Diabetes and hypertension: is there a common metabolic pathway?

Medicinal plants with concomitant anti-diabetic and anti-hypertensive effects as potential sources of dual acting therapies against diabetes and hypertension: A review

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetes and hypertension are pathophysiologically related diseases that co-exist with a wider complex of metabolic diseases having similar set of risk factors. There are numerous ethnopharmacological evidences on the anti-diabetic and/or anti-hypertensive properties of medicinal plants from various parts of the world, which are used as therapies to concomitantly manage diabetes and hypertension.

AIM OF THE REVIEW

This article reviewed findings on medicinal plants with both anti-diabetic and anti-hypertensive effects reported in same experimental study to facilitate the development of dual-acting therapies against diabetes and hypertension.

MATERIALS AND METHODS

A literature search was carried out on different scientific search engines including, but not limited to "PubMed", "Google Scholar", "Scopus" and ScienceDirect to identify published data in which plants in same experimental studies were reported to possess both anti-hyperglycemic and anti-hypertensive effects. Subsequently, the anti-diabetic/anti-hypertensive potency ratio (ψ) of the medicinal plants was computed.

RESULTS

Sixty-four studies with 102 plant species matched the selection criteria. Members of the Fabaceae family were the most investigated plants, while the ψ greatly varied across the plants, with only 11 plants having a ψ ≃ 1. Withania somnifera Dunal was the only plant reported to show blood glucose-lowering and diuretic effects in humans, comparable to daonil. Caffeic acid, chlorogenic acid, caftaric acid, cichoric acid, verbascoside, leucosceptoside A, isoacteoside, fucoxanthin and nicotinamide were the reported dual acting anti-diabetic and anti-hypertensive compounds identified and/or isolated in the plants.

CONCLUSIONS

This review suggests that medicinal plants possess varied therapeutic dynamics against hypertension and diabetes that could be exploited for the discovery of therapeutic preparation(s) or agent(s) for treating the two diseases.

The association between fasting plasma glucose and glycated hemoglobin in the prediabetes range and future development of hypertension

Background

Prediabetes is a well-established risk factor for progression to overt diabetes mellitus (DM), which is in turn associated with development of hypertension (HTN) and vice versa. However, the role of prediabetes and HbA1c in particular as an independent risk factor for the development of hypertension is unclear.

Aim

In this current study, we aimed to evaluate the association between both fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels in the prediabetes range and development of HTN among a large cohort of normotensive subjects.

Design and methods

We investigated 5016 normotensive participants without DM and other cardiovascular risk factors who were annually screened in a tertiary medical center. Subjects were divided into normoglycemic and prediabetic groups. Normoglycemia was defined as HbA1c < 5.7% and FPG < 100 mg/dl. Prediabetes was defined according to the ADA criteria, i.e., 6.5% > HbA1c ≥ 5.7% or impaired fasting glucose (IFG):126 mg/dl > FPG ≥ 100 mg/dl. Subgroup analysis was made by dividing participants into four groups according to FPG and HbA1C levels, i.e., normoglycemia, impaired HbA1c only, IFG only, and both parameters impaired.

Results

During a follow-up of 3.7 ± 2.9 years, 318 (6.3%) subjects developed HTN. A cumulative hazard function for the development of hypertension showed a 2.89-fold ([95% CI 2.19–3.83], p < .0001) increased risk for HTN in the prediabetic population. In a multivariable Cox proportional hazard regression model adjusted to common confounding risk factors for HTN, prediabetes was found to be independently associated with a 1.95-fold ([95%, CI 1.43–2.52] p < .0001) increased risk for hypertension. Impaired HbA1C only was not found to be independently associated with HTN, while IFG only showed a 2.13-fold (95%, [CI 1.46–3.11] p < .0001) increased risk for HTN compared to normoglycemic, and a 2.55-fold ([95% CI 1.85–3.51] p < .0001) increased risk for HTN when both parameters impaired.

Conclusion

Our study demonstrates that FPG in the prediabetes range, albeit not glycated hemoglobin, is independently and significantly associated with future development of HTN. Therefore, our findings further highlight the pivotal predictive role of IFG for HTN development as opposed to the limited independent role of abnormal HbA1c levels.

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0859-4) contains supplementary material, which is available to authorized users.

Type 2 Diabetes Mellitus (T2DM) "Remission" in Non-bariatric Patients 65 Years and Older

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older.

Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as “remission”). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM “remission.”

Results: 4.97% of patients studied met the definition of T2DM “remission” in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05).

Conclusion: T2DM “remission” in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.

