Sugar diabetes is a chronic disease that leads to early disability and worsens the quality of life of the patient. Diabetes is always accompanied by complications of varying severity caused by high levels Sugar in blood. Arterial hypertension sugar diabetes - This is one of the most common complications that requires proper treatment.

Sugar diabetes is the endocrine disorder, as a result of which insulin production is disturbed. There are two types of disease - type 1 and 2 diabetes.

The first-type diabetes is characterized by insulin deficiency due to the destruction of cells located in the pancreas that produce this hormone. The result becomes the complete inability of the body to adjust the level of glucose without delivering insulin from outside (injection). This disease is developing at a young age and remains with a person for life. For life support requires daily insulin injections.

The second type diabetes is the disease acquired at the older age. Pathology is characterized by a violation of the interaction of organism cells with a hormone produced by the pancreas. Insulin is sufficient to control the level of glucose, but the cells are not sensitive to the effects of this substance.

Arterial hypertension is a second-type diabetes satellite, since with a type of type 1 Daily insulin administration ensures full control of the functions of vital organs.

The diabetes of the second type is called metabolic disease. It develops due to obesity, hypodynamine, unbalanced nutrition. As a result, the carbohydrate-fat exchange is disturbed, there is an increase in the level of glucose and cholesterol in the blood. Increased glucose level leads to violation of vessel permeability. With a second-type decomposed diabete, it is a cardiovascular system gets damage first.

The diabetes of the second type is usually developing in full of people in older age.

The reasons for the development of hypertension in diabetes

Violation of glucose tolerance leads to the development of a number of failures in the work of the whole organism. A greater danger to the health and life of the patient is not the diabetes of the second type, but complications of this disease, among which:

• angiopathy;
• encephalopathy;
• nephropathy;
• polyneuropathy.

One of the factors that aggressive the course of the disease and largely worsening the quality of life of the patient is arterial hypertension.

Interesting fact: patients with type 2 diabetes faced with hypertension in about 75% of cases, while on an insulin-dependent type of diseases accounts for no more than 30% of cases of sustainable increase in blood pressure.

High pressure with diabetes mellitus is due to several factors:

• violation of carbohydrate exchange;
• fluid delay in the body and failure in the work of the kidney;
• violation of the structure of the vessels due to the high level of glucose;
• metabolic disorders that increase the burden on myocardium.

Reducing the sensitivity of tissues to insulin produced in the patient's body is always a consequence of metabolic disorders. In patients with diabetes type 2, there is an excess weight, which is one of the predisposing factors predisposing to the development of hypertension.

In addition to changing the structure of the vessels due to the high concentration of glucose, the functionality of the cardiovascular system negatively affects the disorder of the kidney operation during diabetes.

Thus, the main reason high pressure Diabetes is the general health of the patient. It should also be noted that the average age age of type 2 diabetes is 55 years, which in itself contributes to a group of risk of cardiovascular diseases.

The relationship of diabetes mellitus and hypertension imposes a number of restrictions on treatment. The choice of pressure from pressure during diabetes is a complex task that only a specialist can cope with, since some drugs of hypotensive action lead to an increase in blood sugar levels, which is dangerous during decompensated diabetes form.

Diabetes affects many organs, including a cardiovascular system

Why does hypertension in diabetes are particularly dangerous?

Sugar diabetes I. hypertonic disease - These are two "slow killers" of the 21st century. Both diseases cannot be cured once and forever. Type 2 diabetes requires constant compliance with diet and taking measures to normalize metabolism, and hypertension - blood pressure controls with drugs.

Typically, the treatment of hypertensive disease begins with a sustainable increase in pressure over 140 mm.rt.st. If the patient did not find other diseases, diet therapy and mono-therapy are practiced by one drug, to avoid development side Effects. Often, doctors are trying to delay the moment when the patient will have to go to the regular intake of hypotensive drugs. A timely detected hypertension of 1 degree can restrain a long time with the help of diet and sports. In diabet, hypertensive disease progresses with stunning speed.

Treatment question arterial hypertension With diabetes, today it is especially acute. High pressure during diabetes is dangerous to rinse with drugs, since the side effects of diabetics manifest themselves particularly acute. At the same time, pressure indicators for type 2 diabetes mellitus are growing very quickly. If a healthy person has hypertension can progress for years, no time in diabetes has no time, the disease is gaining momentum for several months. In this regard, the prescription of the drug treatment of hypertension in type 2 diabetes mellitus is practiced already at the initial stage of the disease. A sustainable increase in pressure to 130 to 90 in diabetics means the need to receive medicines to normalize it.

High pressure during diabetes is potentially dangerous risks of the development of the following states:

• myocardial infarction;
• brain stroke;
• severe renal failure;
• loss of vision;
• hypertensive encephalopathy.

Complications of high pressure with type 2 diabetes mellitus are difficult to treat and in most cases irreversible. The purpose of treating arterial hypertension in diabetes mellitus is the simultaneous normalization of blood pressure and blood glucose levels. It is important to identify the initial stage of hypertension in a timely manner and take all the necessary measures to prevent its progression.

Understand why it is so important to start the treatment on time, statistics will help. On average, every third person suffers from hypertension in one form or another. This disease leads to early disability and reduces the duration of life on average for 7-10 years. Sugar diabetes acquired at older age is dangerous with complications that are often irreversible. Few of the patients with diabetes 2 types live up to 70 years. Constantly high pressure diabetics with type 2 diabetes mellitus can reduce the duration of life for another 5 years. It is cardiovascular complications for type 2 diabetes in 80% of cases become the cause of death.

Complications irreversible and often end with death

Features of medication treatment

Highlights of hypertension therapy, which are fully applicable in the treatment of diabetes patients:

• control of blood pressure control using drugs;
• purpose of diet and therapy;
• reception of diuretic tools to avoid edema;
• correction of lifestyle.

Tablets from hypertension in diabetes must only be selected by a specialist. Pencil tablets should not interact with diabetes preparations, which are assigned to the patient to control blood glucose levels. The choice of drugs is carried out by the following criteria:

• effective control of blood pressure indicators and the prevention of his jumps;
• protection of myocardium and vessels;
• no side effects and good tolerability;
• lack of influence on metabolism.

Some drugs from sugar diabetes can provoke hypoglycemia and proteinuria, which is warned in the list of probable side effects. These states are potentially dangerous for diabetics and can lead to dangerous consequences.

Treat the increased pressure during diabetes is needed correctly. Preparations should be selected that slowly reduce the pressure and prevent its sharp jumps. It is important to note that a sharp decline in pressure after taking a tablet is a serious test for the cardiovascular system.

To treat the arterial hypertension in diabetes mellitus is necessary for drugs that do not affect the kidney function, since this body is one of the most vulnerable in disabilities of insulin susceptibility.

