Please select the eligibility criteria that correspond to the clinical trial below.
Title: Combined Behavioral and Pharmacological Intervention for Cardiovascular Risk Reduction in Diabetic Patients
Brief Summary: The purpose of this research is to study whether a multidisciplinary education in Diabetes and intervention for cardiac risk reduction in a group setting to modify patient behavior and adjust medications can achieve diabetes guideline goals for glycemia, blood pressure and lipid control.


Options:
A: Inclusion Criteria:

1. Overall average (after 2 visits) systolic ≥180 OR diastolic ≥110 mmHg in undiagnosed patients without macrovascular target organ damage, diabetes or chronic kidney disease
2. Overall average (after 2 visits) systolic ≥140 OR diastolic ≥90 for patients with undiagnosed hypertension with macrovascular target organ damage (coronary artery disease, cerebrovascular disease, DM)
3. In patients with diagnosed hypertension, systolic ≥140 (≥ 130 with DM or CKD) OR diastolic ≥90, (≥ 80 with DM or CKD)
4. Overall average (after 5 visits, for those without macrovascular target organ damage, DM, or CKD and without an existing hypertension diagnosis) systolic ≥140 OR diastolic ≥90 mmHg
5. Overall average (after 7 days of twice-daily home blood pressure monitoring , for those without macrovascular target organ damage, DM, or CKD and without an existing hypertension diagnosis) systolic ≥135 OR diastolic ≥85

Exclusion Criteria:

* Patients with hypertensive urgency or emergency:

  * Urgency: SBP ≥ 180 mm Hg or DBP ≥ 120 mm Hg with no acute signs of end-organ damage
* Unwilling to participate/sign consent form
* Pregnancy
B: Inclusion Criteria:

* bleeding and contractions during pregnancy

Exclusion Criteria:

* women with known allergy to misoprostol,
* a uterine size more than 12 weeks of gestation,
* suspected ectopic pregnancy,
* unstable hemodynamic status and chock,
* signs of pelvic infection and/or sepsis.
C: Inclusion Criteria:

* All diabetic veterans with a Hb-A1c between 7.0- 9.0 % within the last 6 months will be eligible for the study

Exclusion Criteria:

* Patients without an Hb-A1c checked within the last 6 months.
* Patients who are unable to attend the group sessions, either because of lack of transportation, psychiatric instability (suicidal, psychotic), or organic brain injury that preclude them from diabetes self-care.
D: Inclusion Criteria:

* Diagnosis of Hypertension (HTN) captured by ICD-9-CM codes from prior outpatient visits;
* elevated BP (\>140/90 mmHg among non-diabetics; or \>140/80 mmHg among diabetics) during the most recent VA clinic visit or based on the average from the last 3 visits;
* elevated BP measured by the Research Medical Assistant (MA) at the baseline visit.

Exclusion Criteria:

Patients will be excluded for the following safety reasons:

* prior history or current signs of hypertensive emergency including symptoms of angina, stroke, or acute renal failure;
* severe HTN (systolic BP \>200 or diastolic BP \> 114mm Hg);
* history of acute MI, stroke, or unstable angina in the prior 6 months;
* Congestive Heart Failure (CHF) due to systolic dysfunction with a left ventricular ejection fraction \< 35% documented by echocardiography, nuclear medicine study, or ventriculography;
* renal insufficiency, defined by a glomerular filtration rate less than 30 ml/min or previously documented proteinuria \> 1 gram per day;
* significant hepatic disease, including prior diagnoses of cirrhosis, Hepatitis B or C infection, or laboratory abnormalities (serum ALT or AST \> 2 times control or total bilirubin \> 1.5 mg/dl) in the prior 6 months;
* pregnancy;
* prior diagnoses of pulmonary hypertension or sleep apnea (unless treated by continuous positive pressure ventilation);
* poor prognosis with a life expectancy estimated less than 2 years;
* residence in a nursing home or diagnosis of dementia;
* inability to give informed consent or impaired cognitive function (defined as \> 3 errors on the 10-item Pfeiffer Portable Mental Status Questionnaire, administered during study intake);
* no telephone for follow-up calls.

Answer: C