Treatment of high blood pressure in diabetic patients and risk of undernutrition in a population in extreme Western Algeria
Introduction: Assessing the risk of undernutrition in hypertensive diabetics is essential. It makes it possible to detect undernutrition for better care. The objective of our study is to describe the factors influencing this undernutrition.
Methods: A descriptive study was conducted on a sample of 366 diabetics with hypertension and 326 with normo-glycemic hypertension aged 50 years and over. Patients were enrolled at the University Hospital in Tlemcen from January to June 2018. The data collection was carried out using a questionnaire: The MNA (The Mini Nutritional Assessment).
Results: The study made it possible to establish the profile of subjects at high risk of undernutrition. In our sample, age was not correlated with risk of malnutrition in diabetic hypertensives and normo-glycemic hypertensives respectively (p = 0.304 and p = 0.444). The linear regression model uses gender as an age-independent factor that affects the risk of undernutrition (p = 0.001). BMI was one of the most relevant variables for predicting the occurrence of undernutrition (p = 0.000). Thus, diabetic hypertensive patients in our study who were treated with an Angiotensin II receptor blockers , an angiotensin converting enzyme inhibition or an ARB/diuretic combination were more at risk of undernutrition (p = 0.009, p = 0.026 and p = 0.013).
Conclusion: Particular attention should be paid to diabetic hypertensive subject. The treatment of hypertension in diabetics aggravates this malnutrition. Thus, a nutritional status assessment should be established in any diabetic hypertensive patient allowing appropriate therapeutic management to avoid all complications associated with undernutrition.
(2) Diyane Kh, Elmghari G, El Ansari N. Characteristics of the association of type 2 diabetes and high blood pressure in the subject aged 65 and over. Pan Afr Med D. 2013; 14:100
(3) Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP, and al.Weight change in old age and its association with mortality. J Am Geriatr Soc ; 2001 ; 49(10):1309- 18
(4) American Society for Parenteral and Enteral Nutrition. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr ; 2002; 26(Suppl 1):1SA-138SA.
(5) Ferry, M., Alix, E. & Brocker, P. 2007. Nutrition of the elderly person. 3rd edition, Masson, Paris.p 303 .
(6) Alibhai SMH, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people. Can Med Assoc J ; 2005 ; 172(6):773-80.
(7) Ferry M, Alix E, Brocker P, Constans T, Lesourd B, Mischlich D, and al. 2002 Nutrition of the elderly person. Paris: MASSON.
(8) . Woo J, Ho SC, Sham A.Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatr Soc ; 2001 ; 49(6):737-46.
(9) National Agency for Health Accreditation and Evaluation. 2003. Diagnostic evaluation of protein-energy malnutrition in hospitalized adults. Saint-Denis La Plaine: ANAES.
(10) National Collaborating Centre for Acute Care.2006 . Nutrition support in adults : oral nutrition support, enteral tube feeding and parenteral nutrition. London: Royal College of Surgeons of England.
(11) HAS. 2007. Management strategy in case of protein-energy malnutrition in the elderly[Online]. Available: http://www.hassante.fr/portail/upload/docs/application/pdf/synthese_denutrition_personnes_agees.pdf[Accessed 15 April 2012].
(12) Beckett, N. S., Peters, R., Fletcher, A. E.,and al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med, 2008; 358:1887-98.
(13) Alibhai, S. M., Greenwood, C. & Payette, H. An approach to the management of unintentional weight loss in elderly people. CMAJ, 2005; 172:773-80.
(14) ESPEN 2003. ESPEN guidelines for nutrition screening Clin Nutr, 2002; 22:415-21.
(15) Dahlof, B., Devereux, R. B., Kjeldsen, S. E and al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet, 2002; 359:995-1003.
(16) Lithell, H., Hansson, L., Skoug, I.,and al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens, 2003; 21 :875-86.
(17) Papademetriou, V., Farsang, C., Elmefeldt, D., and al . Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE). J Am Coll Cardiol, 2004; 44:1175-80.
(18) ALLHAT. The, Allhat Officers Coordinators for the, Allhat Collaborative Research Group.Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (allhat). JAMA, 2002; 288:2981-2997.
(19) Loesche, W. J., Bromberg, J., Terpenning, M. S.,and al . Xerostomia, xerogenic medications and food avoidances in selected geriatric groups. J Am Geriatr Soc, 1995; 43:401-7.
(20) Melian, E. & Jarvis, B. 2002. Candesartan Cilexetil plus Hydrochlorothiazide Combination. Drugs, 62, 787-816.
(21) Crogan, N. L., Corbett, C. F. & Short, R. A. The minimum data set: predicting malnutrition in newly admitted nursing home residents. Clin Nurs Res, 2002; 11 :341-53.
(22) Mancia, G., Laurant, S., Agabiti-rosei, E., and al Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens, 2009; 27:2121-58.
(23) Vaisse, B., Girerd, X. & Pouchain, D. CRITERE study, Use of fixed combinations of antihypertensive agents containing an inhibitor of the renin-angiotensin system. Analysis of medical practices in France, 2009 ; p 8.
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