Diabetes hypertension management + DVLA

Question 1

What are the blood pressure targets for diabetics?

Answer 1

• if end-organ damage (e.g. renal disease, retinopathy) < 130/80 mmHg
• otherwise < 140/80 mmHg

Question 2

What are the first-line antihypertensives for diabetics?

Answer 2

• ACE-inhibitors because have a renoprotective effect
• Patients of African or Caribbean family origin should be offered an ACE-inhibitor plus either a thiazide diuretic or calcium channel blocker
• Routine use of beta-blockers in uncomplicated hypertension should be avoided, particularly when given in combination with thiazides, as they may cause insulin resistance, impair insulin secretion and alter the autonomic response to hypoglycaemia

Question 3

What is dipyridamole?

Answer 3

Dipyridamole is an antiplatelet mainly used in combination with aspirin after an ischaemic stroke or transient ischaemic attack.

Question 4

What is the mechanism of action of dipyridamole?

Answer 4

• inhibits phosphodiesterase :. elevating platelet cAMP levels :. reduce intracellular calcium levels
• other actions:
  
  • reducing cellular uptake of adenosine
  • inhibition of thromboxane synthase

Question 5

What are DVLA rules on hypertension?

Answer 5

• hypertension - can drive unless treatment causes unacceptable side effects
• no need to notify DVLA
• If Group 2 Entitlement: disqualifies from driving if resting BP consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or more

Question 6

What are DVLA rules on elective angioplasty?

Answer 6

1 week off driving

Question 7

What are DVLA rules on CABG?

Answer 7

4 weeks off driving

Question 8

What are DVLA rules on ACS?

Answer 8

• 4 weeks off driving
• 1 week if successfully treated by angioplasty

Question 9

What are DVLA rules on angina?

Answer 9

driving must cease if symptoms occur at rest/at the wheel

Question 10

What are DVLA rules on pacemaker insertion?

Answer 10

1 week off driving

Question 11

What are DVLA rules on implantable cardioverter-defibrillator (ICD)?

Answer 11

• if implanted for sustained ventricular arrhythmia: cease driving for 6 months
• If implanted prophylatically then cease driving for 1 month
• Having an ICD results in a permanent bar for Group 2 drivers

Question 12

What are DVLA rules for successful catheter ablation for an arrhytmia?

Answer 12

2 days off driving

Question 13

What are DVLA tules on aortic aneurysms of 6cm or more?

Answer 13

• Notify DVLA
• Licensing will be permitted subject to annual review
• An aortic diameter of 6.5 cm or more disqualifies patients from driving

Question 14

What are DVLA rules on heart transplants?

Answer 14

DVLA do need to be notified?