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(Hypertension. 2002;40:781.)
© 2002 American Heart Association, Inc.

Hypertension Grand Rounds

Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive

From SUNY Downstate and VAMC Brooklyn (J.S.), NY; and University of Texas at San Antonio (S.H.), Tex.

Correspondence to James R. Sowers, MD, FACP, FAHA, Professor of Medicine, Cell Biology and Biochemistry, Director, Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate, 450 Clarkson Ave, Box 1205, Brooklyn, NY 11203. E-mail jsowers@downstate.edu

Key Words: diabetes • hyperglycemia • lipids • angiotensin-converting enzyme inhibitors • aspirin

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Case

 
A 38-year-old black woman is see¹n on referral from a family physician. Her medical records indicate that she has had type 2 diabetes diagnosed 3 years previously. She has been treated for her diabetes with diet and a sulfonylurea, Glucotrol X-L 10 mg daily. Her last glycohemoglobin 6 months ago was 8.8%. She has had hypertension for 10 years and is currently receiving 10 mg amlodipine daily, 25 mg hydrochlorothiazide daily, and 4 mg doxazosin every morning. In her records, her physician notes that her blood pressure (BP) has been relatively well controlled, with BPs generally 150/90 mm Hg. She had an EKG 1 year previously, which was remarkable only for left ventricular hypertrophy (LVH) by voltage criteria. Her last total cholesterol was 230 mg/dL, with LDL cholesterol of 145 mg/dL. Her records indicated that she was not started on lipid therapy because her LDL was <150 mg/dL. She has a strong family history of diabetes, hypertension, coronary artery disease, stroke, and kidney disease requiring dialysis.

Physical Examination
The patient’s BP was 154/92 mm Hg, with a pulse of 88 bpm. Her weight was 190 lbs (body mass index, 35 kg/m²). Examination of the head, ears, eyes, nose and throat (HEENT) revealed fundi with background retinopathy (hemorrhages and exudates). Examination of the heart showed that the point of maximum impulse (PMI) was shifted to the anterior auxiliary line and sustained, with an S₄ gallop present. Examination of the patient’s abdomen revealed a waist circumference of 38 inches, a slightly enlarged . . . [Full Text of this Article]

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