Prevalence, awareness, and determinants of type 2 diabetes mellitus among commercial taxi drivers in buffalo city metropolitan municipality South Africa: A cross-sectional survey

Undiagnosed type 2 diabetes mellitus constitutes a significant threat to the health of commercial taxi drivers, safety of the passengers and other road users. This study determines the prevalence of pre-diabetes and type 2 diabetes mellitus among commercial taxi drivers in Buffalo City Metropolitan Municipality (BCMM), Eastern Cape and examines the factors associated with type 2 diabetes mellitus.A cross-sectional survey of 403 commercial taxi drivers was undertaken using the World Health Organization (WHO) STEPwise approach. Anthropometric, blood pressure, and blood glucose measurements followed standard procedure. Diabetes status was determined using the fasting blood glucose (FBG) test. Diabetes was defined as a FBG ≥7.0mmol/L or self-reported history of diabetes or current diabetes medication use (treatment), while pre-diabetes was defined as a FBG of 5.6 to 6.9 mmol/L. Awareness of diabetes was defined as a self-reported history of diabetes.The mean age of the study participants was 43.3 ± 12.5years. Prevalence of pre-diabetes and diabetes were 17% (95% CI: 13.4-20.6) and 16% (95% CI: 12.4-19.6), respectively. Of those who had diabetes (n = 63), the majority were aware of their diabetes status (n = 43) and were on treatment (n = 30). In the unadjusted logistic regression, age, ever married, hypertension, obesity, and driving for more than 5 years were independently associated with diabetes. However, only age >35 (adjusted odds ratio [AOR]= 3.65, CI: 1.17-11.32), ever married (AOR= 3.26, CI: 1.52-6.99) and hypertension (AOR= 3.23, CI: 1.56-6.69) were associated with diabetes in the adjusted logistic regression model.The prevalence of diabetes among commercial taxi drivers in this study is high, almost twice the national prevalence of diabetes in South Africa. Periodic health screening among this sub-population group is important to bridge the gap of undiagnosed diabetes in South Africa.

Population attributable fractions of the main type 2 diabetes mellitus risk factors in women: Findings from the French E3N cohort

BACKGROUND

Although many type 2 diabetes mellitus (T2DM) risk factors have been identified, little is known regarding their contributions to the diabetes burden at the population level.

METHODS

The study included 72 655 French women from the Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective cohort followed between 1993 and 2011. Cox multivariable models including the main T2DM risk factors (metabolic, dietary, clinical, socioeconomic and hormonal) and a healthy lifestyle index combining five characteristics (smoking, body mass index [BMI], alcohol consumption, fruit and vegetable consumption, and physical activity) were used to estimate hazard ratios and population attributable fractions (PAFs) for T2DM.

RESULTS

In multivariate models, factors with the strongest effect on T2DM risk were, in decreasing order, BMI ≥ 30 kg/m² (PAF = 43%; 95% confidence interval [CI] 37-47), high adherence to a Western dietary pattern (PAF = 30%; 95% CI 20-40), hypertension (PAF = 26%; 95% CI 20-32), an acidogenic diet (PAF = 24%; 95% CI 16-32), a family history of diabetes (PAF = 20%; 95% CI 17-22), and, with a negative correlation, moderate alcohol consumption (PAF-19%; 95% CI -34, -4). The PAF for an unhealthy lifestyle was 57% (95% CI 50-63).

CONCLUSIONS

We have been able to sort out and quantify the effect of various dietary and biological T2DM risk factors simultaneously in a single population, and to highlight the importance of a healthy lifestyle for primary prevention: more than half the T2DM cases could have been prevented through a healthier lifestyle.

Effect of Dapagliflozin Treatment on the Expression of Renal Sodium Transporters/Channels on High-Fat Diet Diabetic Mice

BACKGROUND

Inhibition of the Na+/glucose co-transporter 2 is a new therapeutic strategy for diabetes. It is unclear how proximal loss of Na+ (and glucose) affects the subsequent Na+ transporters in the proximal tubule (PT), thick ascending limb of loop of Henle (TAL), distal convoluted tubule (DCT) and collecting duct (CD).

METHODS

Mice on a high fat diet were administered 3 doses streptozotocin 6 days prior to oral dapagliflozin administration or vehicle for 18 days. A control group of lean mice were also included. Body weight and glucose were recorded at regular intervals during treatment. Renal Na+ transporters expression in nephron segments were analyzed by RT-qPCR and Western blot.