If the patient is at the same time hypertension and diabetes, which tablets drink depends on the overall health state. In diabetes mellitus, burdened by hypertensive disease should be achieved by normalization of pressure using drugs. For this purpose, prolonged action drugs are prescribed, providing round-the-clock pressure control:

• aCE inhibitors: Enalapril and Renaten;
• angiotensin II receptor blockers: Kozar, Lozell and Lozap Plus;
• calcium antagonists: Fozinopril, Amlodipine.

ACE inhibitors have more than 40 items, but with diabetes prescribe medicines based on Enalapril. This substance is characterized by a nephroprotective effect. ACE inhibitors delicately reduce blood pressure and do not increase blood sugar, therefore can be used with type 2 diabetes mellitus.

Angiotensin II receptor blockers do not affect the kidney function. Kozar and Lozart prescribe patients with diabetes regardless of age. These drugs rarely provoke side effects, normalize the activity of myocardium and have a prolonged action, thanks to which the pressure is controlled by taking only 1 tablet medication per day.

LOOP PLUS is a combined drug containing angiotensin receptor blocker and hydrochlorotiazide diuretics. When sustainable sugar diabetes compensation, this medicine is one of the best preparations Choosing, however, with a severe form of diabetes and high risks, the disorder of the kidney is not appointed.

Calcium antagonists perform a double function - reduce pressure and protect myocardium. The disadvantage of such drugs is a rapid hypotensive effect, which is why they cannot be taken at very high pressure.

Hypertensive disease or arterial hypertension in diabetes mellitus is not treated with beta-adrenoblockers, since the drugs of this group negatively affect the metabolism and provoke hypoglycemia.

Any medication from hypertension in diabetes must be prescribed only the attending physician. The expediency of using a drug depends on the severity of diabetes and the presence of complications of this disease in the patient.

Prevention of hypertension

Since Hypertension in diabetes is a direct consequence of a high level of glucose, prevention is reduced to the execution of all recommendations of the endocrinologist. Compliance with diet, the normalization of metabolism by getting rid of excess weights, the reception of gluing drugs and sugar drugs - all this makes it possible to achieve sustainable compensation for diabetes mellitus, in which the risk of complications is minimal.

Hypertension is when blood pressure is so raised that therapeutic measures will have much more benefit for the patient than harmful side effects. If you have a blood pressure 140/90 and higher - it's time to actively treat. Because hypertension increases the risk of heart attack, stroke, renal failure or blindness several times. In diabetes 1 or 2 types, the limit threshold of arterial pressure is lowered to 130/85 mm Hg. Art. If you have a higher pressure - you need to make every effort to reduce it.

With diabetes mellitus 1 or 2 types of hypertension is especially dangerous. Because if diabetes is combined with high pressure, the risk of fatal infarction increases 3-5 times, a stroke is 3-4 times, blindness - 10-20 times, renal failure - 20-25 times, gangrenes and leg amputations - 20 times. At the same time, high pressure is not so difficult to lead to normal, unless the kidney disease has not yet entered you too far.

Read about cardiovascular diseases:

The reasons for the development of hypertension in diabetes

In diabetes 1 and 2 types of causes of the development of arterial hypertension can be different. In diabetes mellitus 1, hypertension type in 80% of cases is developing due to kidney damage ( diabetic nephropathy). In diabetes, 2 types of hypertension usually develops in a patient much earlier than violation of carbohydrate metabolism and diabetes itself. Hypertension is one of the components that is the predecessor of type 2 diabetes.

The reasons for the development of hypertension in diabetes and their frequency

Notes to the table. Isolated systolic hypertension is a specific problem of elderly patients. Read more Read the article "Isolated systolic hypertension in the elderly." Another endocrine pathology is a peochromocytoma, primary hyperaldosteroneism, an Izsenko-Cushing syndrome or another rare disease.

Essential hypertension - it is meant that the doctor is not able to establish the cause of the increase in blood pressure. If hypertension is combined with obesity, then, most likely, the cause is the intolerance to food carbohydrates and an increased level of insulin in the blood. This is called "metabolic syndrome", it is well amenable to treatment. Also maybe:

• magnesium deficiency in the body;
• chronic psychological stress;
• incication of mercury, lead or cadmium;
• the narrowing of the large artery due to atherosclerosis.

And remember that if the patient really wants to live, then medicine is powerless :).

High pressure with type 1 diabetes

With diabetes mellitus 1 type main and very hazardous reason Increased pressure is kidney damage, in particular, diabetic nephropathy. This complication develops in 35-40% of type 1 diabetes patients and several stages take place:

• the stage of microalbuminuria (fine albumin protein molecules appear in the urine);
• the stage of proteinuria (the kidneys filter is worse, and large proteins appear in the urine);
• stage of chronic renal failure.

According to FSU Endocrinological science Center (Moscow), among patients with type 1 diabetes without hypertension kidney pathology suffer 10%. In patients at the microalbuminuria stage, this value increases to 20%, at the stage of proteinuria - 50-70%, at the stage of chronic renal failure - 70-100%. The more protein stands out with urine, the higher the blood pressure in the patient - This is a general rule.

Hypertension in the defeat of the kidneys develops due to the fact that the kidneys are poorly derived sodium with urine. Sodium in the blood becomes more, and the fluid accumulates to dilute it. Excessive amount of circulating blood increases blood pressure. If due to diabetes in the blood, the concentration of glucose is increased, then it pulls over even more fluid so that the blood is not too thick. Thus, the volume of circulating blood is still increasing.

Hypertension and kidney disease form a dangerous vicious circle. The body is trying to compensate for the weak work of the kidneys, and therefore the blood pressure increases. It, in turn, increases the pressure inside the glomeri. So called the filter elements inside the kidneys. As a result, the glasses gradually die, and the kidneys work worse.

This process ends with renal failure. Fortunately, on early stages Diabetic nephropathy The vicious circle can be broken if the patient is diligently treated. The main thing is to lower the blood sugar to normal. Also help medicines -, and. You can read more about them below.

Long before the development of the "real" type 2 diabetes the pathogenic process begins with. This means that the sensitivity of the tissues to the action of insulin is lowered. In order to compensate for insulin resistance, it circulates too much insulin in the blood, and this in itself increases blood pressure.

Over the years, the clearance of blood vessels is narrowed due to atherosclerosis, and it becomes another significant "contribution" to the development of hypertension. In parallel, abdominal obesity increases in the patient (around the waist). It is believed that the adipose tissue is distinguished into the blood substances that additionally increase blood pressure.

This whole complex is called. It turns out that hypertension is developing much earlier than type 2 diabetes. It is often found in the patient immediately when the diagnosis of diabetes is determined. Fortunately, it perfectly helps to take control of type 2 diabetes and at the same time hypertension. Details you can read below.

