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I am diabetic, how do I control hypertension?

Q: I am in my early forties. I have mild type II diabetes. Fasting blood sugar 104, PP is 165, my lipid profile is normal, with cholesterol at 165 mg. My B.P. is 140/80. My doctor has prescribed me a statin and also 1.25 mg of cardace. Do I need to take a statin and cardace?

A:1. Just blood glucose values are not enough to be sure you have good diabetes control, you need a glycosylated haemoglobin, done at least twice a year. 2. BP targets for diabetics are much tighter than they used to be. If your BP is persistently >120/ 80, it is a good idea to take a small dose of Cardace. However, have you first adopted lifestyle measures: regular walking (or exercise in some other form), some degree of salt reduction, weight reduction if you are overweight, etc. If not, then it is important to start those on a regular basis, before considering medication. 3. Many experts are now moving towards a polypill concept: give everyone at high risk, eg all diabetics, a small dose of ACE inhibitor (eg cardace), and of statin, and of aspirin, etc. There was one recent paper showing this approach works. I know of many general physicians who start statins in all diabetics, regardless of lipid levels. However, so far it is not standard practice yet, the recommendation being to maintain cholesterol < 200 and LDL < 100. 4. Incidentally, the cost- benefit ratio for aspirin is researched, and ADA does recommend low dose aspirin for all diabetics over the age of 21 years, unless there is a specific contraindication. You may want to ask your doctor about it.

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