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Hypertension O b e se S e d e n ta ry Life style U n h e a lth y E a tin g H a b itsS e co n d -H a n d S m o ke r S o cia lD rin ke r Heredity Increased Age Race

Insulin Resistance Chronic Hypertension

↑ Insulin Demand Endothelial Injury

β-cell Exhaustion and Dysfunction Accumulation of LDL Particles within the Arterial Wall

Impaired Insulin Secretion


WBC Count: 13,400 cells/mm3Adhesion of Circulating Monocytes and T-cells

Minimal Utilization of Glucose by Cells


Insinuation of Monocytes between the Endothelial Cells and Subendothelial Space

Cellular Starvation Polyphagia


Monocytes Transform into Macrophages

epatic Glucose Production (glycogenolysis and gluconeogenesis )


Adipose Tissue Breakdown Monocyte Ingestion of Modified Lipids

Metformin, 500 mg, 1 tab, TID Release of Free Fatty Acids


Proliferation of Smooth Muscle Cells

↑ Hepatic Lipoprotein Synthesis Release of Toxic Products by Macrophages

↑ VLDLs and LDLs Rupture and Fissure of Plaque

Platelet Activation on Contact with Collagen


HYPERGLYCEMIA HYPERLIPIDEMIA

Simvastatin, 40 mg, 1 tab a day Platelet Adhesion and Aggregation


Microvascular Complications Macrovascular Complications
Aspirin, 80 mg, 1 tab a day Platelet Thrombus Formation

Diabetic Nephropathy
Diabetic Retinopathy ↑ FoamActivity
Thrombolytic Activity and ↓ Fibrinolytic
Diabetic ↑Neuropathy Cell Activity
↑ VLDLs and ↓ HDLs THROMBOSIS

Blurring of Vision Polyuria CAD


Numbing of Extremities Sluggish Blood Flow Anterior Cerebral Artery Occlusion
Polydipsia
↑ Arterial Blood Pressure BP: 170/100 mmHg Piracetam, 80 mg, 1 tab a day ↓ oxygen and glucose supply
Tingling of Extremities
Damage to Endothelial Lining Amlodipine, 5-10 mg OD
Creatinine: 1.4 mg/dL
CT Scan: Small Vessel Ischemic RIGHT -HEMISPHERE THROMBOTIC STROKE
Changes
Thrombus Formation
Sodium: 130.9 mEq/L
Left-sided Paralysis Left-sided Weakness
Lymphocytes: 21% CAD CVA
Citicholine, 2 mL, TID
Ciprofloxacin, 500 mg, 1 tab a day Subscapular Pain
Neurobexol, 1 cap a day
Potassium: 5.3 mEq/L