Hyperinsulinism is an increased insulin concentration in the blood. It arises in response to insulin resistance. If the pancreas have to develop an excess amount of insulin, then it is stiguously "wearing". When over the years she ceases to cope - the blood sugar increases and the type 2 diabetes occurs.

How hyperinsulinism increases blood pressure:

• activates the sympathetic nervous system;
• the kidneys are worse removed with the urine sodium and liquid;
• sodium and calcium accumulate inside the cells;
• excess insulin contributes to the thickening of the walls of blood vessels, which is why their elasticity is reduced.

Features of manifestations of hypertension in diabetes

With diabetes, natural daily rhythm of blood pressure fluctuations is disturbed. Normally in man in the morning and at night during sleeping blood pressure 10-20% lower than the day. Diabetes leads to the fact that many hypertensive pressure on the night does not fall. Moreover, with a combination of hypertension and diabetes, night pressure is often higher than the daily.

It is assumed that this violation arises from. Increased level of blood sugar affects the autonomous nervous system, which regulates the vital activity of the body. As a result, the ability of blood vessels to regulate their tone, i.e., narrow and relax depending on the load.

The conclusion lies in the fact that, with a combination of hypertension and diabetes, not only one-time pressure measurements with a tonometer, but also daily 24-hour monitoring are necessary. It is carried out using a special device. According to the results of this study, you can adjust the time of reception and dosage of drugs from pressure.

Practice shows that patients with diabetes 1 and 2 types are usually more sensitive to salts than hypertensive, which have no diabetes. This means that the restriction of salt in the diet can have a powerful therapeutic effect. With diabetes for treatment increased pressure Try to eat smaller salts and after a month, appreciate what happens.

High pressure during diabetes mellitus is often complicated by orthostatic hypotension. This means that blood pressure in the patient is drammed sharply during the transition from the position lying to the standing position or sitting. Ortostatic hypotension is manifested after a sharp rise in dizziness, in the eyes or even fainting.

Like a violation of the daily rhythm of blood pressure, this problem arises due to the development of diabetic neuropathy. The nervous system gradually loses the ability to control the tone of the vessels. When a person gets up quickly, the load immediately rises. But the body does not have time to increase blood flow by vessels, and because of this, well-being worsen.

Ortostatic hypotension makes it difficult to diagnose and treat high pressure. Measure pressure during diabetes is necessary in two positions - and standing, and lying. If the patient has this complication, then to get up to him every time he should slowly, "on well-being".

Our site is designed to propaganda a low-carbohydrate diet with diabetes 1 and 2 types. Because eat smaller carbohydrates is the best way Reduce and maintain your blood sugar. Your need for insulin will decrease, and this will help improve the results of the treatment of hypertension. Because the more insulin circulates in the blood, the higher the blood pressure. We have already discussed this mechanism in detail above.

Recipes for low-carbohydrate diet with diabetes 1 and 2 types

To what level to reduce pressure during diabetes?

Patients with hypertension with diabetes mellitus are patients with a high or very high risk of cardiovascular complications. They are recommended to reduce blood pressure up to 140/90 mm Hg. Art. In the first 4 weeks, if they move well the appointed drugs. In the following weeks, you can try to reduce the pressure to about 130/80.

The main thing is how the patient transfers medicinal therapy and its results? If bad, then reduce blood pressure should be slower, in several stages. At each of these stages - by 10-15% of the initial level, within 2-4 weeks. When the patient adapts - increase dosages or increase the amount of drugs.

If it reduces blood pressure in stages, it allows to avoid episodes of hypotension and thus reduce the risk of myocardial infarction or stroke. Lower border of the threshold of normal blood pressure - 110-115 / 70-75 mm Hg. Art.

There are groups of patients with diabetes, which have to reduce the "upper" blood pressure up to 140 mm Hg. Art. And below may be too difficult. Their list includes:

• patients who have already amazed target organs, especially the kidneys;
• patients having cardiovascular complications;
• older people, due to the age damage of vessels atherosclerosis.

It is difficult to choose pills from pressure for a patient who has diabetes mellitus. Because the disturbed exchange of carbohydrates imposes restrictions on the use of many drugs, including from hypertension. Choosing the drug, the doctor takes into account how the patient controls its diabetes and which related diseases, except hypertension, has already developed.

Good diabetes pressure pills should have the following properties:

• significantly lower blood pressure, and at the same time so that side effects were as small as possible;
• do not worsen the control of blood sugar, do not increase the levels of "bad" cholesterol and triglycerides;
• protect heart and kidneys from harm that diabetes and high pressure are applied.

Currently, there are 8 groups of drugs from hypertension, of which 5 main and 3 additional. Tablets that belong to additional groups are prescribed, as a rule, in combination therapy.

Pressure drugs

Diuretics (diuretic drugs) from pressure

Classification Diuretikov

Detailed information about all these diuretic drugs can be found. And now let's discuss how diuretics are treated with a hypertension during diabetes.

Hypertension in patients with diabetes often develops due to the fact that the volume of circulating blood is increased. Also diabetics distinguishes increased sensitivity to salt. In this regard, diuretics are often prescribed to treat elevated blood pressure during diabetes. And many patients with diuretic drugs help well.

Doctors appreciate thiazide diuretics for the fact that these drugs are about 15-25% reduce the risk of heart attack and stroke in patients with hypertension. Including those who have type 2 diabetes mellitus. It is believed that in small doses (equivalent of hydrochlorotiazide< 25 мг в сутки) они не ухудшают контроль сахара в крови и не повышают “плохой” холестерин.

Thiazide and thiazid-like diuretics are contraindicated patients at the stage of chronic renal failure. Loop diuretics, on the contrary, are effective in renal failure. They are prescribed if hypertension is combined with edema. But there are no data that they protect the kidneys or heart. Painting and osmotic diuretic drugs during diabetes do not apply at all.

With hypertension, in combination with diabetes mellitus, small doses of tiazide diuretics are usually prescribed together with or. Because diuretic drugs themselves, without other drugs, are not effective in such a situation.

Beta blockers

Medicines from a group of beta blockers are:

• selective and non-selective;
• lipophilic and hydrophilic;
• with internal sympathomimetic activity and without it.

All these are important properties, and it is advisable to spend the patient to spend 10-15 minutes to deal with them. And at the same time, learn about contraindications and side effects of beta blockers. After that you can understand why the doctor prescribed one or another drug.

Beta blockers must be prescribed by diabetes mellitus if it is diagnosed with something from the following list:

• coronary heart disease;
• heart failure;
• a sharp post-instruction period - for the prevention of myocardial repeated infarction.

In all these situations, beta blockers reliably reduce the risk of death from cardiovascular diseases and other reasons.

At the same time, beta-blockers are able to mask the symptoms of the impending severe hypoglycemia, and also make it difficult to exit the hypoglycemic state. Therefore, if diabetics is impaired hypoglycemia recognition, then these medicines can only be prescribed with high caution.

