The group members are reviewing a 50-year-old African American male patient with stage 2 hypertension. His chief complaint is difficulty adhering to a low sodium diet. His medical history, lifestyle factors, and lab results indicate issues including overweight status, high cholesterol, family history of hypertension, and high sodium intake. The group developed a nutrition care plan to address his problems through goals of weight loss, improved lab values, normalized blood pressure, and increased adherence to a low sodium diet. A sample menu was created meeting his nutritional needs through a low sodium, low fat diet.
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of time. The three most common causes of CKD are,
-Diabetes mellitus
-Hypertension and
-Glomerulonephritis.
Together, these cause about 75% of all adult cases.
Pneumonia is an inflammatory condition of the lung
affecting primarily the microscopic air sacs known as
alveoli.
Pneumonia is the most common infectious cause of death
in the United States.
It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young, the
elderly, and the chronically ill.
Pneumonia is usually caused by infection with viruses or
bacteria and less commonly by other microorganisms,
certain medications and conditions such as autoimmune
Diseases
Myocardial Infarction - Case Presentation and an OverviewAbubakkar Raheel
Case Presented by Final Year MBBS sudents of Frontier Medical College at the 1st Clinico-Pathological Conference for the year 2015.The Presentation is divided into two parts. First part is about a case of an Acute ST Segment elevated Myocardial Infarction with. Its management at the Hospital and the findings. Second part is about the pathophysiology, Cinical signs and symptoms and an effective gold standard treatment of MI.
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of time. The three most common causes of CKD are,
-Diabetes mellitus
-Hypertension and
-Glomerulonephritis.
Together, these cause about 75% of all adult cases.
Pneumonia is an inflammatory condition of the lung
affecting primarily the microscopic air sacs known as
alveoli.
Pneumonia is the most common infectious cause of death
in the United States.
It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young, the
elderly, and the chronically ill.
Pneumonia is usually caused by infection with viruses or
bacteria and less commonly by other microorganisms,
certain medications and conditions such as autoimmune
Diseases
Myocardial Infarction - Case Presentation and an OverviewAbubakkar Raheel
Case Presented by Final Year MBBS sudents of Frontier Medical College at the 1st Clinico-Pathological Conference for the year 2015.The Presentation is divided into two parts. First part is about a case of an Acute ST Segment elevated Myocardial Infarction with. Its management at the Hospital and the findings. Second part is about the pathophysiology, Cinical signs and symptoms and an effective gold standard treatment of MI.
Abnormally high levels of lipids (fats) in the blood. Usually with no symptoms but can lead to cardiovascular diseases.
How to improve lipid profile.With the help of statins or fibrates and a healthy lifestyle, you can usually manage dyslipidemia. The key is to keep taking medications if they’re effective at managing your numbers and you aren’t experiencing any side effects. Sometimes people reach their cholesterol targets by dietary mangement and stop taking their statins.
Obesity is an emerging pandemic. Obesity is the root cause of many non communicable diseases like Diabetes , Hypertension, CAD. The younger generation are affected by obesity and leading to morbidity and mortality
Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag. Der Vortrag ist auf einem hohen Niveau und richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.
Masterclass Liver Care - Vitafoods 2016Koen Jacobs
Liver care is a growing area of concern. Incidents increased between 2013 and 2014 by 73.7% to a total of 45.9 million adults. Choline is a key driver of fat metabolism, which is critical to maintain a healthy liver. Choline, in combination with the right delivery form, successfully addresses this emerging health need.
Bethany Doerfler MS, RD, LDN discusses top nutrition concerns of scleroderma patients, as well as the results of a recent medical nutrition therapy study. She also discusses strategies for healthy eating, combating GI issues, maintaining muscle, a Mediterranean diet, supplements and more.
Iron and folate deficiency in women of childKern Rocke
An assignment for the course Community Nutrition.
Project entitled "Iron and Folate Deficiency in Women of Child Bearing Age in the Eastern Region of Trinidad
Food product development group assignment presentation #3Kern Rocke
Course: Food Product Development
Group Assignment looking at the consumer acceptability of fast food outlets in and around the University of the West Indies, St.Augustine Campus
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Case study hypertension presentation show
1.
2. Group Members
• Meera Maraj
• Omari Joseph
• Nailah Antoine
• Mikhail Lutchmedial
• Kern Rocke
3. Patient Profile and
Medical Records Data
Age= 50 years
Sex= Male
Ethnicity= African American
Occupation= High School Football Coach
Height= 6 feet 3 inches
Weight= 220 lbs
BP= 160/100
Medical Hx= Stage 2 (essential) Hypertension
P.A.= Walks 30 mins, 4-5 times per week
Previously a 2- pack a day smoker
Previous Dietary Tx= 4-gm Na Diet
Pharmacological Tx = 25 g hydrochlorothiazide qd
4. Patient Profile and
Medical Records Data
Chief Complaint:
Difficulty in adhering to a reduction of salt in the diet.
Food tastes bland and tasteless.
