DOI: https://doi.org/10.30841/2307-5112.4.2020.217397

The Patient with Hypertension and Type II Diabetes mellitus in General Practice: Modern Aspects of Therapy

В. М. Ждан, Є. М. Кітура, М. Ю. Бабаніна, О. Є. Кітура, М. В. Ткаченко

Abstract


The type 2 diabetes mellitus (DM) has been shown to double the risk of cardiovascular disease in men and three times in women, and the presence of hypertension (AH) further increases the risk of diabetes by four times. Among patients with hypertension, the prevalence of diabetes is 2–2,5 times higher than in people with normal blood pressure. Elevated blood pressure is one of the risk factors for the development of macro- and microvascular complications in patients with diabetes. The UKPDS study found that an increase in systolic blood pressure (CAT) for every10 mmHg. Art. in patients with type 2 diabetes was associated with an increase in mortality by 17 %, myocardial infarction – by 12 % and microvascular complications – by 13 %. On the example of the given clinical case of a patient with hypertension in combination with type II diabetes, the peculiarity of the course of the disease, risk factors are considered. Desired therapeutic target levels were determined: blood pressure <130/80 mm Hg Art., HbAlc <7 % –7,5 %; LDL cholesterol <1.8 mmol/l; weight loss by 5–7 %; slowing the progression / regression of nephropathy (microalbuminuria). The strategy of drug therapy of hypertension in combination with diabetes is combination therapy in most patients, especially in the context of lower target blood pressure levels, using to improve adherence to treatment of fixed combinations (step-by-step therapy) in one tablet for most patients.

Among the most adequate combinations of antihypertensive drugs that have an evidence base and can be used in patients with hypertension with diabetes, the following are recommended: angioconversion enzyme inhibitor (ACE inhibitor) + calcium channel blockers (BCC) + diuretic; angiotensin receptor blockers (ARBs II) + BCC + diuretic; ACE inhibitors + diuretics; ARB II + diuretic; BPC + diuretic; BPC (amlodipine, lercanidipine) + β-blocker (with vasodilating effect).

Keywords


arterial hypertension; clinical case; diabetes mellitus; antihypertensive therapy

References


Вдовиченко В.І., Кульчицький В.В. (2015). Гіпертонічна хвороба в поєднанні із цукровим діабетом 2 типу: суперечливість поглядів на тактику ведення. Український терапевтичний журнал, 1, 63–68.

Ілляш М.Г., Базика О.Є., Довганич Н.В., Яринкіна О.А., Старшова О.С. (2016) Артеріальна гіпертензія та цукровий діабет: сучасні аспекти лікування. Практикуючий лікар, 2(5), 5–9.

Коваленко В.Н., Свищенко Е.П. (2009) Артериальная гипертензия у особых категорий больных. Киев: Морион: 374.

Коваль С.М., Снігурська І.О., Пенькова М.Ю., Мисниченко О.В., Літвінова О.М., Юшко К.О. (2018). Сучасні підходи до медикаментозного контролю артеріальної гіпертензії у хворих на цукровий діабет. Раціональна фармакотерапія, 2(47), 25–33.

Сіренко О. (2018). Рекомендації Європейського товариства кардіологів (European Society of Cardiology, ESC) і Європейського товариства гіпертензії (European Society of Hypertension, ESH) з лікування артеріальної гіпертензії 2018р. Артериальная гипертензия, 5(61), 58–156.

(1998). UK Prospective Diabetes Study Group. Tight blood pressure control and risk of [microvascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ, 317, 703–713.

(2013). ESH/ESC Guidelines for management of arterial hypertension. J. of Hypertension, 31, 1281–1357.

Barkoudah E., Skali H., Uno H. et al. (2012). Mortality rates in trials of subjects with type 2 diabetes. J. Am. Heart Assoc, 1(1), 8–15.

Brunström M., Carlberg B. (2016). Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ, 352. doi: https://doi.org/10.1136/bmj.i717.

Haffner S.M., Lehto S., Ronnemaa T. et al. (1998). Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med, 339, 229–234.

Redon J., Cifkova R., Laurent S. et al. (2009). Mechanisms of hypertension in the cardiometabolic syndrome. J Hypertens, 27, 441–451.

Sundström J., Sheikhi R., Ostgren C.J. et al. (2013). Blood pressure levels and risk of cardiovascular events and mortality in type-2 diabetes: cohort study of 34 009 primary care patients. J. Hypertens, 31, 1603–10.




Copyright (c) 2020 В. М. Ждан, Є. М. Кітура, М. Ю. Бабаніна, О. Є. Кітура, М. В. Ткаченко

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ISSN 2412-8708 (Online), ISSN 2307-5112 (Print)

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ISSN (print): 2307-5112.