Prevalence of undiagnosed non-insulin-dependent diabetes mellitus and impaired glucose tolerance in a cohort of older persons with hypertension

The diabetic hypertensive (or hypertensive diabetic)--a compelling need to optimize blood pressure

In summary, the present information on treating hypertension in the diabetic overwhelmingly indicates a compelling need to lower BP to target diastolic BP of 80 mmHg or less, to be less concerned about the types of drugs used than the blood pressures achieved and the concordance with therapy and to rely on two or more antihypertensive drugs in the majority of cases. Management of the hypertensive diabetic is very cost-effective. It is clear that we must engage in total cardiovascular risk management if we are to prevent the microvascular and macrovascular complications in the hypertensive diabetic (or the diabetic hypertensive).

Should we consider performing oral glucose tolerance tests more frequently in postmenopausal women for optimal screening of impaired glucose tolerance?

OBJECTIVE

To investigate an optimal screening protocol for impaired glucose tolerance (IGT) and type II or non-insulin-dependent diabetes mellitus (DM) by using fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) in postmenopausal women.

DESIGN

One hundred consecutive postmenopausal women were screened with FPG determination, and then all underwent an OGTT. Basal serum lipid and insulin levels of these women were also determined. Insulin sensitivity was determined by using the homeostasis model assessment. Receiver operating characteristic analysis was performed to determine the efficacy of these variables in detecting women with IGT and DM, and optimal cutoff values were determined.

RESULTS

FPG with a cutoff value of 98 mg/dL had the best combination of sensitivity (71%) and specificity (76%) for the detection of IGT and DM. Combined FPG and body mass index screening (with the optimal cutoff value of 26.5 kg/m2) improved the sensitivity to 96% but decreased the specificity to 47%. This combined screening protocol detected 94% of the women with IGT and all diabetic women.

CONCLUSIONS

Given that IGT and DM are common among postmenopausal women and DM can be prevented by nonpharmacologic interventions in women with IGT, OGTT may be used more frequently among these women. Our data indicate that for optimal screening of non-insulin-dependent DM and IGT, OGTT should be considered in postmenopausal women, especially when risk factors in addition to age are present. This model may detect most of the women with IGT and almost all diabetic women.

Treating hypertension in the elderly

Hypertension is highly prevalent in elderly individuals, the most rapidly growing segment of the US population. Epidemiologic studies have established that increased risk of cardiovascular disease is associated with elevated blood pressure. Treatment of hypertension in elderly patients significantly reduces their cardiovascular morbidity and mortality. However, antihypertensive therapy is often challenging in this patient population because of potential metabolic and physiologic alterations, multiple comorbidities, polypharmacy, and biologic variability. Drugs with a convenient dosing schedule, minimal side effects, and the ability to impact comorbid conditions are important considerations in the treatment of hypertension in the elderly.

Issues and trends in care of the hypertensive client

This article discusses issues and trends in care of the hypertensive client that pertain to practice, education, research, and health policy. Clinical practice issues center around obtaining accurate blood pressure measurements and educating patients about health promotion interventions and use of medications. These topics are important in the education of the beginning nurse student as well. Researchers have studied risk factors, incidence, and prevalence in global populations; use of pharmacologic agents; and investigative methods employing technology. Researchers are beginning to explore more holistic approaches to controlling risk factors before hypertension occurs. Funding for public education regarding prevention and control of hypertension is a number one health policy issue.