6. Pathophysiology of
Hypertension
• Hypertension is the chronic elevation of blood
pressure that, in the long-term, causes end-organ
damage and results in increased morbidity and
mortality.
• Occurs due to the abnormal functioning of the
arterial pressure related to the central nervous
system, renin-angiotensin-aldosterone system,
endothelial dysfunction, genes and even due to
certain environmental factors.
7. Pathophysiology of
Hypertension
• Factors which contribute to the development of
hypertension are:
Aging
Genetics
Obesity
Smoking
Salt Sensitivity
High Frequent Alcohol Consumption
High Fat Diet
Low Fiber Diet
• Normal blood Pressure is calculated as: 120/80 in
healthy adults.
8. Pathophysiology of
Hypertension
• Resting Blood Pressure ≥ 140/90 on two separate
occasions in an individual is characterized as either
Stage I or Stage II Hypertension.
• Resting Blood Pressure ≥ 130/80 in diabetic patients
increases their risk for the development of heart
disease.
12. Anthropometrics
• BMR = 66 + (13.7 x 100kg) + (5 x 190.5cm) – (6.8 x 50)
x 1.48
= 66 + 1370 + 952.5 – 340 x 1.48
= 2048.5 x 1.48
= 3031.8 kcals/ day
• EER = 864 – (9.72 x 50) + PA x (14.2 x 100) + (503 x 1.905)
=864 – 486 + (PA x 1420 + 958.2)
=378 + (PA x 2378.2)
=378 + (1.27 x 2378.2)
=378 + 3020.3
=3398.3 kcals/ day
13. Biochemical
Biochemical Patient value – mg/dl Normal value – mg/dl
parameter
Total cholesterol 300 140-199
LDL cholesterol 135 <130
HDL cholesterol 35 37-70
Triglycerides 250 35-160
14. Biochemical
• Altered Lipid Values as a result of:
1) High Saturated Fat and Trans-Fat Intake
2) High Sugar Intake
3) High Alcohol Intake
4) Overweight
15. Clinical
Healthy, male who looks his age
Temp= 98.6 0F BP= 160/100 mmHg
HR= 80 bpm RR= 15 bpm
Regular rate and rhythm, normal heart sounds (No
clicks, murmurs, or gallops)
No edema present on the skin and on hands and feet
16. Clinical
• Diagnosis of Stage 2 (Essential) Hypertension 1 year
ago
• Medical History shows that the subject’s mother
died from a Myocardial Infarction Related to
Uncontrolled Hypertension
• Hypertension of subject may have been caused
due to genetic history of hypertension
17. Dietary- History
24-hr Recall
Usual dietary intake:
AM: 1 c coffee (black)
Hot (oatmeal with 1 tsp margarine and 2 tsp sugar) or cold (Frosted
Mini- Wheats) cereal.
½ c 2% milk
1 c orange juice
Snack 2 c coffee (black)
1 glazed donut
Lunch: 1 can Campbell’s tomato bisque soup
10 saltines
1 can diet cola
After work: 2 (usually) gin and tonics (3 oz gin with 5 oz tonic)
PM: 6 oz baked chicken (white meat no skin) (seasoned with salt pepper,
garlic)
1 large baked potato with 1 T butter, salt and pepper
1 c glazed carrots (1 tsp sugar, 1 tsp butter)
Dinner salad with ranch – style dressing (3 tsp)- lettuce, spinch,
croutons, sliced cucumber
HS snack: 2 c butter pecan ice cream
20. Recognition of Diet/ Drug
Interaction
• High intakes of salt in the diet increases the excretion
of Potassium while taking hydrochlorothaizde can
lead to development of hypokalemia
• High intakes of Caffeine while taking
hydrochlorothaizde can lead to a strong diuretic
effect on the body thereby leading to dehydration
• Untreated dehydration can lead to heart injury,
cerebral edema, kidney failure, hypovolemic shock
and even death.
22. Nutritional Needs
Calculations
CHO requirements = 45% - 65% based on a 2000 calorie
intake
If 45% - 65% of carbohydrates are recommended based on
a 2000 calorie intake
X % - Y of carbohydrates are recommended based on a
3031.8 calorie intake
X% - Y% = (45% - 65%) * 3031.8 / 2000
= (136,431% - 197,067) / 2000
= 68.2g – 98.5g
23. Nutritional Needs
Calculations
• PRO requirements = 10% - 35% based on a 2000 calorie
intake
If 10% - 35% of proteins are recommended based on a 2000
calorie intake
X % - Y of proteins are recommended based on a 3031.8
calorie intake
X% - Y% = (10% - 35%) * 3031.8 / 2000
= (30,318% - 106,113) / 2000
= 15.2 g – 53.1g
24. Nutritional Needs
Calculations
FAT requirements = 40% - 65% based on a 2000 calorie
intake
If 40% - 65% of proteins are recommended based on a 2000
calorie intake
X % - Y of proteins are recommended based on a 3031.8
calorie intake
X% - Y% = (40% - 65%) * 3031.8 / 2000
= (121,272% - 197,067) / 2000
= 60.6 g – 98.5 g
26. Nutrition Diagnosis
• Overweight as related to high carbohydrate and fat
diet as evidenced by BMI of 27.56 and % IBW of
112.24 %.