Selective beta blockers have the smallest negative effect on metabolism during diabetes. This means that if the patient's testimony requires beta-blockers, then you need to use cardioslelective preparations. Beta blockers with vasodinating activity - nonbivolol (root) and carvedilol (Coriol) - can even improve the metabolism of carbohydrate and fats. They increase tissue sensitivity to insulin.

Note. Carvedilol - although not selective beta blocker, but it is one of modern drugswhich is widely used, effectively acts and, probably, does not worsen the metabolism in diabetes.

Modern beta blockers, rather than the preparations of the previous generation, are recommended to give preference in the treatment of diabetes patients, as well as patients from the risk group of type 2 diabetes mellitus. In contrast, non-selective beta-blockers that do not have vasodilatory activity (propranolol) increase the risk of type 2 diabetes.

Angiotensin-II receptor blockers (angiotensin receptor antagonists)

You can find detailed information about these relatively new drugs. For the treatment of high pressure and kidney problems in diabetes, angiotensin-Ii receptor blockers are prescribed if the patient has developed a dry cough. This problem occurs about 20% of patients.

Angiotensin-II receptor blockers are more expensive than ACE inhibitors, but do not cause a dry cough. All that is written in this article is higher in the section on ACE inhibitors, applies to the angiotensin receptor blockers. Contraindications are the same, and the same tests need to be taken during the reception of these drugs.

It is important to know that angiotensin-Ii receptor blockers reduce the left ventricular hypertrophy of the heart better than the ACE inhibitors. Patients carry them better than any other medicines from high pressure. The side effects have no more than at placebo.

This is about new drug. It was developed later than ACE inhibitors and angiotensin receptor blockers. Rasilez was officially registered in Russia
In July 2008. The results of long-term studies of its effectiveness are still expected.

Rasilez - direct Renin inhibitor

Rasilez prescribed along with aPF inhibitors or angiotensin -ii receptor blockers. Such combinations of drugs provide expressed action on the protection of heart and kidney. Rasilez improves blood cholesterol and increases tissue sensitivity to insulin.

Alpha adrenoblocators

For long-term treatment of arterial hypertension, selective alpha-1-adrenoblays are used. The drugs of this group include:

• prazozin
• doxazozin
• terasosin

Pharmacokinetics of selective alpha-1-adrenoblockers

Side Effects of Alpha Adrenoblockers:

• ortostatic hypotension, up to fainting;
• edema feet;
• cancellation syndrome (blood pressure strongly jumps "ricochet");
• resistant tachycardia.

Some studies have shown that alpha adrenoblockers increase the risk of heart failure. Since then, these drugs do not use much popular except some situations. They are prescribed together with other drugs in hypertension, if the patient has a benign prostatic hyperplasia.

In diabetes, it is important that they have a beneficial effect on metabolism. Alpha-adrenoblockers lower blood sugar, increase the sensitivity of tissues to insulin, improve cholesterol and triglycerides.

At the same time, heart failure is contraindicated to use them. If the patient is manifested by orthostatic hypotension, then the alpha-adrenoblocrators cannot be prescribed.

What pills to choose to treat hypertension during diabetes?

In recent years, more and more doctors are inclined to for the treatment of high pressure, it is better to appoint not one, but at once 2-3 drugs. Because patients usually act at the same time several mechanisms for the development of hypertension, and one medicine cannot affect all reasons. Plus tablets are because they are divided into groups that they act differently.

A single-only medicine allows you to lower the pressure to the norm not more than 50% of patients, and then if hypertension was initially moderate. At the same time, combination therapy allows you to use smaller doses of drugs, and still get better results. In addition, some tablets weaken or completely eliminate side effects of each other.

Hypertension is not dangerous by itself, but the complications that it causes. Their list includes: heart attack, stroke, renal failure, blindness. If high blood pressure is combined with diabetes, the risk of complications increases several times. The doctor assesses this risk for a particular patient and after that decides, begin treatment with one tablet or immediately use a combination of drugs.

Explanations to Figure: Hell - blood pressure.

The Russian Association of Endocrinologists recommends the following strategy for treating moderate hypertension in diabetes. First of all, an angiotensin receptor blocker or an ACF inhibitor is prescribed. Because drugs from these groups protect the kidneys and the heart better than other drugs.

If monotherapy inhibitor APE or angiotensin receptor blocker does not help sufficiently reduce blood pressure, they recommend adding a diuretic. What kind of diuretic tool choose - depends on the safety of the kidney function in the patient. If there is no chronic renal failure - thyazid diuretics can be used. The drug Indapamide (arithon) is considered one of the safe diuretic products for the treatment of hypertension. If renal failure has already been developed - loop diuretics are prescribed.

Explanation of the drawing:

• Blood pressure;
• SCF - the speed of glomerular filtration of the kidneys, read more "What tests need to be passed to test your kidneys";
• CPN - chronic renal failure;
• BKK-DGP - Dihydropyridine calcium channel blocker;
• BKK-NDGP - non-dihydropyridine calcium channels blocker;
• BB - beta blocker;
• iAPF - an ACF inhibitor;
• Ara is an angiotensin receptor antagonist (angiotensin-II receptor blocker).

It is advisable to prescribe drugs that contain 2-3 actors in one tablet. Because the smaller the pills, the more the patients they take them.

Short list combined drugs From hypertension:

• corenediek \u003d Enalapril (ReniPee) + hydrochlorotiazide;
• fozid \u003d fozinopil (monophil) + hydrochlorotiazide;
• co-dotroid \u003d leasing (dotroid) + hydrochlorotiazide;
• hyzar \u003d losartan (Kozar) + hydrochlorotiazide;
• naliprell \u003d perindopril (pretarium) + thiazid-like Diuretik Indapamide Retard.

It is believed that ACE inhibitors and calcium channel blockers enhance the ability of each other to protect the heart and kidneys. Therefore, the following combined drugs are prescribed:

• tarka \u003d Trandolapril (Hopper) + verapamil;
• presant \u003d perindopril + amlodipine;
• equator \u003d leasing + amlodipine;
• exeff \u003d Valsartan + Amlodipine.

We are strongly warned by patients: do not appoint yourself your own medicine from hypertension. You can severely suffer from side effects, right up to death. Find a qualified doctor and consult it. The doctor observes hundreds of patients with hypertension every year, and therefore it accumulates practical experience as medicines act and which of them are more efficient.

Hypertension and sugar diabetes: conclusions

We hope you turned out to be useful this article about hypertension in diabetes mellitus. High pressure during diabetes is a huge problem for doctors and for patients themselves. Especially urgent is the material that is presented here. In the article "Causes of hypertension and how to eliminate them. Analyzes with hypertension "You can find out in detail what tests must be passed for effective treatment.