RESULTS

Dapagliflozin treatment resulted in a significant reduction in body weight and blood glucose compared to vehicle-treated controls. mRNA results showed that Na+-hydrogen antiporter 3 (NHE3), Na+/phosphate cotransporter (NaPi-2a) and epithelial Na+ channel expression was increased, Ncx1, ENaCβ and ENaCγ expression declined (p all < 0.05), respectively, in dapagliflozin-treated mice when compared with saline vehicle mice. Na-K-2Cl cotransporters and Na-Cl cotransporter mRNA expression was not affected by dapagliflozin treatment. Na+/K+-ATPase (Atp1b1) expression was also increased significantly by dapagliflozin treatment, but it did not affect Atp1a1 and glucose transporter 2 expression. Western blot analysis showed that NaPi-2a, NHE3 and ATP1b1 expression was upregulated in dapagliflozin-treated diabetic mice when compared with saline vehicle mice (p < 0.05).

CONCLUSION

Our findings suggest that dapagliflozin treatment augments compensatory changes in the renal PT in diabetic mice.

Awareness and practice of aerobic exercise and yoga among hypertensive patients in Anand city

BACKGROUND

Aerobic exercise is helpful in reducing elevated blood pressure (BP). It was also found that yoga is useful in reducing raised BP. Thus, they both can be used in prevention and treatment of hypertension. Hence, the study aimed to observe both awareness and practice of aerobic exercise and yoga among hypertensive patients in Anand city.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted. A questionnaire was prepared containing 24 questions about awareness and practice of aerobic exercise and yoga among hypertensive patients. The questions were explained to all the patients, and 200 patients were recruited from Anand city through convenience sampling.

RESULTS

Two-hundred patients were included in this study, of which 100% were aware of hypertension. 67.68% were aware of the role of aerobic exercise in hypertension, of which 58.29% practiced them. The awareness of the role of yoga in hypertension was noted in 33.67% of patients, of which only 13.07% practiced pranayama and 9.50% practiced asanas.

CONCLUSION

There was a complete awareness of hypertension among hypertensive patients. A large number of patients were aware of the role of aerobic exercise in hypertension, but only few of the patients practiced them. However, there was less awareness of the role of yoga in hypertension and even lesser number practiced them.

Angiotensin Converting Enzyme Gene Insertion/Deletion Polymorphism Is Not Responsible for Antihypertensive Therapy Induced New Onset of Type 2 Diabetes in Essential Hypertension

Background:

Antihypertensive drug therapies have been reported to be associated with new onset of type 2 diabetes mellitus in some hypertensive patients after prolonged use. Angiotensin converting enzyme (ACE) gene has been found to affect essential hypertension, response of antihypertensive therapies, and glycemic disturbances. Therefore, ACE gene I/D polymorphism may be associated with risk of new onset of type 2 diabetes via metabolic disturbances, glycemic dysregulation, and insulin resistance.

Aim:

To assess the correlation between ACE gene I/D polymorphism and glycemic disturbance under influence of diuretic and other antihypertensive drug therapies.

Materials and methods:

We recruited 270 normotensive patients as control (150 men and 120 women), 270 hypertensive patients (95 men and 175 women), and 240 hypertensive with new onset of diabetes patients (80 men and 160 women). All samples were genotyped for ACE gene polymorphic alleles and relationship between different genotypes and anthropometric and clinical parameters along with drug therapies was established and analyzed.

Results:

Baseline clinical (systolic blood pressure, diastolic blood pressure, and fasting blood glucose level) and anthropometric parameters (height, weight, waist circumference, hip circumference, waist-hip ratio, and body mass index) of study populations were found highly statistically significant (P < .05) when compared among study groups. Furthermore, genotype wise comparison of all these parameters in essential hypertensive (EH) and essential hypertensive with onset of diabetes (EHNOD) patients found most of them nonsignificant and no variation was found with respect to different genotypes of ACE gene. The genotype wise comparison of clinical parameters among different antihypertensive drug therapy was found statistically nonsignificant in both EH and EHNOD patients.

Discussion:

Anthropometric parameters can be taken as the risk indicator factors for hypertension and diabetes. However, ACE gene polymorphism may not be a risk factor for development of diabetes in hypertensive patients.

Conclusion:

The present study suggested that ACE gene polymorphism did not show any significant association with the risk of new onset of diabetes in EH patients and more detailed studies with large population size are needed.

