Diabetes Resources Hypertension—Back to the Basics Practical Information for New Mexico

Diabetes Resources
Practical Information for New Mexico
Health Care Professionals
TM
P.O. Box 3548
Albuquerque, NM 87190
(866) 796-9121
(505) 796-9121
www.nmtod.org
In each issue of Diabetes
Resources we have provided
specific information about
management for diabetes,
including important tests
and resources to help reduce
complications associated
with the disease. Information
is included about the ABCs
of diabetes: A1C testing
2-4 times per year, Blood
pressure screening at every
visit, and annual Cholesterol
testing. Additional clinical
information is also provided.
A dilated eye exam, sensory
foot exam and screening
for kidney disease are each
recommended annually.
Attention to these risk
factors reduces the chance
for cardiac, renal, eye and
vascular disease secondary to
diabetes.
In support of the New Mexico
Adult Diabetes Practice
Guideline 2011, please see
the reverse side of Diabetes
Resources for recommendations for care including
resources and tools that can
help in your efforts to provide
education and support among
your patients with diabetes.
A quarterly publication for clinicians caring for people with diabetes - Vol. 15 No. 9, 2011
Hypertension—Back to the Basics
The Issue:
v
Did you know?
The presence of
hypertension doubles the
risk of cardiovascular
disease, compared to
having diabetes without
hypertension.
v
If you bring blood pressure down by 10 mmHg, you can
reduce the relative risk of death by 15%, microvascular
complications by 13%, and myocardial infarction by
11%.1 Medication management is usually indicated,
with strong evidence supporting the consideration of
ACEI and ARB class drugs. There are no absolute
contraindications to any class of anti-hypertensive agent
solely because of diabetes, including the beta-blockers.
v
Weight reduction lowers blood pressure, in addition to
improving blood glucose and lipid control. Losing one kilogram of body weight can decrease
mean arterial blood pressure by 1 mmHg.2
The Current Clinical Recommendation:
The New Mexico Adult Diabetes Practice Guideline 2011 recommends that all people with diabetes
have a blood pressure check at every visit to their health care professionals. The goal is a blood
pressure of < 130/80 mm Hg.3
New Resource Available:
Reducing Cardiometabolic Risk: Patient Education Tool Kit
To assist with your educational efforts, a comprehensive kit of reproducible patient
education handouts on topics related to cardiometabolic risk reduction, pre-diabetes,
diabetes, and CVD. Developed by the American Diabetes Association, American
College of Cardiology and Preventive Cardiovascular Nurses Association, the kit
covers 29 topics and is available in English and in Spanish. A CD-ROM version of
this toolkit is also available.
Check www.nmtod.org for
organizations that have graciously
provided funding for Diabetes
Resources.
New Mexico Health Care Takes On
Diabetes, a New Mexico non-profit
corporation, is a broad coalition of
New Mexico’s diabetes care professionals, New Mexico Health Plans,
the New Mexico Department of
Health, and the New Mexico Medical
Review Association, with technical
and administrative support from the
American Diabetes Association.
Hypertension is twice as common in people with diabetes.
Some studies estimate the majority of the risk of diabetes
complications is attributable to concomitant hypertension.
Request a copy on CD:
http://professional.diabetes.org/ResourcesForProfessionals.
aspx?cid=77080&utm_source=offline&utm_medium=print&utm_
campaign=RCMR.
United Kingdom Prospective Diabetes Study (UKPDS).
Diabetes Care 2008, 31:S1-S2.
3
Based on The American Diabetes Association’s Clinical Practice Recommendations of January 2010.
1
2
Resources for Clinicians
The following resources are FREE and can be downloaded from the New Mexico Health
Care Takes On Diabetes website at www.nmtod.org. For further information contact Charm
Lindblad, Executive Director, at 505.796.9121 or toll-free 1.866.796.9121.
Blood Pressure Screening: A Step-by-Step Guide—Measuring blood pressure
is a basic fundamental skill, yet often performed inaccurately. Various levels of personnel from
medical assistants to nurses are responsible for taking patients’ blood
pressures, but many have not been trained appropriately. This simple
step by step guide describes a technique that will help produce accurate
readings by which the provider can base a management plan. It can also
serve as a training guide for new staff learning this skill for the first time.
There are no copyright restrictions. This form can be found on the New
Mexico Health Care Takes On Diabetes website.
