Intensive BP Control Or Not For Those with Diabetes and CKD

So, the message to walk away with is that intensive lowering of systolic BP had the effect of increasing the risk of CKD in patients whether they had type 2 diabetes or not, but the incident risk of CKD was higher in individuals with type 2 diabetes.

http://www.diabetesincontrol.com/intensive-bp-control-or-not-for-those-with-diabetes-and-ckd/

Hi Graham,
A complex problem. This is talking about getting systolic below 120.  Alpha blockers cause heart failure and CKD, perhaps angiotensin blockers more appropriate for diabetics since hyperinsulinemia triggers angiotensin 2 and puts up BP! Some BP drugs make diabetes worse re:beta blockers.
Some patients have horrific bps that need treating.
BP needs analysis as to cause before prescription.
regards
Derek

Get the insulin level down first and then see if BP still needs treating. Yes I read a recent paper suggesting that ARBs are preferable to ACE inhibitors now the price has dropped (out of patent) because they have fewer side effects.

Currently I'm on 5mg Amlodipine, a calcium channel blocker, widely used here I suspect because of the price. I suspect my BP has gone a bit high because my thyroid has settled somewhat high but no longer considered to be high enough for further treatment. I might ask to add an ARB. On the other hand a stroke is not one of the worst ways to go as long as I ensure that it is fatal.

Blimey that took a long time for the paper to come up, I'll read it later.

Good reason do home monitoring of BP then, if surgery readings were taken at face value I would have probably had my medication reviewed and upped. I'm happy with systolic 130 - 140 and with kidneys functioning well not interested in adding meds to lower BP further

chris c wrote:Get the insulin level down first and then see if BP still needs treating. Yes I read a recent paper suggesting that ARBs are preferable to ACE inhibitors now the price has dropped (out of patent) because they have fewer side effects.

Currently I'm on 5mg Amlodipine, a calcium channel blocker, widely used here I suspect because of the price. I suspect my BP has gone a bit high because my thyroid has settled somewhat high but no longer considered to be high enough for further treatment. I might ask to add an ARB. On the other hand a stroke is not one of the worst ways to go as long as I ensure that it is fatal.

Blimey that took a long time for the paper to come up, I'll read it later.

Hi Chris, I was on Amlodipine for years until I stopped temporarily for some reason and all my joint pain disappeared!
So I tried it again and the joint pain I'd had years came back, so I stopped the stuff pdq!
regards
Derek

graham64 wrote:Good reason do home monitoring of BP then, if surgery readings were taken at face value I would have probably had my medication reviewed and upped. I'm happy with systolic 130 - 140 and with kidneys functioning well not interested in adding meds to lower BP further

Yes I tend towards white coat syndrome AKA sitting in the waiting room for ages syndrome.

Once my BP was very high when the nurse took it, way out of line compared to my home meter.They gave me a 24 hour holter monitor and it was resolutely normal. Next time the nurse took it it was also normal, I suspect her machine had gone out of calibration. That can also happen.

Interesting about the Amlodipine. I've never had symptoms from it, or from Simvastatin when I used to take it, but I read recently that it is contraindicated with statins so I wonder if it affects muscles through the same pathway.

chris c wrote:

graham64 wrote:Good reason do home monitoring of BP then, if surgery readings were taken at face value I would have probably had my medication reviewed and upped. I'm happy with systolic 130 - 140 and with kidneys functioning well not interested in adding meds to lower BP further

Yes I tend towards white coat syndrome AKA sitting in the waiting room for ages syndrome.

Once my BP was very high when the nurse took it, way out of line compared to my home meter.They gave me a 24 hour holter monitor and it was resolutely normal. Next time the nurse took it it was also normal, I suspect her machine had gone out of calibration. That can also happen.

Interesting about the Amlodipine. I've never had symptoms from it, or from Simvastatin when I used to take it, but I read recently that it is contraindicated with statins so I wonder if it affects muscles through the same pathway.

Same here I had the 24 hour BP monitor a few years ago due to high surgery readings the readout was fine, don't think there was a problem with the nurses machine as the high surgery BP's still continue 

I had another one when my thyroid first blew up. The new machine doesn't have a readout so I couldn't see what my BP was doing.

Used to be BP was "normal" if systolic was 100+your age. I recall a recent more sophisticated algorithm along the same lines of "normal" increasing with age.

Another new BP study 

Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study

http://care.diabetesjournals.org/content/41/6/1134

pdf

http://sci-hub.hk/10.2337/dc17-2443

will read later