Effects of Talinum triangulare leaf flavonoid extract on streptozotocin-induced hyperglycemia and associated complications in rats

Talinum triangulare leaf flavonoid extract (TTFE) was evaluated for its effects on streptozotocin-hyperglycemia and associated complications especially as it relates to dyslipidemia, lipid peroxidation, and renal dysfunction in rats. Two normoglycemic rat groups designated: control (administered distilled water) and control + TTFE (administered 10 mg/kg b.w. TTFE) and two streptozotocin-induced (STZ) diabetic rat groups designated: STZ-control (administered distilled water) and STZ + TTFE (administered 10 mg/kg TTFE). The treatment was given orally once daily for 21 consecutive days. Body weight and insulin concentration showed significant improvement while blood glucose, uric acid, creatinine, and total bilirubin concentrations were significantly reduced in diabetic rats administered TTFE compared to diabetic untreated rats. Furthermore, triglycerides, total cholesterol, LDL-cholesterol, and malondialdehyde concentrations were significantly lowered in diabetic rats administered TTFE compared with diabetic untreated rats. Key enzymes involved in carbohydrate breakdown and cholesterol synthesis, α-amylase and 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, respectively, were significantly inhibited in TTFE-treated diabetic rats compared to diabetic control. Results presented in this study suggest that administration of TTFE for 21 days normalized STZ-induced hyperglycemia and its associated dyslipidemia by a mechanism involving inhibition of α-amylase and HMG-CoA reductase activities, respectively, in rats.

Silibinin decreases hepatic glucose production through the activation of gut-brain-liver axis in diabetic rats

Silibinin, a flavonolignan derived from milk thistle (Silybum marianum), has been revealed to have a beneficial effect on improving diabetes-impaired glycemic control. However, the underlying mechanism is still unclear. In the present study, to evaluate whether the gut-brain-liver axis, an important neural pathway for the control of hepatic glucose production, is involved in silibinin-regulated glucose homeostasis, the expression of glucagon-like peptide-1 receptor (GLP1R) in the duodenum, activation of neurons in the nucleus of the solitary tract (NTS), as well as glycogen accumulation and expression of gluconeogenic enzymes in the livers of diabetic SHRSP·Z-Leprfa/IzmDmcr (SP·ZF) rats with 4-week oral administration of silibinin (100 and 300 mg kg-1 day-1) were evaluated. Common hepatic branch vagotomy was further conducted in high-fat diet/streptozotocin (HFD/STZ)-induced diabetic SD rats to confirm the role of the gut-brain-liver axis in silibinin-improved glycemic control. The results revealed a significant inhibition of fasting blood glucose after SP·ZF rats were administrated with silibinin for 4 weeks. The expression of GLP1R in the duodenum and the activation of neurons in the NTS increased, while hepatic glucose production decreased on silibinin administration. However, the hypoglycemic effect of silibinin was reversed by common hepatic branch vagotomy in diabetic SD rats. Our study suggested that silibinin may be useful as a potential functional food ingredient against diabetes by triggering the gut-brain-liver axis.

Evaluating All Potential Oral Complications of Diabetes Mellitus

Diabetes mellitus (DM) is associated with several microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular diseases. The pathogenesis of these complications is complex, and involves metabolic and hemodynamic disturbances, including hyperglycemia, insulin resistance, dyslipidemia, hypertension, and immune dysfunction. These disturbances initiate several damaging processes, such as increased reactive oxygen species (ROS) production, inflammation, and ischemia. These processes mainly exert their damaging effect on endothelial and nerve cells, hence the susceptibility of densely vascularized and innervated sites, such as the eyes, kidneys, and nerves. Since the oral cavity is also highly vascularized and innervated, oral complications can be expected as well. The relationship between DM and oral diseases has received considerable attention in the past few decades. However, most studies only focus on periodontitis, and still approach DM from the limited perspective of elevated blood glucose levels only. In this review, we will assess other potential oral complications as well, including: dental caries, dry mouth, oral mucosal lesions, oral cancer, taste disturbances, temporomandibular disorders, burning mouth syndrome, apical periodontitis, and peri-implant diseases. Each oral complication will be briefly introduced, followed by an assessment of the literature studying epidemiological associations with DM. We will also elaborate on pathogenic mechanisms that might explain associations between DM and oral complications. To do so, we aim to expand our perspective of DM by not only considering elevated blood glucose levels, but also including literature about the other important pathogenic mechanisms, such as insulin resistance, dyslipidemia, hypertension, and immune dysfunction.

Epidemiology of Self-Reported Diabetes Mellitus in the State of Maranhão, Northeastern Brazil: Results of the National Health Survey, 2013

Objective: To estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in adults from the State of Maranhão, Northeastern Brazil. Methods: A cross-sectional study was carried out with 1774 individuals aged ≥18 years participating in the National Health Survey of 2013 in Maranhão. The adults were selected by probabilistic sampling and interviewed face-to-face by in-home visits. The Poisson regression model was used to verify the factors associated with DM. Results: The prevalence of DM was 5.39% (95% confidence interval [95% CI]: 3.73–7.73). After adjustment of the regression model for age, gender, smoking, education, hypertension, and hypercholesterolemia, DM was statistically associated with age ≥60 years, female sex, low educational level, and self-report hypertension. Conclusion: The present study found the prevalence of self-reported DM similar to that estimated in the general population of Brazil. Public policies for prevention and control should intensify control, especially in the subgroups most vulnerable to DM.

