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February 6, 2006

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Question from Athens, Ohio, USA:

My 77 year old grandmother has an untreatable aneurysm, which has caused mini strokes and some slight dementia. She was diagnosed about a year and a half ago with type 2 diabetes and her doctor agreed to place her on oral medication, as long as she monitored her diet and kept her blood sugar under control. At her last visit, her cholesterol was elevated and, recently, she has been having blood pressure problems, particularly low blood pressure. We have ruled out the possibility of the aneurysm being the cause of the blood pressure issues, however, I am not certain that the cause isn't the diabetes. In my studies of dietetics as an undergraduate, we learned that diabetes can most certainly influence both blood pressure and cholesterol issues, particularly blood pressure if kidney problems are suspected. Should we investigate further into this or wait it out? Her general practitioner just told her to monitor her diet more closely as if it was no big deal.

Answer:

When an aneurysm is present, the blood pressure control is critical to preventing rupture or further dilatation that leads to rupture. Therefore, the side effect of the blood pressure control is low blood pressure. Her doctor will have to help you decide whether this is too low or part of the side effects of good control. Diabetes is more likely to cause elevated blood pressure, especially in the presence of kidney involvement. My thoughts are that the cholesterol-lowering is important and generally applied to patients with diabetes. In fact, the practice guidelines from the American Diabetes Association indicate that patients with type 2 diabetes should be on a statin for cholesterol-lowering. Some think that older patients may not benefit, but this is not true. Acute cholesterol-lowering in older individuals serves to stabilize any plaque formation that may serve to fracture and cause a thrombosis in an artery.

JTL