - May have no known cause - May be associated with other diseases

Hypertension in the United States: 

Hypertension in the United States > 50 million Americans Increases with age More common in men than women < 45 years old Less of a gender difference in people >65 years old

Signs of Hypertension: 

Signs of Hypertension Silent disease Often there are little or no signs to indicate a person has hypertension Sometimes headache, fast heart rate, dizziness

Complications of Hypertension: 

Complications of Hypertension Hypertension can lead to: - Cardiovascular Disease (CVD) (i.e. heart attack) - Stroke or TIA - Kidney failure or problems

Risk Factors of Hypertension: 

Risk Factors of Hypertension Obesity and Inactivity High Cholesterol Diabetes or Pre-Diabetes Excessive Salt Intake Cigarette Smoking Alcohol consumption (>3 drinks per day)

Target Goals for Blood Pressure: 

Target Goals for Blood Pressure Normal range is: 120/80 mmHg For people with Hypertension and Diabetes, their goal is: < 130/80 mmHg

Treatment Options for Hypertension: 

Treatment Options for Hypertension Non-Drug Therapy - Weight loss (even just 10 lbs) - Less salt - Balanced diet - Appropriate fat intake - Activity (exercise) - Stop Smoking - Stress Management Drug Therapy - Diuretics (water pills) - ACE inhibitors - ARB’s - B-blockers - Calcium Channel Blockers - Alpha agents - Miscellaneous

People with Diabetes and High Blood Pressure: 

People with Diabetes and High Blood Pressure Angiotension Converting Enzyme (ACE) inhibitors are usually the preferred drug lowers BP in the kidneys to prevent kidney problems. Angiotension Receptor Blockers (ARB) are also a preferred choice Usually given if ACE inhibitors are not working or if people have side effects from ACE inhibitors

Healthy Eating with Hypertension: 

Healthy Eating with Hypertension Choose a variety of nutritious foods Eat appropriate amounts of food at regular times Avoid skipping meals Reduce fat intake Limit alcohol and salt intake

Heart Healthy Choices: 

Heart Healthy Choices

Benefits of Exercise: 

Benefits of Exercise Burns calories and fat Increases muscle mass, which helps you lose weight! Strengthens heart, lungs and bones Helps you feel better Lowers risk of heart disease Helps lower blood pressure

Managing Stress: 

Managing Stress Get enough sleep Keep taking your medicine, and make sure you eat regularly! Exercise Do things you enjoy Laugh regularly Learn a stress-reduction technique Seek support from family, friends, or a support group.

Caffeine and Hypertension: 

Caffeine and Hypertension

Over-the-Counter Medications: 

Over-the-Counter Medications Some Over-the-Counter medications can raise blood pressure - Sudafed (psuedoephedrine) - Motrin, Ibupropen, Aleve (high doses) - Nicotine replacement items

Tips for Blood Pressure Control: 

Tips for Blood Pressure Control Check your Blood Pressure Regularly Eat a Healthy Balanced Diet Stay Active Keep Blood Glucose levels as close to normal as possible Stop Smoking Know Your Blood Pressure Medications and Be Aware of their Side Effects Ask About Over-the-Counter Medications Before Taking Them Relax, Laugh Often and Enjoy Life

Cholesterol: 

Cholesterol

Problems from High Cholesterol: 

Problems from High Cholesterol Coronary heart disease angina, heart attack Cerebrovascular disease Stroke, TIAs Peripheral arterial disease Pain in legs American Heart Association, 2000.

The Good, Bad & Ugly Lipids: 

The Good, Bad & Ugly Lipids The Bad Cholesterol -LDL Low density lipoprotein Most damaging to the arteries The Good Cholesterol –HDL High density lipoprotein Cleans up after the bad cholesterol The Ugly Cholesterol - TG Triglycerides Mainly from diet Can damage arteries

LDL (Bad Cholesterol) Levels in Type 2 Diabetes: 

LDL (Bad Cholesterol) Levels in Type 2 Diabetes LDL levels are similar to people without diabetes LDL particles are smaller and denser compared to people without diabetes This is due to high TG (Ugly cholesterol) levels

Small, Dense LDL Particles: 

Lamarche B, et al. Diabetes Med. 1999;25:199-211. Tribble DL, et al. Atherosclerosis. 1992;93:189-199. Small, Dense LDL Particles Associated with a 3 x greater risk of heart disease Damage occurs because the small LDL can enter artery walls faster and easier than larger LDL particles. The get into places they should not be and cause damage

Triglycerides and Diabetes: 

Garg A, et al. Diabetes Care. 1990;13:153-169. Patti L, et al. Diabetologia. 1989;30:530A. Bierman EL. Arterioscler Thromb. 1992;12:647-656. Triglycerides and Diabetes High TG levels can result from: Overproduction of VLDL in the liver Problems in breakdown of TG

DIABETIC DYSLIPIDEMIAManagement Goals: 

DIABETIC DYSLIPIDEMIA Management Goals LDL cholesterol Primary Target  LDL (<100mg/dl) HDL cholesterol  HDL (>40mg/dl) Triglycerides  TG (<150mg/dl) Stabilize small dense LDL

Treatment Options: 

Treatment Options Nonpharmacologic Options Diet Weight reduction Exercise/physical activity Pharmacologic Options Statins Fibrates Niacin Bile Acid Sequestrants Selective Intestinal Absorption Inhibitors Others (TZD’s, herbs)

Treatment for High Cholesterol: 

Treatment for High Cholesterol Statins are usually the first choice to stabilize and lower LDL Fibrates can decrease TG Niacin can increase HDL

Tips for Cholesterol Control: 

Tips for Cholesterol Control Have your doctor check your Cholesterol regularly Eat a Healthy Balanced Diet Stay Active Keep Blood Glucose levels as close to normal as possible Stop Smoking Know Your Cholesterol Medications and Be Aware of their Side Effects Ask About Over-the-Counter Medications Before Taking Them Relax, Laugh Often and Enjoy Life

Thank You For Your Participation.What Questions Can We Answer For You?: 

Thank You For Your Participation. What Questions Can We Answer For You? scorne@midwestern.edu