Managing High Blood Pressure and Type Two Diabetes

The Disease Processes of the Patient 

The Patient is a 46-years old African-American woman suffering from high blood pressure and type two diabetes with a body mass index(BMI) of 27. High blood pressure (B.P.) occurs when there is transitory or chronic elevation of blood pressure in the arteries, which can cause damage to the cardiovascular. The disease is caused by many factors including, smoking, insufficient calcium intake, overweight, genetic factors, aging, lack of vitamin D, and the presence of comorbid diseases like people with type 2 diabetes (Fuchs & Whelton, 20200. The symptoms associated with hypertension include nausea, fatigue, dizziness, headaches, irregular heartbeat, and vision problems. 

The Patient also has type 2 diabetes, also known as Diabetes Mellitus (D.M.), which happens due to high blood glucose. The blood sugar becomes high in the body because most of them are not absorbed in the cells since the body does not produce enough insulin. Despite affecting people of all ages, type 2 diabetes often affects older and middle-aged people (Papatheodorou et al., 2018). The disease is more prevalent in individuals who are African-American, Asian American, and Hispanic. Various factors such as overweight, genes, physical inactivity, and health issues like high blood pressure can cause type 2 diabetes. The symptoms include tiredness, blurred vision, frequent hunger, and numbness. 

Approach to the Pharmacological Treatment Plan that Should Optimize Her Health 

Pharmacological treatment should involve the use of antihypertensive treatment. The woman can be given diuretic therapy through reduced urinary calcium excretion to prevent osteoporosis and bone loss. Since the Patient is African American, the prescription of Angiotensin-converting enzymes (ACE) inhibitors and Angiotensin 11 receptor blockers (ARBs) will be ineffective because she has lower levels of renin activity (Williams et al., 2016). As a result, the Patient should take Thiazide diuretics composed of hydrochlorothiazide (HCTZ) or chlorthalidone. Since HCTZ has not managed to help her reach the optimal goal, the Patient can use chlorthalidone because it is more effective and potent. Additionally, the Patient should be given the combination of Calcium channel blockers (CCB), prescribed as amlodipine, and the diuretic due to her very high blood pressure. Moreover, metformin drugs such as Glumetza and Fortamet should also be prescribed to help treat type 2 diabetes because they are useful in lowering the production of glucose in the liver and effectively improve the body's sensitivity to insulin. 

Personalized Optimal Goal for the Patient and National Guidelines Discussions that Support the Personalized Goals 

My optimal goal is to personalize treatment to the Patient by considering her unique needs and goals. The goal is to initiate and combine both pharmacological and non-pharmacological treatments toward a lowers level strategy. The strategy will help achieve a systolic blood pressure below 140 and then push for another achievable goal. Different measures will be put into considerations to avoid the possible outcome of lightheadedness. Regarding the confounding factors such as type 2 diabetes, the strategy will push the Patient to reduce her weight and avoid salt intake to avoid medical issues when working towards the optimal goal. Thiazide diuretics and CCBs will also be used together to achieve the target. 

"Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure' provides national guidelines. The report incorporates new information from different researches regarding hypertension. It stresses the observation of non-pharmacological interventions such as sodium restriction, intake of potassium supplements, and increased structured physical exercise. The report requires that people with hypertension and D.M. should be given antihypertensive medications with a goal treatment goal of 130/80 mm Hg (Whelton & Carey, 2017). All the first-line antihypertensive drugs are effective in adults with diabetes mellitus (D.M.) and hypertension. Additionally, the guidelines indicate that African American adults with high blood pressure and D.M. be prescribed thiazide diuretics or CCB. The two antihypertensive agents should be combined for people with very high-pressure levels to achieve the B.P. target of <130/80 mm Hg. 

Potential Pharmacological Interactions and Necessary Patient Education on the Interactions 

Potential pharmacological interaction is possible became the Patient will often receive various drugs to treat both type 2 diabetes and hypertension. The possible interaction will involve the combination of antihypertensive and metformin. Thiazide drugs like hydrochlorothiazide can inflate the blood glucose level and cause interference in diabetic management. Additionally, diuretics can cause the development of lactic acidosis, a condition that may occur when treatments are combined with metformin products (Heise et al., 2015). As a result, the Patient can frequently experience fatigue, discomfort, irregular heartbeat, difficult breathing, and abdominal pain. 

