Introduction :
Hypertension (defined as a blood pressure 140/90 mmHg) is an extremely common comorbid condition in diabetes, affecting 20–60% of patients with diabetes, depending on obesity, ethnicity, and age. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance also including central obesity and dyslipidemia.
Hypertension is high blood pressure. "Pulmonary" refers to the lungs. Pulmonary hypertension is high blood pressure in the lungs' blood circulation, most often without high blood pressure in the rest of the body. The lungs are delicate structures. They can't tolerate normal body blood pressure. The blood pressure in the lungs is only one-fifth of body blood pressure.
It is important to take steps to keep your blood pressure under control. Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure
In some particular situations, certain classes of anti-hypertensive drugs are preferable to others as the first line (choice) drugs. For example, Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blocking (ARB) drugs are the drugs of choice in patients with heart failure, chronic kidney failure (in diabetics or non-diabetics), or heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction), as these have remodeling effect on heart muscles
How is pulmonary hypertension diagnosed?
Because pulmonary hypertension may be caused by many medical conditions, a complete medical history, physical exam, and description of your symptoms are necessary to rule out other diseases and make the correct diagnosis. During the physical exam, your health care provider will:
listen for abnormal heart sounds such as a loud pulmonic valve sound, a systolic murmur of tricuspid regurgitation, or a gallop due to ventricular failure.
examine the jugular vein in the neck for engorgement.
examine the abdomen, legs, and ankles for fluid retention.
examine nail beds for bluish tint.
look for signs of other underlying diseases that might be causing pulmonary hypertension.
How hypertension is treated?
Many people can lower their blood pressure significantly with lifestyle changes, such as weight loss and exercise, but most still need medication to keep their blood pressure in the healthy range.
Whichever therapy you choose, it is important to have your blood pressure checked regularly to make sure that your treatment is working.
Uncontrolled high blood pressure is a leading cause of heart disease, heart attacks, heart failure, kidney failure, vision problems, and stroke.
Drug treatments
If your blood pressure remains high, your doctor may prescribe you one or more of the following antihypertensive drugs.
ACE inhibitors or angiotensin II receptor antagonists (eg ramipril, losartan) - these make the walls of the blood vessels relax and widen.
Calcium channel blockers (eg amlodipine) or alpha blockers (eg doxazosin) - these help widen the blood vessels.
Diuretics (eg bendroflumethiazide) - these increase the amount of water and salt removed from your blood by your kidneys. This triggers hormones which lower blood pressure.
Beta-blockers (eg atenolol) - these drugs reduce the work your heart has to do, by reducing your pulse rate at times when it may beat too forcefully such as during exercise or when you are feeling stressed.
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