Comparison of Interventions to Improve Long-Term Medication Adherence Across Different Clinical Conditions: A Systematic Review With Network Meta-Analysis

Background: Medication non-adherence has a dynamic, temporal and multifactorial nature with a significant impact on economic and clinical outcomes. Interventions to improve adherence are complex and require adaptation to patients' needs, which may include patient's medical conditions. The aim of this study was to assess the comparative effectiveness of medication adherence interventions per type of clinical condition on adult patients.

Methods: A systematic review with network meta-analysis was performed (PROSPERO registration number of CRD42018054598). An initial Pubmed search was conducted to select meta-analyses reporting results of interventions aiming to improve medication adherence. Primary studies were selected and those reporting results with a long-term follow up (≥10 months) on adult patients were included for data extraction. Study characteristics, description of interventions and adherence outcomes were extracted. Adherence interventions were classified in four groups: educational, attitudinal, technical, and rewards. Clinical conditions were classified in four groups: circulatory system and metabolic diseases, infectious diseases, musculoskeletal diseases, and mental, behavioral or neurodevelopmental disorders. Network meta-analyses with effect sizes expressed as odds ratio (OR) with a 95% credibility interval (CrI) were built. Ranking probabilities for each measure of adherence were calculated by using surface under the cumulative ranking analysis (SUCRA).

Results: A total of 61 meta-analysis and 149 primary studies were included in the qualitative synthesis and 80 primary studies in the quantitative analysis. The most effective interventions were: educational + technical 79.6% [OR: 0.44 (CrI: 0.26, 0.73)] and 73.3% [OR: 0.56 (0.36, 0.84)] in circulatory system and metabolic diseases and infectious diseases respectively. Attitudinal intervention had the greatest probability for musculoskeletal diseases of 92.3% in SUCRA [OR: 0.30 (0.10, 0.86)]. Finally, educational + attitudinal interventions had the greatest effect (SUCRA 73.8%) for mental, behavioral or neurodevelopmental disorders, although this was not significant according to consistency analysis.

Conclusion: Effectiveness of interventions seems to be related to the clinical condition. Educational and technical interventions resulted in a major effect on long-term management of medication adherence in patients with infectious diseases (HIV) and circulatory system and metabolic diseases whereas attitudinal components presented a higher effect on musculoskeletal and mental, behavioral or neurodevelopmental disorders.

Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

BACKGROUND

Cardiac autonomic neuropathy (CAN) is a commonly overlooked complication of Type 2 Diabetes Mellitus (T2DM) characterized by imbalance between sympathetic and parasympathetic supply to the heart. The susceptibility of heart to dysrhythmias and fatal events increases during and after exercise due to a shift in autonomic regulation. Diabetes and hypertension (HTN) frequently occur concurrently and both conditions lead to impaired cardiac autonomic control. However, their impact together on post-exercise autonomic recovery remains to be explored.

OBJECTIVE

The objective of the study was to investigate the effect of co-existence of HTN on cardiac autonomic recovery (assessed by heart rate recovery and heart rate variability) in patients with T2DM.

METHODS

Forty eight type 2 diabetic patients (24 normotensive, 24 hypertensive), 24 non-diabetic patients with essential HTN, and 27 healthy controls, were recruited into the study and assessed for heart rate recovery (HRR) following a graded maximal test. Also, heart rate variability (HRV) was recorded before and following the bout of maximal exercise.

RESULTS

Heart rate recovery at 1 (HRR1min) and 2 (HRR2min) minute(s) showed significant effects for DM (p < 0.001) and HTN (p < 0.001), while DM × HTN interaction was found to be non-significant. Resting HRV showed a significant decline in time-domain variables for the DM group (p < 0.01). Recovery of HRV showed a significant effect of time (p < 0.05) for all indices, the group effect was found significant only for time-domain measures (p < 0.05).

CONCLUSION

Both HRR and HRV recovery were impaired in DM and HTN. Moreover, the co-existence of HTN had a synergistic effect, causing further worsening of autonomic recovery in T2DM.