Back to
Basics:
Bloo
ions for d Pressure
Accurate
Screenin
Measurem
g
ent
Considerat
Preparatio
• Patient
should be
• Patient
comforta
bly seated
should be
in a chair,
• The upper
at rest
arm should for at least 5 minutes feet on the floor,
constrictive
be free of
with his/her
all clothing before beginning
• The arm
the measure back supported,
; shirt sleeves
should be
or lying down
ment
should be
• Legs should
supporte
removed
d at the
be uncrosse
, not rolled
d with feet patient’s heart level
up, if at all
on the floor
with
or footrest elbow slightly flexed
n Steps
Cuff App
rop
• Width
of the
and shoulder inflatable bladder
should be
) or encircle
wrapped
40% of circumfe
80%
around a
rence
big arm will of the upper arm.
- 9”, regular
give an abnorma Be sure to use of arm (measured
9” - 13”,
• Bladder
at midpoin
large 13”
lly high reading,a large cuff on
should be
- 17”.
large individu t between elbow
• Lower
centered
and vice
edge
over the
versa. Standard als. A narrow
artery
• Cuff should should be placed
cuff
cuff size
2 to 5 cm
is; small
• Cuff should be completely
(1 to 2 in)
7”
deflated
above antecubi
be snugly
• Tubing
and smoothl when applied
tal space
should rest
at the medial y wrapped around
(inner) aspect
the arm
of the arm
riatene
ss
Examin
er Techniq
• Position
gauge so
• Palpate
that it is
viewed
brachial or
radial artery straight on
palpated,
then deflate
and
accurate
the cuff slowly inflate the cuff
reading)
(this indicates 30 mm Hg above
• Apply
stethosc
the point
level at which
contact with ope bell lightly
you will need where the pulse
to the brachial
the cuff or
is no
• Inflate
to inflate
clothing
artery with
the cuff to
cuff to assurelonger
no space
30 mm Hg
(2 to 3 mm
an
between
the skin and
• Note the Hg per heartbea above point where
stethoscope,
the previous
t)
onset
avoiding
ly palpated
systolic blood of the first sound,
pulse was
followed
pressure
• Average
not felt. Deflate
two or more and the disappea by muffling, then
cuff slowly
rance of
disappearance
mm Hg,
readings
sound
of sound.
• Record additional readings separated by 2 minutes is the diastolic
The first
both the
blood
sound is
of rest. If
systolic and should be taken and
the
the first two pressure
the diastolic
averaged
readings
blood pressure
differ by
Note variable
more than
s
s that can
5
past 30
alter
ues
minutes,
a
bladder distentio exercise, cold patient’s blood pressure
environm
: eating,
n.
ent, pain
or discomfo drinking or smoking
rt, exertion,
within
Care 2002;
fatigue, caffeine
25(supplement
and
1):
Source: Diabetes
71S
P.O. Box
rque, NM 3548
87190
(866) 796-9121
(505) 796-9121
Albuque
Screening and Treatment for Hypertensive Patients with Diabetes:
A One-Page Tool—This simple table outlines the ADA recommendations for blood
pressure screening, diagnosis, and treatment for patients with diabetes. How often should
blood pressure be screened in this population? At what systolic and
diastolic levels are lifestyle modifications recommended? When should
antihypertensive medications be prescribed and what are the current drugs
of choice? This one page guide summarizes these recommendations to
assist providers with managing their diabetes patients with hypertension.
There are no copyright restrictions. This form can be found on the New
Mexico Health Care Takes On Diabetes website.
Scree
ning
Hype
and
rtens
Tre
ive Pa atmen
tients t for
ning
with
Di
Scree
Check
blood
pressu
Repea
re at every
t on a
separ
routin
>130
e diabe
/80 mmH ate day
if blood
tes visit
g
pressu
re is
Ortho
static
assess
blood
for the
pressu
presence re shoul
of auton d be perfo
omic
rmed
neuro
pathy to
lic: 130-1
and/o 39 mmH
g
r
olic: 80-89
mmH
g
abete
Diag
nosis
Goal:
s
< 130/8
0 mm
Hg
rtensi
on: >130
mm Hg
systol
ic
> 80 and/or
mm Hg
diasto
lic
Hype
Systo
Diast
Treatm
Editorial Committee:
Charm Lindblad, MHA
Managing Editor
Bruce A. Mann, MD, FACP
Editor-in-chief
Colleen Campbell, RPh, MBA
Alicia Chavez, PharmD
Gloria Jean Collins, RN, MBA
Sheila Conneen, PhD, MPH, MSN, ANP-BC
Lee DuBois
Panela Hislop, BSHS
M. L. Johnston, MS, RD, CDE
Pamela Kovach, RN
Linda Macdonald, MD
Jeanine Patterson, MS, RN, COHN-S