After reading our materials, patients will be able to better understand the hypertension in diabetes 1 and 2 types to adhere to the strategy of effective treatment, extend their life and legal capacity. Information about pressure pills is well structured and serve as a comfortable crib for doctors.

We want to emphasize once again that - an effective means to reduce blood sugar in diabetes, as well as bring blood pressure to normal. This diet is useful to adhere to patients with diabetes not only the 2nd, but even 1 type, except for cases of severe kidney problems.

Perform our or. If you limit carbohydrates in your diet, it will increase the likelihood that you can lead arterial pressure to normal. Because the less insulin circulates in the blood, the easier it is to do it.

Hypertensive disease occurs by 50% more often in patients with diabetes. Therapy contains a special menu in hypertension and diabetes, as well as changes in the style of life. But 65-90% of patients should take antihypertensive drugs to reduce blood pressure numbers. In 3 out of 10 people with a type 1 type and 8 out of 10 people with a type of type 2, an increased blood pressure is developing at a certain stage. In the presence of such pathology, one should strive to maintain the optimal degree of blood pressure. The presence of increased blood pressure (hypertension) is one of several predisposing risk factors that increase the likelihood of infarction, stroke and some other complications.

Forms of hypertension

Increased pressure in the vascular bed in conditions of SD is defined as systolic blood pressure ≥ 140 mm Hg. and diastolic blood pressure ≥ 90 mm Hg.st. Severe two forms of high blood pressure (blood pressure) with diabetes:

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• Isolated hypertension on the background of the SD;
• Hypertension caused by diabetic nephropathy;

Diabetic nephropathy is one of the main microvascular problems of diabetes and is the leading root cause of the development of acute renal failure in the Western world. As well as the main component of morbidity and mortality in patients with type 1 and 2 diabetes. Often the type 1 type is manifested by hypertensive disease due to the development of pathology in kidney vessels. In patients with diabetes mellitus 2, high blood pressure diabetes often exists to the primary manifestation of pathological manifestations in the kidneys. In one study, 70% of patients with first-type diagnosed diabetes mellitus have already had hypertension.

Causes of the development of arterial hypertension in diabetes

In the world about 970 million people suffer from hypertension. WHO regards hypertension as one of the most important reasons for premature death in the world, and this problem extends. In 2025, it is estimated that there will be 1.56 billion people living with high blood pressure. Hypertension is developing due to the main factors that are present independently or together:

• The heart works with a greater force, pumping blood along the vessels.
• Suggested or closed by atherosclerotic plaques vessels (arterioles) have resistance to blood flow.

Increasing blood glucose and hypertensive disease has common pathogenesis paths, such as a sympathetic nervous system, a renin-angiotensin-aldosterone system. These paths interact and affect each other and generate a vicious circle. Hypertension and diabetes are the final results of metabolic syndrome. Therefore, they can develop one after another at the same person or independently of each other.

Risk factors and symptoms of disease

According to the American Diabetic Association, a combination of 2 pathologies is especially fatal and significantly increases the risk of a heart attack or stroke. SD 2 of the type and arterial hypertension also increases the chances for the defeat of other organs and systems, such as the defeat of the enema of the kidney and retinopathy vessels (pathology of the convulsion vessels of the eye). 2.6% of the case of blindness occur in diabetic retinopathy. Uncontrollable diabetes is not the only health factor that increases the risk of raising blood pressure. The chances of necrosis of the heart muscle or hemorrhage into the brain increase exponentially, if there is more than one of the following risk factors:

• stress;
• diet with elevated fat content, salt;
• sedentary lifestyle, adamina;
• elderly age;
• obesity;
• smoking;
• alcohol consumption;
• chronic diseases.

As a rule, hypertensive disease does not have specific symptoms and is accompanied by headache, dizziness, edema. That is why you need to regularly check the level of blood pressure. The doctor will measure it at each visit, and also recommend checking it at home every day. Most often, diabetes is manifested by such symptoms:

• frequent urination;
• strong thirst and hunger;
• increase weight or fast weight loss;
• men's sexual dysfunction;
• numbness and tingling in their hands and legs.

How to reduce pressure?

If there are high levels of sugar, it is recommended to hold hell at 140/90 mm Hg. Art. and below. If the pressure numbers above should begin treatment. Also, problems with the kidneys, sight or presence in the past transferred stroke are direct readings for therapy. The choice of the drug is selecting the attending physician depending on age, chronic diseases, diseases of the disease, tolerance of the drug.

Medicinal products for treatment while simultaneously

Treatment of arterial hypertension in diabetes must be comprehensive. Antihypertensive preparations of the first line include 5 groups. The first medicine, which is most often used in concomitant diabetes, is a drug from a group of angiotensin surgery enzyme inhibitors (IAPF). In case of intolerance, the IAPF is prescribed a group of angiotensin 2 receptor blockers (sardans). In addition to the hypotensive (reduced pressure) of the action, these drugs are able to prevent or slow down the defeat of the kidney and retinal vessels in people suffering from the CD. ACE inhibitor should not be combined with an angiotensin receptor antagonist 2 in therapy. To improve the effect of hypotensive drugs, add to the treatment of diuretics, but only with the recommendation of the attending physician.

Turn

Hypertension - increased blood pressure. Pressure with diabetes mellitus 2 typesit is necessary to hold in numbers 130/85 mm RT. Art. More high rates Increase the likelihood of a stroke (3-4 times), heart attack (3-5 times), blindness (10-20 times), renal failure (20-25 times), gangrena with subsequent amputation (20 times). To avoid such terrible complications, their consequences should be taken by hypotensive drugs in diabetes.

Hypertension: causes, species, features

What unites sugar diabetes and pressure? Combines the defeat of the organs: the heart muscles, kidneys, blood vessels, the mesh shell of the eye. Hypertension in diabetes is often primary, precedes the disease.

Features of hypertension in diabetics

Patients:

1. The rhythm of blood pressure is violated - when measuring night rates turn out to be higher than daytime. The reason is neuropathy.
2. The effectiveness of the agreed work of vegetative nervous system: The control of the tone of blood vessels is disturbed.
3. The orthostatic form of hypotension is developing - low pressure under diabetes mellitus. A sharp rise of a person causes attack of hypotension, a darkening in the eyes, weakness appears, a faint condition.

Hypertension: Treatment

When to start the treatment of hypertension during diabetes mellitus? What kind of pressure during diabetes is dangerous to health? As soon as a few days, pressure during type 2 diabetes is kept at 130-135 / 85 mm. RT. Art., Need treatment. The higher the indicators, the higher the risk of various complications.

Diuretics

Treatment must be started with diuretic tablets (diuretics). Basic diuretics for diabetics 2 type list 1

Important: Diuretics break the electrolyte balance. Magic, sodium, potassium from the body is removed, so triamteren, spirironolactone is prescribed to restore the electrolyte balance. All diuretics are accepted only by medical testimony.

