151
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Padwal RS, Rabkin S, Khan N. Assessment and management of resistant hypertension. CMAJ 2014; 186:E689-97. [PMID: 25135921 DOI: 10.1503/cmaj.130764] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Raj S Padwal
- Department of Medicine (Padwal), University of Alberta, Edmonton, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta.; Division of Cardiology (Rabkin), Department of Medicine (Rabkin, Khan), University of British Columbia, Vancouver, BC; Center for Health Evaluation and Outcome Sciences (Khan), Vancouver, BC
| | - Simon Rabkin
- Department of Medicine (Padwal), University of Alberta, Edmonton, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta.; Division of Cardiology (Rabkin), Department of Medicine (Rabkin, Khan), University of British Columbia, Vancouver, BC; Center for Health Evaluation and Outcome Sciences (Khan), Vancouver, BC
| | - Nadia Khan
- Department of Medicine (Padwal), University of Alberta, Edmonton, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta.; Division of Cardiology (Rabkin), Department of Medicine (Rabkin, Khan), University of British Columbia, Vancouver, BC; Center for Health Evaluation and Outcome Sciences (Khan), Vancouver, BC
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152
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Morley JE. Why Have the Complications of Diabetes Mellitus Declined Over the Past 30 Years? J Am Med Dir Assoc 2014; 15:449-453. [DOI: 10.1016/j.jamda.2014.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/21/2022]
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153
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Gokturk H, Ulusu NN, Gok M, Tuncay E, Can B, Turan B. Long-term treatment with a beta-blocker timolol attenuates renal-damage in diabetic rats via enhancing kidney antioxidant-defense system. Mol Cell Biochem 2014; 395:177-86. [DOI: 10.1007/s11010-014-2123-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/02/2014] [Indexed: 12/22/2022]
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154
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Takahara M, Shiraiwa T, Shindo M, Arai A, Kusuda Y, Katakami N, Kaneto H, Matsuoka TA, Shimomura I. Efficacy and safety of 10-mg azilsartan compared with 8-mg candesartan cilexetil in Japanese patients with hypertension: a randomized crossover non-inferiority trial. Hypertens Res 2014; 37:852-7. [DOI: 10.1038/hr.2014.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/26/2014] [Accepted: 03/10/2014] [Indexed: 11/09/2022]
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155
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Lopez-Jaramillo P, Lopez-Lopez J, Lopez-Lopez C, Rodriguez-Alvarez MI. The goal of blood pressure in the hypertensive patient with diabetes is defined: now the challenge is go from recommendations to practice. Diabetol Metab Syndr 2014; 6:31. [PMID: 24594121 PMCID: PMC3973894 DOI: 10.1186/1758-5996-6-31] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 02/22/2014] [Indexed: 02/08/2023] Open
Abstract
The recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown. Hypertension is present in 20% to 60% of patients with type 2 diabetes, depending on age, ethnicity, obesity, and the presence of micro or macro albuminuria. High blood pressure substantially increases the risk of both macro and micro vascular complications, doubling the risk of all-cause mortality and stroke, tripling the risk of coronary heart disease and significantly hastening the progression of diabetic nephropathy, retinopathy, and neuropathy. Thus, blood pressure lowering is a major priority in preventing cardiovascular and renal events in patients with diabetes and hypertension. During many years the BP goals recommended in patients with diabetes were more aggressive than in patients without diabetes. As reviewed in this article many clinical trials have demonstrated not only the lack of benefits of lowering the BP below 130/80 mmHg, but also the J-shaped relationship in DM patients. Overall we discuss the importance of define the group of patients in whom significant BP reduction could be particularly dangerous and, on the other hand, those with a high risk of stroke who could benefit most from an intensive hypotensive therapy. In any case, the big challenge now is avoid the therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.
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Affiliation(s)
- Patricio Lopez-Jaramillo
- Research Institute and Clinic of Diabetes and Metabolic Syndrome, Fundación Oftalmológica de Santander (FOSCAL), Calle 155 A No 23-09, Torre Milton Salazar, Urbanizacion El Bosque, Floridablanca, Santander, Colombia
- MASIRA Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Jose Lopez-Lopez
- Medical School, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | - Cristina Lopez-Lopez
- Medical School, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
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156
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Zreikat HH, Harpe SE, Slattum PW, Mays DP, Essah PA, Cheang KI. Effect of Renin-Angiotensin system inhibition on cardiovascular events in older hypertensive patients with metabolic syndrome. Metabolism 2014; 63:392-9. [PMID: 24393433 PMCID: PMC3957480 DOI: 10.1016/j.metabol.2013.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 11/02/2013] [Accepted: 11/08/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Metabolic syndrome (MetS) is associated with cardiovascular disease (CVD). Insulin resistance has been hypothesized as the underlying feature of MetS. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are widely used antihypertensives that may improve insulin sensitivity. The aim of the study is to evaluate the effect of ACEI/ARB on incident CVD events in older hypertensive patients with MetS. MATERIALS/METHODS We used the Cardiovascular Health Study, a prospective cohort study of individuals>65years of age to evaluate ACEI/ARB use and time to CVD events (including coronary and cerebrovascular events). The study included 777 subjects who had hypertension and ATP III-defined MetS, but free of CVD and diabetes at baseline. Cox regression models were used to evaluate the effect of ACEI/ARB as compared to other antihypertensives on the time to the first CVD events. RESULTS ACEI/ARB use was associated with a decreased risk of CVD events (adjusted HR=0.658, 95 % C.I. [0.436-0.993]) compared to other antihypertensives. When CVD endpoints were evaluated separately, use of ACEI/ARB was associated with lower rates of angioplasty and coronary events (HR of 0.129 and 0.530 respectively, with 95 % CI [0.017-0.952] and [0.321-0.875]). CONCLUSIONS ACEI/ARB use was associated with a lower risk of CVD events in older hypertensive patients with MetS, primarily due to a reduction in coronary events. The potential protective effect of ACEI/ARB on CVD events in older individuals with MetS will need further confirmation from prospective studies.
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Affiliation(s)
- Hala H Zreikat
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Spencer E Harpe
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia W Slattum
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - D'arcy P Mays
- Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Paulina A Essah
- Department of Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kai I Cheang
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.
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157
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Bertoluci MC, Pimazoni-Netto A, Pires AC, Pesaro AE, Schaan BD, Caramelli B, Polanczyk CA, Júnior CVS, Gualandro DM, Malerbi DA, Moriguchi E, Borelli FADO, Salles JEN, Júnior JM, Rohde LE, Canani LH, Cesar LAM, Tambascia M, Zanella MT, Gus M, Scheffel RS, dos Santos RD. Diabetes and cardiovascular disease: from evidence to clinical practice - position statement 2014 of Brazilian Diabetes Society. Diabetol Metab Syndr 2014; 6:58. [PMID: 24855495 PMCID: PMC4030272 DOI: 10.1186/1758-5996-6-58] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/07/2014] [Indexed: 02/06/2023] Open
Abstract
There is a very well known correlation between diabetes and cardiovascular disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious cardiovascular diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and cardiovascular disease: Glicemic Control, Cardiovascular Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology.
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Affiliation(s)
| | | | | | | | - Beatriz D Schaan
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Caramelli
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carisi Anne Polanczyk
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Emilio Moriguchi
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Luis Eduardo Rohde
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luis H Canani
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Marcos Tambascia
- Faculdade de Ciências Médicas da Universidade de Campinas, Campinas, SP, Brazil
| | | | - Miguel Gus
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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