Patient education is necessary to help in providing adequate information regarding any potential interactions. The Patient should be informed on the importance of dose adjustments and frequent monitoring to determine drug safety. The provision of necessary information enables the Patient to know any possible outcome and proper management. 

The Interdisciplinary Team Involved in the care of the Patient 

The interdisciplinary team helps in controlling and improving the quality of blood pressure care for the Patient. The team comprises the Patient, primary care provider, and experts like cardiologists, pharmacists, nurses, dietitians, social workers, physician assistants, and community health workers. The physician and his/her assistant help in managing the routine and complex blood pressure care. The cardiologist provides healthcare for cardiac diseases and factors that can lead to major cardiovascular problems (Whelton & Carey, 2017). The nurse is responsible for providing accurate assessment, education, drug reconciliation, and lifestyle modification guidelines. 

On the other hand, the pharmacist provides comprehensive drug management such as identifying drug-related problems, modification, and medication regime education. Whereas the dietician helps the Patient understand the necessary dietary habits by setting and monitoring healthy lifestyle goals. The social worker assesses and seeks solutions to the Patient's psychological, financial, and cultural barriers. The team collaborates to compliment the primary caregiver's activities by creating process support and sharing hypertension and diabetes care duties. 

Non-pharmacological educational needs for the Patient 

Non-pharmacological interventions are also necessary for reducing the daily prescription of antihypertensive drugs. The interventions help in delaying the transition from prehypertension to hypertension level. The Patient can be advised to comply with various non-pharmacological approaches such as dietary management, engaging in physical exercise, avoiding stressful activities, and eliminating alcohol intake. The necessary dietary modification should encourage a high intake of grains, dairy products, vegetables, and food with high potassium salt contents and phosphorus (Mahmood et al., 2019). The Patient should avoid consuming food that contains sodium because they propel the increase in pressure levels. Secondly, the woman can practice physical exercise to reduce the high BMI and lower the hypertension level. 

Additionally, avoiding lifestyle stressors, anxiety, and depression is also useful in reducing blood pressure. Besides, the woman should eliminate alcohol consumption and discourage the high intake of coffee and caffeine products. These interventions will contribute to the management of hypertension and type 2 diabetes. 

Health Maintenance Needs that Help the Patient to Maintain Optimized Health 

Because the Patient has resistant hypertension, the health maintenance will require greater adherence to both pharmacological and non-pharmacological interventions to maintain the optimal goal. First, there will be a need to change hypertension medications to determine the best combination that can effectively work for her. The Patient will also be advised to avoid taking the non-prescribed medications and monitor her blood level at home to determine white coat hypertension's possible occurrence. Finally, adherence to healthy lifestyle practices, including a healthy diet, reduced salt, maintenance of the required BMI, and alcohol avoidance, will significantly help achieve the average health of 120/80 mm Hg. 

References 

Fuchs, F. D., & Whelton, P. K. (2020). High blood pressure and cardiovascular diseases. Hypertension .,75(2),285-292. https://doi.org/10.1161/HYPERTENSIONAHA.119.14240 

Heise, T., Mattheus, M., Wourle, H. J., Broedl, U. C., & Macha, S. (2015). Assessing pharmacokinetic interactions between the sodium-glucose cotransporter 2 inhibitor empagliflozin and hydrochlorothiazide or torasemide in patients with type 2 diabetes mellitus: a randomized, open-label, crossover study. Clinical Therapeutics ., 37(4), 793-03. https://doi.org/10.1016/j.clinthera.2014.12.018 

Mahmood, S., Shah, K. U., Khan. T. M., Nawaz, S., Rashid, H., Baqar, S. W. A., & Kamran, S. (2019). Non-pharmacological management of hypertension: in light of current research. Irish Journal of Medical Science (1971-), 188(2), 437-452. https://doi.org/10.1007/s11845-018-1889-8 

Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of Diabetes 2017. Journal of diabetes research . https://doi.org/10.1155/2018/3086167 

Whelton, P. K., & Carey, R. M. (2017). The 2017clinical practice guideline for high blood pressure. Jama. 318(21), 2073-2074. https://doi.org/10.1001/jama.2017.18209 

Williams, K. S., Ravenell. J., & Ogedegbe G. (2016). Hypertension Treatment in Blacks: Discussion of the U.S Clinical Practical Guidelines. Progress Cardiovascular Diseases . https://doi.org/10.1016/j.pcad.2016.09.004