Hypotensive drugs: groups

The choice of drugs is the prerogative of doctors, to engage in self-medication is dangerous to health and life. Selecting drugs from diabetes and preparations for the treatment of type 2 diabetes mellitus, doctors are guided by the condition of the patient, the characteristic of drugs, compatibility, choose the safest forms for a particular patient.

Hypotensive preparations for pharmacokinetics can be divided into five groups.

Tablets from pressure during diabetes 2 type list 2

Important: Tablets from high pressure - beta blockers with vasodilators - the most modern, practically safe drugs - expand small blood vessels, has a favorable effect on carbohydrate-lipid exchange.

Please note: some researchers believe that the safest hypertension pills with sugar, insulin-dependent diabetes - nebivolol, carvedilol. The remaining tablets of the beta-blockers group are considered dangerous, incompatible with the main disease.

Important: beta blockers disguise symptoms of hypoglycemia, so they must be assigned to greater caution.

Hypotensive drugs during diabetes 2 type list 3

Important: Selective alpha blockers have the "first dose effect". The first reception of the tablet leads to an orthostatic collapse - due to the expansion of the blood vessels, the sharp rise causes blood outflow from the head down. A person loses consciousness and can get injured.

Preparations for the treatment of hypertension in diabetes mellitus 2 type list 4

Ambulance tablets for emergency decline in blood pressure: Andipal, captopril, nifedipine, clofelin, anaprilin. The action lasts up to 6 hours.

Tablets from hypertension in diabetes 2 type list 5

Preparations to reduce pressure are not limited to these lists. The list of drugs is constantly updated with new, more modern, efficient developments.

Reviews

Victoria K., 42 years old, designer.

I have two years hypertension and type 2 diabetes mellitus. Tablets did not drink, treated herbs, but they no longer help. What to do? Girlfriend says that you can get rid of the high pressure if you take bisaprolol. What pills from pressure is better to drink? What to do?

Victor Podorin, an endocrinologist.

Dear Victoria, I would not advise you to listen to a girlfriend. No appointment of a doctor takes medicines not recommended. Increased pressure during diabetes mellitus has different etiology (causes) and requires a different approach to treatment. Medicine from high pressure prescribes only a doctor.

Folk remedies from hypertension

Arterial hypertension causes a violation of carbohydrate metabolism in 50-70% of cases. In 40% of patients occurs against the background of arterial hypertension, the development of type 2 diabetes. The reason is insulin resistance - immunity of insulin. Sugar diabetes and pressure requires immediate treatment.

Treatment of hypertension by folk remedies in diabetes mellitus need to begin with respect for the rules of a healthy lifestyle: maintaining a normal weight, abandon smoking, drinking alcoholic beverages, limit salt consumption, harmful products.

Folk remedies for reducing pressure in diabetics 2 type list 6:

Treatment of hypertension by folk remedies with diabetes mellitus is not always effective, so along with the phytotherapy, you need to take medications. Folk remedies should be used very carefully, after consultation with the endocrinologist.

Power Culture or Proper Diet

Diet with hypertension and type 2 diabetes is aimed at reducing the blood pressure and normalization of blood glucose levels. Meals with hypertension and type 2 diabetes mellitus need to be coordinated with an endocrineologist and a nutritionist.

Food rules:

1. Balanced nutrition (the right ratio and number) of proteins, carbohydrates, fats.
2. Low carb, rich in vitamins, potassium, magnesium, microelements of food.
3. Eating for more than 5 g of salt per day.
4. A sufficient amount of fresh vegetables and fruits.
5. Fractional nutrition (at least 4-5 times a day).
6. Compliance with diet number 9 or number 10.

Conclusion

Hypertension medicines are widely represented on the pharmaceutical market. Original drugsGenerics of different pricing policies have their advantages, indications and contraindications. Sugar diabetes and arterial hypertension accompany each other, require specific therapy. Therefore, in no case cannot be engaged in self-medication. Only modern methods of treating diabetes and hypertension, qualified destinations of the endocrinologist and cardiologist will lead to the desired result. Be healthy!

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The combination of diabetes and hypertension has the general pathogenesis paths. These diseases have a powerful damaging effect on the human body. The first target authorities suffer: the vessels of the retina, heart, kidney, brain vessels. When progressing both diseases, disability is possible. For this reason, diabetics show constantly monitoring the level of systolic and diastolic pressures. In the case of their persistent increase, it is necessary to begin the appropriate treatment of hypertension in type 2 diabetes mellitus.

What is hypertension

Medicine this disease is defined as a persistent increase in blood pressure from 140/90 mm RT. Art. and higher. Essential hypertension is about 90-95% of cases. It appears as an independent disease and is characteristic of type 2 diabetes mellitus. Hypertension in 70-80% of cases precedes this pathology, and only 30% of patients develop after kidney damage. There is also secondary hypertension (symptomatic). It develops with type 1 diabetes.

Causes of High Pressure Diabetes

Depending on the type of diabetes, the reasons for the development of hypertension are determined. With 1 type of 80% of cases of arterial hypertension develop due to diabetic nephropathy, i.e. Due to the defeat of the kidneys. In the case of type 2 diabetes, the pressure increases even before it occurs. It precedes this serious disease, speaking part of the metabolic syndrome.

SD 1 type

The difference of type 1 diabetes mellitus (SD 1) is the constant need of the patient in insulin injections - substances that helps glucose is in cells, which ensures their livelihoods. It ceases to be generated in the body itself. The cause of most cases of such a disease is the death of more than 90% of the pancreas cells. This type of SD insulin-dependent is inherited, and not acquired during life. Among the causes of arterial hypertension, as they are noted as follows:

• hypertension isolated systolic - 5-10%;
• essential hypertension - 10%;
• diabetic nephropathy and other kidney problems - 80%.

SD 2 type

There is also an insulin-dependent type of diabetes (SD 2). It is distributed among adults after 40 years, but sometimes there are also children. The cause of the disease is the insufficient production of the pancreas insulin. As a result, exchange processes cannot flow normally. SD 2 is purchased during life. Especially often it occurs in patients with obesity or excess weight.

Hypertension on the background of this type of CD develops as a result:

• pathology endocrine system – 1-3%;
• violations of the patency of kidney vessels - 5-10%;
• nephropathy diabetic - 15-20%;
• hypertension isolated systolic - 40-45%;
• hypertension of the essential (source type) - 30-35%.

How does hypertension appear in diabetes

With some type, large arteries and small vessels in the human body are affected. Due to lowering their elasticity, pressure drops begin. Most diabetics, due to high blood pressure, the brain circulation is disturbed. Treatment of hypertension in diabetes depends on its manifestations. With SD 1, it is interconnected with diabetic nephropathy, which strikes the nerves of the peripheral nervous system and structural kidney units, causing:

1. The appearance in the urine of albumin - microalbuminuria. Speaker early symptom Enhance arterial pressure.
2. Proteinuria. It is a decrease in the filtering ability of the kidneys. The consequence becomes the appearance in the urine of a common protein. Under proteinuria, the risk of developing hypertension increases to 70%.
3. Chronic renal failure. At this stage, complete kidney dysfunction is observed, which is a 100% guarantee for the development of malignant hypertension.

