Hypertension
HTN and T2D are closely interlinked. Chronic high blood glucose damages the lining of the blood vessels, leading to damage and stiffness. Excess glucose binds to proteins in blood vessel walls, forming advanced glycation end products. These products cause the vessel walls to thicken and form plaques. Also, excess glucose leads to oxidative stress and reduces nitric oxide, which impairs vasodilation. These combined processes thicken and damage blood vessels, reduce circulation, promote atherosclerosis, and increases blood pressure. Diabetes can also damage the kidneys with high blood glucose levels, and when the kidneys are injured, they may retain more salt and water, elevating blood pressure as well due to RAAS activation. HTN is also related to open angle glaucoma via blood vessel damage in similar mechanisms as explained above. If a patient has hypertension like George, it is important to assess their blood pressure, kidney function, and their electrocardiogram. These key assessments rule out arrythmias, heart damage, and early signs of impaired kidney function.
Vascular damage from chronic high blood pressure over time: arteries thicken, sclerose, the lumen becomes narrowed, and the endothelium becomes damaged. Arteries are not able to deliver blood to the body as efficiently.
Decreased blood flow: reduced oxygen delivery to tissues and organs may become ischemic, This can also lead to CKD. This is also likely causing George's Peripheral Arterial Disease symptoms as well.
-
George is currently on Lasix, a loop diuretic, to help manage his hypertension. Loop diuretics decrease sodium and water reabsorption in the kidney tubules, leading to increased urination. This helps to reduce George's blood volume, resulting in a decreased blood pressure and less overall strain on George's cardiovascular system.
Potassium (3.3): George's potassium is currently low due to his Lasix and HCTZ medication. Both medications are potassium-wasting diuretics, meaning George is losing more potassium in his urine than normal, leading to slightly low levels. George may benefit from an oral Potassium supplement.
-
Hydrochlorothiazide: HCTZ is also a diuretic that leads to less sodium and water reabsorption in the convoluted tubules of the nephron. This helps to reduce George's blood volume, resulting in a decreased blood pressure and less overall strain on George's cardiovascular system.
CoQ capsule: This is a coenzyme that can help to mildly reduce blood pressure. It helps to relax blood vessels, leading to vasodilation, and can help to lower blood pressure further if used in combination with additional blood pressure medications.
If a patient has HTN, it is important to assess the organ systems that HTN can damage. Assessment of George's eyes for retinopathy, kidney function tests and urine output to assess for CKD, signs of fluid volume overload such as edema and JVD, neurological assessments for headaches and CVA symptoms, respiratory assessments if FVE is evident, and an overall assessment of George's lifestyle such as his exercise habits, diet, stress levels, and drinking or smoking habits are also important.