As in other areas of clinical medicine, success in treating patients with diabetes mellitus and arterial hypertension depends largely on how wisely the doctor and patient use the abilities to control the disease. Optimal metabolic control of glycemia and lipids, the main indicators of microcirculation are the main factors at all stages of treatment of patients with diabetes. Therapy should be aimed at reducing blood pressure to such a level as to prevent the complications of diabetes and hypertension or to slow their development.
There is no cure for arterial hypertension and diabetes mellitus, but appropriate therapy can change the course of the disease. Recommendations on lifestyle changes, nutrition, attempts to lose weight and limit sodium intake cannot replace effective antihypertensive therapy. However, in patients with diabetes, as well as obesity and lipid metabolism, it is necessary to introduce restrictions in the diet. Reasonable physical exertion should be recommended, and if the patient is a smoker, one should try to convince him to quit smoking.
Heart failure, clinical manifestations of coronary sclerosis, cerebrovascular accident and renal failure are subject to conventional treatment and do not constitute contraindications to sound antihypertensive therapy.
Not all specialists agree that patients with a mean diastolic BP of 90 mmHg. Art. antihypertensive drugs should be prescribed, if non-drug means did not lead to the normalization of blood pressure. However, many believe that the drug treatment of mild hypertension brings undoubted benefits. With diabetes, the presence or threat of complications, as well as in cases where the diastolic blood pressure is 95 mmHg. Art., it is impossible to postpone drug treatment, expecting problematic results of dietotherapy. Extensive modern research has demonstrated the significant success of antihypertensive therapy in isolated SAH. In patients 60 years and older with a systolic blood pressure of 160 mmHg. Art. and diastolic less than 90 mm Hg. Art., the use of antihypertensive drugs reduced the number of cases of stroke and other serious cardiovascular complications by 36%. The effect of treatment was manifested in elderly patients of different ages, both younger and older.
With the exception of patients over 65 years of age, treatment should be directed to a decrease in blood pressure to the norm (i.e. <140/90 mmHg) or before, if possible, close to normal, a level tolerable for the patient and his cardiovascular system. Reducing diastolic blood pressure to <85 mm may actually increase mortality due to coronary vascular lesions, especially among patients with previous clinical manifestations of coronary artery disease.
It is usually convenient for the patient to measure blood pressure at home, provided that he or someone from his family is instructed in detail and that these instructions are constantly checked and the sphygomanometer is carefully and regularly calibrated.
Drug antihypertensive therapy should be pathogenetic, carried out continuously for many years. A serious problem in the treatment of hypertension is that the patient does not always feel subjective symptoms. Willingness to take medication is reduced if the drug causes side effects. Along with the value of blood pressure, a number of criteria are taken into account that are important for determining the indications for initiating antihypertensive therapy: gender (men due to risk factors more often need pharmacological approaches), genetic factors — an earlier family history of vascular diseases is taken therapy of hypertension. In patients with diabetes mellitus with ischemic heart disease when combined with obesity, hyperlipoproteinemia or renal failure, left ventricular hypertrophy, low levels of physical activity, especially careful reduction .