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Passive and Active Monitoring

Passive and Active Monitoring. 1. BP Apparatus within reach It can be recommended that Mr. AP borrow/buy a BP apparatus so he can monitor his BP Proper use, reading of the PB app should be taught to AP and his family

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Passive and Active Monitoring

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  1. Passive and Active Monitoring

  2. 1. BP Apparatus within reach • It can be recommended that Mr. AP borrow/buy a BP apparatus so he can monitor his BP • Proper use, reading of the PB app should be taught to AP and his family • Regular monitoring should be logged (BP should be taken 2x a day, one in the morning and in the afternoon, both sitting and standing to account for postural hypotension) • If a BP app cannot be bought, going to the local health center for regular BP may also be done, but may be too tedious.

  3. 2. Control of Blood Sugar • proper diet, exercise and compliance to Metformin is recommended • FBS or RBS monitoring may be done in the case where DM gets worse • having a food diary to recall and have a strict control of the diet may also be done

  4. 1. BP Control Evaluation • measure the BP in the clinic and check BP readings of the past 2 weeks • if the BP is within target (not more than 130/80 mmHg), treatment can be maintained • if BP is still elevated, treatment may be evaluated. • may change the dose, or add another drug (take into consideration additional cost) • re-examine the non-pharmacologic aspects of the treatment: compliance, diet, lifestyle, proper monitoring of BP

  5. 2. Blood Sugar levels • FBS may be monitored so as to monitor the progression of the diabetes • FBS levels should be within 80-120mg/dl, before a meal 3. Left Ventricular Hypertrophy Status • A repeat EKG may be done once the BP goal is reached

  6. If possible, avoid intake of drugs that raise BP • Glucocorticoids, NSAIDs • Lifestyle Modification • Smoking cessation • Sodium restriction, sodium chloride intake should not exceed 5g • Consume more meals rich in potassium, calcium and magnesium • Eat more fish and 4-5 servings of vegetables and fruits daily • Drink low fat milk • Physical exercise • Moderate intensity exercises (endurance + resistance), 30-45 min/d • Moderation of alcohol consumption • Limit alcohol consumption to 30 ml per day of a light alcoholic beverage  • Maintenance of ideal body weight

  7. References • American Diabetes Association. Available at <http://www.diabetichealthinfo.com/View.aspx?url=Article800> • August, Phyllis. Initial Treatment of Hypertension. N Engl J Med 2003 348: 610-617 • National Institute of Health. JNC-7: Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at <http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf> • Schrier, Robert W., Estacio, Raymond O.Additional Follow-Up from the ABCD Trial in Patients with Type 2 Diabetes and Hypertension. N Engl J Med 2000 343: 1969

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