1. Metabolic Syndrome and Diabetes – How These Affect Hypertension
Management – DeHoff
a). Describe the characteristics that are associated with increased risk for diabetes
b). List the antihypertensive agents associated with increased risk for diabetes
c). Based on the available evidence, defend the current BP targets for patients with
diabetes. Metabolic Syndrome and Diabetes Essay
2. Single gene polymorphisms and Hypertension – Wingo
a). Describe the role of the renin-angiotensin-aldosterone system in the preservation of blood
pressure under normal physiologic circumstances and explain how the effector portions of this
system work to regulate blood pressure.
b). With what other systems do they coordinately work to increase blood pressure, and what
other systems specifically oppose their action?
c). Explain, with specific examples, how abnormal regulation or action of aldosterone can lead
to hypertension. You should list at least three clinical conditions that result from abnormal
regulation of the action of aldosterone.
Step 1/2
1. Metabolic Syndrome and Diabetes – How These Affect Hypertension Management – DeHoff
a) Characteristics associated with increased risk for diabetes include obesity, sedentary lifestyle, family history of diabetes, advanced age, race/ethnicity (e.g., African Americans, Hispanics/Latinos, Native Americans), high blood pressure, high cholesterol and triglycerides, history of gestational diabetes, and polycystic ovary syndrome.
b) Antihypertensive agents associated with increased risk for diabetes include thiazide diuretics, beta-blockers, and alpha-2 agonists. However, the benefits of blood pressure control outweigh the risks of these agents in most patients with hypertension.
c) Current blood pressure targets for patients with diabetes are <130/80 mmHg according to the American Diabetes Association guidelines. This recommendation is based on multiple randomized clinical trials demonstrating the benefits of intensive blood pressure control in reducing cardiovascular events and mortality in patients with diabetes.
Step 2/2
2. Single gene polymorphisms and Hypertension – Wingo
a) The renin-angiotensin-aldosterone system (RAAS) is a hormonal system that regulates blood pressure by controlling sodium and water balance. Renin, released by the kidneys in response to decreased blood pressure or blood volume, cleaves angiotensinogen to angiotensin I. Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II, which stimulates the release of aldosterone from the adrenal glands. Aldosterone acts on the kidneys to increase reabsorption of sodium and excretion of potassium, leading to increased blood volume and blood pressure. b) The sympathetic nervous system and the endothelin system work coordinately with the RAAS to increase blood pressure. The natriuretic peptide system opposes the action of the RAAS by promoting natriuresis and diuresis, leading to decreased blood volume and blood pressure. c) Abnormal regulation or action of aldosterone can lead to hypertension in several ways. Primary aldosteronism (also known as Conn syndrome) is a condition characterized by excess aldosterone production by the adrenal glands, which can lead to hypertension and hypokalemia. Secondary aldosteronism can occur in response to decreased blood flow to the kidneys or increased renin production, leading to increased aldosterone secretion and hypertension. Aldosterone receptor mutations or dysregulation of aldosterone signaling pathways can also lead to hypertension. Clinical conditions that result from abnormal regulation of aldosterone action include primary aldosteronism, renal artery stenosis, and heart failure.
Final answer
Conclusion, metabolic syndrome and diabetes can increase the risk of hypertension and may require the use of antihypertensive agents that carry an increased risk for diabetes. However, the benefits of blood pressure control outweigh the risks of these agents in most patients with hypertension. Current blood pressure targets for patients with diabetes are <130/80 mmHg, based on multiple randomized clinical trials demonstrating the benefits of intensive blood pressure control in reducing cardiovascular events and mortality in patients with diabetes. The renin-angiotensin-aldosterone system plays a key role in regulating blood pressure, and abnormal regulation or action of aldosterone can lead to hypertension and other clinical conditions. Understanding the interplay between these systems is crucial for effective management of hypertension. Metabolic Syndrome and Diabetes Essay