Judy Rigdon, RN
Krista Salazar, Pharm D, PhC
Shanelle Scales, PharmD
ent
Lifest
yle
• Contr Intervention
Systo
s:
lic: >140
• Limit ol weight
mmH
• Regu sodium and
and/o
g
Diast
olic: > r
If goal lar exercise alcohol
90 mmH
not achiev
g
ed after
Initia
l Drug
3 mont
• Angio
Choic
hs then
es:
begin
• Angio tensin-conv
medic
ation
Secon tensin recep erting enzym
therap
d
e (ACE
y
• β-blo Line Drug tor block
ers (ARB ) inhibi
Choic
• Low- ckers or
tors and/o
es:
s)
Patien
r
ts
Third dose diure
micro with hyper
tic
Line
album
• Calciu
Drug
inuria tension accom
Choic
Patien
or clinic
More m Channel
e:
panie
ts over
than one
d by
al album
Block
witho
55 years,
ers
of the
inuria
ut
ACE
above
with or
cardio hypertensio
inhibi
medic
vascu
not tolera tor or
ations
lar risk n but with
ARB
ted)
may be
Patien
anoth
(subs
titute
er
ts with
ACE
neces
one for
sary
inhibi
recen
tor (if
t myoc
the other
Expert
not contr
ardial
if first
infarc
Consens
aindic
choic
tion
• If ACE
ated)
e
us:
Addit
inhibi
• In
ion of
tors
elderl
β-blo
• Patien y patien or ARBs
ckers
are
ts,
ts
patien not achiev blood pressu used, monit
ts
ing
or renal
re shoul
of patien with severe target blood
d be
function
renal
ts with
pressu lowered
and
diseas
Source
hyper
e shoul re on three gradually serum potas
: Diabet
tensio
d be referr
es Care
to
n.
drugs
sium
2003;
levels
, includ avoid comp
ed to
.
26 (s
licatio
ing
a specia
80-82
list expera diuretic, ns.
).
ienced and
in the
care
Graphic Layout: Anna Dykeman, MA
New Mexico Medical Review Association
Albuq
P.O.
Box
uerqu
e, NM 3548
87190
(866)
(505) 796-9121
796-9
121
Diabetes and Cardiovascular Disease Provider Reference Guide—Physicians
can feel overwhelmed and frustrated by the daunting task of addressing diabetes with their
patients given the physical, emotional, social and environmental factors associated with this
disease. In an effort to address these issues and improve patient care and outcomes, this
reference guide was developed in cooperation with expert panels of physicians and other health
care providers to determine the most effective ways to prevent, assess and treat diabetes and
related cardiovascular disease. access the Reference Guide at www.thecmafoundation.org/
projects/aped/Provider_DiabetesRefGuide2010.html.
Websites—The editorial committee has identified websites that you may find
informative:
vAmerican Heart Association, Heart of Diabetes Program:
www.americanheart.org/diabetes
vNM Department of Health, Diabetes Prevention and Control Program:
www.diabetesnm.org
vAmerican Stroke Association: www.strokeassociation.org
vCenters for Disease Control and Prevention (CDC) Heart Disease page:
www.cdc.gov/HeartDisease/
vAmerican College of Cardiology: www.acc.org
vNational Diabetes Education Program: www.ndep.nih.gov
vAmerican Diabetes Association: www.diabetes.org
v
National Institute of Diabetes and Digestive and Kidney Disease, National Institute of
Health: www.niddk.nih.gov/health/diabetes/diabetes.htm
vNational Institutes of Health: www.diabetes.niddk.nih.gov
These websites may be accessed directly or through the New Mexico Health Care Takes
On Diabetes website www.nmtod.org.*
Advisory Board:
Kathleen Colleran, MD
Program Director, Endocrinology and
Metabolism, Department of Internal Medicine
University of New Mexico School of Medicine
Judith Gabriele, MPH
Program Manager, Diabetes Prevention
and Control Program, New Mexico
Department of Health
Jeremy Gleeson, MD, FACP, CDE
Medical Director, Dept. of Endocrinology
& Diabetes, ABQ Health Partners
Yvonne Peperzak-Blake, RN, MS, CDE
Valerie Quinn, RN, BS, CDE
CEO,Clinical Director
Diabetes Self-Management Center
Donna Tomky, MSN, RN, C-ANP, CDE
Nurse Practitioner, Dept. of Endocrinology
& Diabetes, ABQ Health Partners
Copyright 2011 by New Mexico
Health Care Takes On Diabetes.
Permission for educational use
may be obtained at 505.796.9121.
*Please note that these websites do not necessarily represent the views of NMHCTOD. They are listed for your reference and
convenience. NMHCTOD does not evaluate websites for content accuracy or application to any clinical situation.
Printed 2011