• Altered nutrition related laboratory values related to
high fat diet as evidenced by total blood
cholesterol of 300mg/dL, blood triglycerides of
250mg/dL, LDL of 135mg/dL and HDL of 35mg/dL.
• Altered metabolic status (hyper) related to high salt
and fat intake, family history of hypertension as
evidenced by blood pressure of 160/100 mmHg
and death of patient’s mother from MI related to
uncontrolled hypertension.
27. Nutrition Diagnosis
• Inadequate mineral intake (Potassium and
Calcium) related to low dietary intake as
evidenced by dietary intake of 81.1% Potassium
and 84.2% Calcium.
• Low adherence to nutrition recommendations
related to patient’s low adherence to a 4mg sodium
diet as evidence by chief complaint of foods being
bland and tasteless.
29. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Overweight To achieve a weight To provide a 2925 24 hr recall, food
loss of 20-22 lbs in 10 kcal/day low sodium frequency
months. and Low fat, questionnaire,
reduced diet. monthly weight
check-up.
Altered nutrition The patient will To provide a diet To monitor pt.
related laboratory achieve lower low in lipids laboratory values.
values laboratory values to (saturated fat and
reach normal range. cholesterol) and to
Cholesterol = 140-199 increase daily
mg/dL physical activity
LDL-C = < 130 mg/dL levels.
HDL-C = >40 mg/dL
To educate pt. on
TG = 35-160 mg/dL
choosing foods low
in saturated fat,
cholesterol and
triglycerides.
30. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Altered metabolic status Patient should achieve a To increase activity Monthly blood pressure
(hyper) normotensive BP of (aerobic) to 60 minutes, 5 measurements, food
≤ 120 mmHg times/week. frequency questionnaire
80 To provide a low sodium and 24-hr recall.
diet (< 2300 mg/day) –
based on the DASH Diet.
To decrease the
consumption of fast
foods on weekends from
Fridays and Saturdays
once/week to Fridays
and Saturdays once
every 3 weeks.
To increase consumption
of low sodium home
cooked meals.
31. Nutrition Care Plan
Problem Goal Strategies Monitoring and
Evaluation
Inadequate mineral To increase consumption To provide a diet rich in Food frequency
intake (Potassium (K) of foods rich in K and Ca. K and Ca using foods questionnaire, monthly
and Calcium(Ca)) such as low-fat dairy biochemical tests.
products (Ca), mango
(K), tomatoes (K),
tomatoes (K), leafy green
vegetables (Ca and K),
fish (K).
Low adherence to To increase adherence to a To provide nutrition Food frequency
nutrition related low sodium diet. education and questionnaire, 24-hr
recommendations counselling on the recall.
importance of adherence
to a low sodium diet to
patient and patient’s
wife.
32. Menu
Breakfast:
2 servings of whole wheat cereal
2 servings of a medium sized banana (sliced)
2 servings of 1% or low fat milk
1 serving of garlic tea
Snacks: (AM)
1 large mango
1 20oz bottle water
33. Menu
Lunch:
2 servings of mackerel (steamed / lemon)
3 servings of whole wheat pasta
1 serving of cooked pigeon peas
2 servings of vegetables – 1 toss salad (1c lettuce, carrots)
1 serving of olive oil
3 servings of vegetable / fruit juice – beet root (1.5 serv) &
pineapple juice (1.5 serv)
Snack: (PM)
1 20oz bottle water
1 medium orange
3 servings of Trail Mix
34. Menu
DINNER:
4 servings of whole wheat bread (Home-made, low
sodium)
1 serving tomatoes
1 serving lettuce
1 serving salmon
1 cup of water (8oz)
37. References
Life Extension. 2012. “Risk Factors for High Blood Pressure.” Accessed November 10 th, 2012.
http://www.lef.org/protocols/heart_circulatory/high_blood_pressure_04.htm.
Mahan, L. Kathleen, and Escott- Stump, Sylvia. 2008. Krause’s Food and Nutrition and Diet
Therapy. 12th edition. Philadelphia: W.B. Saunders Co.
United States Department of Agriculture. (N.d.) “SuperTracker” Accessed 3rd November, 2012.
https://www.supertracker.usda.gov/default.aspx.
Vanlterson, Erik. 2010. “Proper Nutrition for Hypertension Patients.” Livestrong.com. November
2nd. Accessed November 12th, 2012. http://www.livestrong.com/article/295001-proper-
nutrition-for-hypertension-patients/.
Weber, Craig. 2009. “Diabetics and High Blood Pressure.” About.com. July 23. Accessed
November 10th, 2012.
http://highbloodpressure.about.com/od/highbloodpressure101/a/diabetes-hbp.htm.