Risk factors for self-reported diabetes among Bhutanese adults: A nationally representative survey data analysis

Background

Bhutan, a small land-locked country in the eastern Himalayas has been undergoing an epidemiological and nutritional transition in the last two decades. The objective of this paper was to determine the prevalence and explore the risk factors of self-reported diabetes among Bhutanese adults.

Methods

We conducted a secondary data analysis among adults 18 years and older Bhutanese using the data from the National Health Survey 2012 (NHS, 2012) of Bhutan. The self-reported information on risk factors was obtained using standard protocols of the WHO STEPwise approach to Surveillance. The outcome of interest was self-reported diabetes on medication. Adjusted and unadjusted logistic regression analyses were performed to identify the risk factor of diabetes.

Results

A total of 31,066 participants aged 18 years and older were included for the analysis. The prevalence of self-reported hypertension was 1.8% (491). Risk factors for diabetes were: age groups: 35–44 years adjusted odds ratio (AOR) = 2.82 (95% CI, 1.07, 7.41), 45–54 years AOR = 6.02 (95% CI, 2.29, 15.83), 55–64 year AOR = 15.7 (95% CI 5.93, 41.55) and >65 years AOR = 19.60 (95% CI, 6.93, 55.71); high school and diploma/certificate education AOR = 2.57, (95% CI 1.62, 4.07) and AOR = 3.92 (95% CI 1.70, 9.07); and urban dwellers AOR = 2.37, (95% 1.58, 3.57); hypertension AOR = 3.3, (95% CI 2.47, 4.41); and fruit servings of 1–3 per week AOR = 1.63 (95% CI 1.15, 2.31).

Conclusion

The number of Bhutanese adults with diabetes and co-morbidities associated with it is likely to increase with the ageing of the population, nutrition transition, and high rural-urban migration in the near future. This calls for an urgent need to implement strategies to prevent diabetes in the Bhutanese population targeting risk factors including healthy lifestyle with increased physical activities and reduced smoking. At the same time treating other chronic morbidities including hypertension.

A smartphone-assisted microfluidic chemistry analyzer using image-based colorimetric assays for multi-index monitoring of diabetes and hyperlipidemia

A smartphone-assisted microfluidic chemistry analyzer using an image-based colorimetric detection method was successfully developed for the simultaneous analysis of three diabetes- and hyperlipidemia-related indexes, glucose (GLU), triglyceride (TG), and total cholesterol (TC). A fan-shaped microfluidic chip was designed and optimized to reliably allocate a premixed serum sample into four reaction chambers by a simple pipetting. The color changes of the peroxidase-H₂O₂ enzymatic reactions in the chambers were captured and analyzed using a smartphone-controlled analyzer with a LED light source and a CCD camera. The highly quantitative relationships between the analyte concentrations and the color characteristic values of the green channel of the captured images were successfully established, enabling accurate and reproducible detections of GLU, TG, and TC simultaneously at a low cost. The parallel analyses of 111 serum samples using our system and a conventional chemistry analyzer were conducted, yielding an excellent correlation and consistency between these two systems. This study proved the feasibility of performing the multi-index monitoring of diabetes, hyperlipidemia, and other chronic diseases on a point-of-care platform at a high fidelity, but a low cost.

Danhong injection in cardiovascular and cerebrovascular diseases: Pharmacological actions, molecular mechanisms, and therapeutic potential

Cardiovascular and cerebrovascular diseases are the main cause of mortality worldwide, currently with less than optimum therapeutic options. Danhong injection (DHI) is a medicinal preparation based on two eminent Chinese herbal medicines, Salviae Miltiorrhizae (Dan Shen; family: Lamiaceae) and Flos Carthami (Hong Hua; family: Compositae/Asteraceae). DHI has been mainly used in the clinical therapy of cardiovascular (such as acute coronary syndrome and angina pectoris) and cerebrovascular diseases (such as stroke) in China for many years. The pharmacological properties of DHI include anti-inflammatory, anti-oxidant, anti-coagulatory, hypolipidemic, anti-apoptotic, vasodilatory, and angiogenesis-promoting actions. DHI offers a safe and effective therapeutic agent against cardiovascular and cerebrovascular diseases by modulating multiple disease-relevant signaling pathways and molecular targets. Herein, we provide a comprehensive review of the phytochemistry, therapeutic effects, molecular mechanisms, and adverse reactions of DHI in cardiovascular and cerebrovascular diseases. We also highlight the latest pharmacological advances and therapeutic potential of this promising herb-derived cardiovascular drug preparation.

Predictive factors for hyperglycaemic progression in patients with schizophrenia or bipolar disorder

BACKGROUND

Patients with schizophrenia or bipolar disorder have a high risk of developing type 2 diabetes.

