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ASK THE DOCTOR ���������������������������� ����������������� by
Wesley W. Wilson, MD Artwork:� Medical
caduceus ���� NOTE:�
If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office.� The only questions Dr. Wilson will be able to answer are the
ones used in this column. ���� Wesley
W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic
in Missoula, Montana.�
Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical
school. He remains interested and involved in diabetes education
for patients and professionals. ���� Q:� I work in a high‑stress environment (I'm
a coach) and I'm worried about my blood pressure.� How damaging is high blood pressure to a diabetic like me?� What should I be doing to keep my blood pressure down in a healthy range? ���� ���� A:� Dear coach: ���� I share
your concerns about blood pressure.�
It is important to differentiate "hypertension"
from "high stress" since many persons confuse the terms.� There is some connection between stress and elevated blood pressure,
but each can occur without the other and both may occur together.� ���� Hypertension
is defined as "an abnormally high blood pressure."� The
first point then, is what is your blood pressure now?� If
it is above 130/85 and if you have diabetes you would be classified a "hypertensive."�
Most authorities feel the blood pressure must be 140/90
to be classed as hypertension in non‑diabetics.� The difference is related to the extreme damage that elevated blood pressure can cause in persons with diabetes.� Persons who don't have diabetes are harmed by elevated blood pressure with increased risk of stroke, heart disease and kidney
problems. The risks are much greater in persons with diabetes.��
The United Kingdom Prospective Diabetes Study showed that careful control of blood sugar reduced the risk of development of microvascular complications in persons
with type 2 diabetes similar to that seen in the DCCT with
type 1 diabetes.� I
found it interesting that careful control of blood pressure gave even greater protection from microvascular diseases than did blood sugar control
in the UKPDS Study results.� In addition, the reduction of heart disease and stroke was far greater with blood pressure control than with blood sugar control. ���� The question
of how to control your blood pressure (I presume it is over 130/85) is more difficult and will require more input from your "health care provider"
(I prefer doctor).� You
should exercise regularly and maintain a "lean and mean" ideal weight.� Your blood sugars should be controlled and you should test often enough to obtain
a hemoglobin A1c level of 7% or less.� You should unwind and get away from the stress and conflict at least several
times each day.� Dietary
salt reduction may not reduce your blood pressure much, but it should help make the control
a bit easier. ���� Your doctor
will need to evaluate your physical and laboratory status.�
Your eyes should be checked for any sign of retinopathy, as the presence of diabetic retinopathy strongly suggests nephropathy, kidney disease, may
be present as well. ���� The degree
of blood pressure control seems more important than the choice of drugs used to achieve
that control.� A
group of drugs called ACE (Angiotensin Converting Enzyme) inhibitors seem to offer particular protection to the kidneys in persons with diabetes.�
Control of blood pressure is vital for people with diabetes,
and testing blood pressure by the patient is as important
as treating blood sugar.� The target blood pressure is 135/85 or less.� Home
blood pressure monitoring is essential to allow you to know how you are doing.� There are a variety of devices that can give you reliable blood pressure readings.
It is essential that you receive instruction on how
to use the equipment when you purchase it. ���������������������������������� |
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