CD 2 types more often develops against the background of obesity. If the disease is combined with hypertension, then its occurrence is associated with intolerance to food carbohydrates or high blood glucose levels. It precedes violations of glucose metabolism in the body. This condition is called "metabolic syndrome". The correction of insulin resistance is carried out with low-carb power supply.

How to treat hypertension during diabetes

Patients with such diseases are chosen by special treatment. They need normalization of blood pressure, otherwise, according to cardiologists, high risk of developing cardiovascular complications: ischemic heart disease (IBS), heart failure, stroke. Dangerous consequence It is hypertensive crisis. Treatment is integrated. It includes:

1. Low carb diet. To avoid sharp fluctuations in blood pressure, it is necessary to lower the content in the diet of low-density lipoproteins and glucose.
2. Pressure tablets in diabetes mellitus include different categories of medicines that affect certain mechanisms, lowering pressure.
3. Folk Methods. They restore the disturbed metabolism, thereby reducing the pressure. Before using alternative medicine, you must consult with an endocrinologist to individually choose the appropriate medicinal herbs or recipes.

Low carb diet

One of the main ways to normalize blood sugar levels and reduce pressure is a low-carb diet. All products used for dishes must be subject to sparing culinary processing. To do this, use cooking, baking, quenching and cooking for a couple. Such methods of processing are not irritated by the walls of the vessels, which reduces the risk of developing malignant hypertension.

The daily diet should include vitamins and trace elements that help improve blood circulation in target organs. When making a menu, you must use the list of allowed and prohibited products. The first category includes:

• seafood;
• fruit kissel;
• degreased dairy products;
• herbal tea;
• marmalade;
• bread of coarse grinding flour;
• eggs;
• lean grade meat and fish;
• vegetable broth;
• greens;
• dried fruits;
• vegetables.

The use of these products gradually stabilizes blood pressure levels. Proper nutrition In diabetes of the second type with hypertension, reduces the number of appointed hypotensive drugs. Include useful food in the diet is not enough. It is also necessary to abandon a number of products:

• sharp types of cheese;
• marinades;
• alcohol;
• bakery products;
• chocolate;
• fat broths;
• coffee and coffee beverages;
• fatty meat and fish;
• pickles;
• sausages, smoked sausages.

Medical therapy

A specific cure for hypertension in diabetes mellitus is chosen with extreme caution, because for many medicines, this disease is a contraindication. The basic requirements for drugs are as follows:

• ability to reduce blood pressure at a minimum of side effects;
• lack of influence on the amount of glucose in the blood, the level of "bad" cholesterol and triglycerides;
• the presence of the effect of protecting the kidneys and hearts from the combination of SD and hypertension.

Today there are several groups of medicines. They are divided into two categories: basic and auxiliary. Additional preparations are used when prescribing the patient of combination therapy. Composition used medicinal groups Reflected in the table:

Folk treatments

Recipes of alternative medicine more gently affect the body, helping to reduce the manifestations of side effects and speed up the action of medicines. Should not rely solely on folk remediesAnd before their use, you must consult with your doctor. Among effective recipes The following are highlighted against high pressure:

1. Collect number 1. Prepare 25 g of lattice grass, 20 g of dill seeds, 25 g of hawthorn flowers. Mix the ingredients and grind with a coffee grinder. On the specified amount of grasses take 500 ml of boiling water. Throw a mixture for about 15 minutes on a small fire. Before applying to filter through the gauze. Use no more than 4 glasses per day for 4 days.
2. Collect number 2. On 1 liter of boiling water to take 30 g of currant leaves, 20 g of oreganic and chamomile flowers, 15 g of a brawl. Tray mixture on slow heat for 10-15 minutes. Use for half an hour before meals 3 times a day.
3. About 100 g of berries hawthorn brew boiling water, boil them on a small fire about a quarter of an hour. Next, give the brave to cool at room temperature. Before use, strain through the gauze. You need to drink a decoction instead of ordinary tea throughout the day.

Hypotensive drugs

The traditional method of treating hypertension in diabetes is the reception of antihypertensive medicines. There are different types of such funds. Their difference lies in the action mechanism. The doctor can assign one medicine, i.e. Monotherapy. The treatment is most often used in the form of combined therapy - as defined either at once several types of tablets. It helps reduce dosages of active ingredients and reduce the number of side effects. Several tablets affect various mechanisms for the development of hypertension.

Beta adrenoblocators

These are drugs that reduce the frequency of heart abbreviations. In case of hypertension, they are prescribed in case of constant atrial fibrillation, tachycardia, after heart attack, angina and chronic insufficiency Hearts. The effect of these medicines is to block beta-adrenoreceptors located in different organs, including the heart and vessels.

The side effect of all beta blockers is masking signs of hypoglycemia. The output from such a state slows down. For this reason, beta-blockers are contraindicated by patients who feel the beginning of signs of hypoglycemia. All actors of beta blockers will end on "-LOL." There are several groups of such drugs: lipophilic and hydrophilic, without internal sympathomimetic activity or with it. According to the main classification, beta blockers are:

1. Non-selective. They block beta1 and beta2 receptors, enhance insulin resistance. It also distinguishes the drug anaprilin with propranolol in the composition.
2. Selective. Beta2 receptor blocking causes undesirable effects, such as bronchial spasms, provoking asthma attacks, vessel spasms. For this reason, electoral beta blockers were created. They are called cardioslective and block only beta1 receptors. Here are the existing substances Bisoprolol (Concor), metoprolol, atenolol, betaxolol (Locase). They also strengthen insulin resistance.
3. Beta blockers with vasodilatory effect. These are more modern and safe pills from hypertension during diabetes mellitus. They are characterized by fewer side effects, favorably affect the carbohydrate and lipid profile, reduce insulin resistance. The most suitable in this group for diabetics are drugs dilantrend (carvedilol) and a haillet (nebivolol).

Calcium channel blockers

Abbreviated these drugs are referred to as BBK. They block the slow canals in the blood vessels and the heart muscle, which are opened under the action of norepinephrine and adrenaline. As a result, there is less calcium - a trace element that activates many bioenergy processes in muscle cells. This leads to extension of vessels, against the background of which the number of heart abbreviations is reduced.

Calcium antagonists sometimes cause headache, tides, swelling, constipation. For this reason, they are replaced by magnesium preparations. They not only reduce pressure, but also improve the work of the intestines, soothing the nerves. In diabetic nephropathy, it is necessary to preliminarily comply with the doctor. Types of BBK are allocated depending on which channels are blocked:

1. Verapamil group. These medicines affect muscle vessels and hearts. This includes drugs of NEDIGIDROPIRODINOINS groups: phenylaclamines (verapamil), benzothiazepines (Dilziamathem). They are forbidden to be used together with beta-blockers due to the risk of rhythm disorders. The result may be an atrioventricular blockade and a heart stop. Verapamil and Dilziamathem - a good alternative to beta-blockers when they are contraindicated, but necessary.
2. Group of nifedipine and dihydropyridine BBK (ends on "-dipin"). These medicines practically do not affect the work of the heart, so they are allowed to combine with beta blockers. The minus they are becoming the increase in the pulse than the heart is trying to maintain pressure when it decreases. In addition, all BBCs do not have nephroprotective activity. Contraindication to use are hyperglycemia and unstable angina. In this category there are several subtypes of Dihydropyridine Drugs:
   • nifedipin - Corinthar, Corinthar Restard;
   • felodipine - Adalat SL, Nimodipin (Nimotop);
   • lercanidipine (Lercamen), Laudipin (Sakur), Amlodipine (Norvask), Nagardipine (Barisin), Isragian (Lomir), Nitrendipin (Baipress).

Diuretics

Diabetic has increased sensitivity to salt and increased circulating blood. As a result, blood pressure increases. To reduce it, diuretics use (diuretics). They remove excess liquid and salt from the body, reduce the volume of circulating blood, which helps to reduce systolic and diastolic pressure.

Against the background of SD diuretics, they are often combined with beta-blockers or ACE inhibitors, as in the form of monotherapy they picked their ineffectiveness. There are several groups of diuretics:

APF inhibitors

Treatment of hypertension in diabetes is not without inhibitors of angiotensin glossy enzyme, especially in the presence of complications on the kidneys. Contraindication to their use is pregnancy, hypercalemia and an increase in serum creatinine. In patients with diabetes 1 and 2 types, ACE inhibitors are the preparations of the first line of choice. They are prescribed during proteinuria and microalbuminuria.

The effect of drugs is to increase tissue sensitivity to insulin. This ensures the prevention of type 2 diabetes. ACE inhibitors expand the vessels, and sodium and water due to them cease to accumulate in the tissues. All this leads to a decrease in pressure. The names of the ACE inhibitors ends on "-pril." All medicines are divided into the following groups:

1. Sulfgidrile. This includes Benazepril (potential), captopril (Kopoten), Zofensoid (Zocardis).
2. Carboxyl. Includes perindopril (preshairium, noliprel), Ramipril (Amprilan), Enalapril (Berlipril).
3. Phosphinyl. In this group, fodicard and fozinopoid are allocated.

Auxiliary drugs

If the patient is appointed combined therapy, then the main drugs are used auxiliary. They are used with caution due to possible side effects. Indication for appointment auxiliary means It is the impossibility of treating the main drugs. For example, from ACE inhibitors in some patients there is a dry cough. In such a situation, a qualified doctor translates the patient to the therapy of angiotensin receptor antagonists. Each case is considered individually depending on the patient's condition.

Direct inhibitor Renin

The drug Resiliez is a direct inhibitor of renaine with pronounced activity. The effect of the drug is aimed at blocking the process of conversion of angiotensin from I form I form. This substance narrows the vessels and makes the adrenal glands produce a hormone aldosterone. Arterial pressure Reduced after long use Reception. The advantage of the medicine is that its effectiveness does not depend on weight, patient age.

By minuses include the impossibility of using during pregnancy or its planning in the near future. Among the side effects after receiving reception, there are:

• anemia;
• diarrhea;
• dry cough;
• rash on the skin;
• increasing the level of potassium in the blood.

It is worth noting that long-term research of racileese has not yet been carried out. For this reason, doctors only assume that the medicine has the effect of kidney protection. Racilenez is more often combined with angiotensin II receptor blockers and ACE inhibitors. Against the background of their reception, the drug increases tissue sensitivity to insulin and improves blood performance. Racilez is contraindicated at:

• renovascular hypertension;
• childhood up to 18 years;
• regular hemodialysis;
• nephrotic syndrome;
• increased sensitivity to the drug component;
• heavy degree liver dysfunction.

Alpha adrenoblocators

The following group of auxiliary drugs for the treatment of hypertension in diabetes is α-adrenoblays. They block α-adrenoreceptors, which are located in many tissues and organs. Like beta receptors, they are stimulated by norepinengine and adrenaline. Alpha-adrenobral drugs are:

1. Non-selective (only alpha1 receptors are blocked). With hypertension on the background of diabetes are not used.
2. Selective (block alpha1 and alpha2 receptors). Apply only in combination therapy. Separately never used. In the group of selective alpha-adrenobloclars, prazozin, Terasosin (Nethegis), doxazosin (Cardur) are distinguished.

Selective alpha adrenoblays affect the level of glucose and lipids. Additionally, they reduce insulin resistance. Contraindications for the use of this category of drugs:

• ischemic disease without parallel treatment of beta-adrenoblockers;
• pronounced aterosclerosis;
• bradycardia;
• the tendency to the orthostatic reaction (characteristic of the elderly with diabetes);
• heart palpitations;
• expressed autonomous neuropathy;
• violations brain circulation;
• diseases of the kidneys

The main disadvantage of these drugs is the "first dose effect". This means that at first taking minor and large vessels are expanding. The result may be fainting when a person gets up. This condition is referred to as an orthostatic collapse (orthostatic hypotension). The state of a person is normalized if he takes horizontal position.

The danger lies in high risk of injury during fainting. With further reception of alpha-adrenobloclars, this effect disappears. To minimize the negative effect of the first dose, it is necessary:

• the first time to take a small dosage, do it for the night;
• a couple of days before the start of treatment, take diuretic;
• dose to increase over several days.

Agonists imidazolin receptors

So called the drugs of central action. They affect brain receptors. The effect of agonists is to weaken the work of the sympathetic nervous system. The result becomes a decrease in pulse and pressure. Examples of imidazoline receptor agonists are:

• rilmenidin - Albarel;
• moxonidine - physiotense.

The lack of drugs is that their effectiveness in hypertension is proved only in 50% of patients. In addition, they have a number of side effects, such as:

• dry mouth;
• insomnia;
• asthenia.

The advantage of therapy with such drugs is the absence of cancellation syndrome and tolerance. They are first prescribed to people in old age, especially with concomitant pathology, including diabetes mellitus. Agonists of imidazolin receptors with:

• hypersensitivity;
• severe heart rhythm violations;
• impaired synutrial and AV conductivity of II-III degree;
• bradycardia is less than 50 shots per minute;
• heart failure;
• unstable angina;
• pronounced disorders of the kidneys and liver;
• pregnancy;
• glaucoma;
• depressive states;
• disturbation of peripheral blood circulation.

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