AIMS

To identify predictive factors for hyperglycaemic progression in individuals with schizophrenia or bipolar disorder and to determine whether hyperglycaemic progression rates differ among antipsychotics in regular clinical practice.

METHOD

We recruited 1166 patients who initially had normal or prediabetic glucose levels for a nationwide, multisite, l-year prospective cohort study to determine predictive factors for hyperglycaemic progression. We also examined whether hyperglycaemic progression varied among patients receiving monotherapy with the six most frequently used antipsychotics.

RESULTS

High baseline serum triglycerides and coexisting hypertension significantly predicted hyperglycaemic progression. The six most frequently used antipsychotics did not significantly differ in their associated hyperglycaemic progression rates over the 1-year observation period.

CONCLUSIONS

Clinicians should carefully evaluate baseline serum triglycerides and coexisting hypertension and perform strict longitudinal monitoring irrespective of the antipsychotic used.

DECLARATION OF INTEREST

The authors report no financial or other relationship that is relevant to the subject of this article. Relevant financial activities outside the submitted work are as follows. I.K. has received honoraria from Astellas, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Nippon Chemiphar, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; has received research/grant support from AbbVie GK, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, GlaxoSmithKline, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Takeda Pharmaceutical, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; and is a member of the advisory boards of Dainippon Sumitomo Pharma and Tanabe Mitsubishi Pharma. Y.T. has received speaker's honoraria from Dainippon-Sumitomo Pharma, Otsuka, Meiji-Seika Pharma, Janssen Pharmaceutical, Daiichi-Sankyo Company, UCB Japan and Ono Pharmaceutical. K.U. has received honoraria from Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin. B.Y. has received speaker's honoraria from Otsuka Pharmaceutical and Janssen Pharmaceutical. J. I. has received honoraria from Dainippon Sumitomo Pharma, Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, MSD, Novartis Pharma, Otsuka Pharmaceutical and Mochida Pharma.

Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines

We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2-3.0), 55-64 years (AOR: 1.6, 95% CI: 1.4-1.9), and 45-54 years (AOR: 1.4, 95% CI: 1.3-1.6) age groups, females (AOR: 2.0, 95% CI: 1.7-2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0-2.8), diabetes (AOR: 1.4, 95% CI: 1.2-1.6), secondary (AOR: 1.2, 95% CI: 1.1-1.4), or college education level (AOR: 1.8, 95% CI: 1.4-2.3), middle (AOR: 1.3, 95% CI: 1.1-1.6), richer (AOR: 1.5, 95% CI: 1.2-1.8) or richest (AOR: 2.0, 95% CI: 1.6-2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2-1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3-2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.

The effect of insulin-induced hypoglycemia on inflammatory markers: A systematic review

INTRODUCTION

The effects of acute hypoglycemia on markers of inflammation have been investigated, but the results have been heterogeneous.

OBJECTIVE

We aimed to perform a systematic review about the acute effects of insulin-induced hypoglycemia on inflammatory markers in patients with diabetes as well as non-diabetic subjects.

METHODS

A systematic search of the literature using the electronic databases MEDLINE and SCOPUS was conducted through September 2017. Search terms included: "hypoglycemia"," insulin", "cytokines", and "inflammation". We included original studies assessing peripheral inflammatory markers during insulin-induced hypoglycemia in humans.

RESULTS

Two hundred twenty-two citations were initially retrieved. Eleven studies were included in our systematic review. Acute hypoglycemia increases total leukocyte number and several pro-inflammatory markers. Elevation in pro-inflammatory markers in response to insulin-induced acute hypoglycemia appears to be of similar magnitude in non-diabetic subjects and in type-1 diabetic patients with intact awareness of hypoglycemia. Adrenaline rises in response to acute hypoglycemia correlates with the increase of pro-inflammatory markers.

CONCLUSION

Acute hypoglycemia induces a pro-inflammatory state in both type-1 diabetic and non-diabetic subjects with no apparent significant difference between these two populations. Activation of the sympathetic nervous system is a likely mediator of these effects.

Evolution of blood pressure control identification in lieu of post-surgery diabetic patients: a review

The blood pressure disparity is the major problem in post-operative surgery especially diabetic patients, because there is substantial interrelation between diabetic and hypertension and this abnormality creates complicated problems and needs to be controlled by continuous monitoring based on the severity. To overcome this problem, implementation of automatic drug infusion is required for critical patients, by which workload of the clinical staffs are reduced. Most commonly the sodium nitroprusside (SNP) is used to reduce the blood pressure in fast action based on the prescribed level. In this paper three different types of estimation techniques (PID, IMC and MPC) are uses to identify the valuation. The strength of the projected controller performance is evaluated under different types of patients such as sensitive, and normal along with insensitive patients. Therefore, this paper review the validation results based on the optimized SNP infusion rate for persistent Blood pressure control compare then the reviewed methods. The MATLAB simulation is used to evaluate the efficiency of the proposed work and obtain the results based on the projected values.

Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review

OBJECTIVE

To analyze scientific productions about the relationship between HIV and Systemic Arterial Hypertension (SAH) in people living with HIV/AIDS (PLWHA).

METHOD

Integrative literature review in six databases, held in March 2016. "AIDS" and "hypertension" were the keywords used in Portuguese, English and Spanish languages. We found 248 articles and selected 17. The categories formulated were "prevalence of SAH in PLWHA," "risk factors for SAH in PLWHA" and "adverse events of antiretroviral therapy (ART) that contribute to HAS."

RESULTS

There is no consensus whether HIV and ART influence the SAH development, but there are several risk factors for SAH among PLWHA. It was observed that protease inhibitors medicines influence SAH the most.

CONCLUSION

Guidelines for SAH prevention must be performed in all individuals, however, in PLWHA, they must focus on characteristic risk factors of this population.

Association of soil potassium and sodium concentrations with spatial disparities of prevalence and mortality rates of hypertensive diseases in the USA

Crop available soil potassium is generally low and on the decline in the southeastern states of the USA because of the increasing crop and runoff removal and decreasing application of potassium fertilizer. Hypertension-related mortality rates are also high in the southeastern states and are on the rise. Among 41 elements analyzed from 4856 sites across all 48 states, potassium is identified as the only independent element whose soil concentration has significant association with spatial disparities of essential hypertension and hypertension-related mortality rates in the 48 states between 1999 and 2014. Essential hypertension and hypertension-related mortality rates of the 6 states with the lowest soil potassium concentration are about 50-26% higher than that of the 6 states with the highest soil potassium concentration in the 48 states (RR: 1.50, 1.26, low CI 95% 1.47, 1.25 and upper CI 95% 1.53, 1.27, respectively). Though sodium was not identified as an independent factor, an apparent significant inverse correlation exists between hypertension prevalence rates and soil sodium concentration in the 48 states (r = - 0.66, p = 0.00). There likely has been a decline of potassium in USA produces per unit weight over time and a likely association between this decline and increasing hypertension rate, particularly in the southeastern states. Hence, results of this study suggest the need of increasing potassium intakes for reducing hypertension-related mortality rates in the southeastern states. Results of this study also support further examination of potential benefits of sodium from mixture of non-chloride salts in natural produces.

Hypertension management for community-dwelling older people with diabetes in Nanchang, China: study protocol for a cluster randomized controlled trial

BACKGROUND

Although China has a large number of older people living with diabetes and hypertension, the primary care system is underdeveloped and so management of these conditions in community care settings is suboptimal. Studies have shown that the collaborative care model across care settings that address both pharmacology and nonpharmacology interventions can achieve hypertension control for older people with diabetes. Barriers to implementing and evaluating this model of care are widely recognized in low and middle-income countries including China. This study will therefore test the hypothesis that a hypertension management program built on collaboration between hospitals and community health service centers in China can improve blood pressure control in people aged 60 years and older with diabetes as compared to usual care.

METHODS

A cluster randomized controlled trial will randomly allocate 10 wards from four hospitals in Nanchang to either an intervention group (N = 5) or a usual care group (N = 5). At least 27 participants will be recruited from each ward and the estimated sample size will be 135 patients in each group. The intervention includes individualized self-care education prior to discharge and 6-month follow-up in community health service centers. Health professionals from both hospitals and community health service centers will be resourced to collaborate on the implementation of the postdischarge interventions that reinforce self-care. The primary outcome is systolic blood pressure at 6-month follow-up adjusted for baseline value. Secondary outcomes are self-care knowledge, treatment adherence, HbA1c and lipid levels, quality of life, the incidence of adverse events and the incidence of unplanned hospital readmission at 6-month follow-up adjusted for baseline value. A multilevel mixed-effect linear regression model will be used to compare the changes in health outcomes between the intervention and usual care groups.

DISCUSSION

This study will determine whether collaborative care among health professionals between hospitals and community health service centers will improve hypertension management for older people with diabetes in the study sites. The program, if effective, will have an immediate application to hypertension management in the healthcare system in China.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, ACTRN12617001352392 . Retrospectively registered on 26 September 2017.

Projecting the Burden of Chronic Kidney Disease in a Developed Country and Its Implications on Public Health

BACKGROUND

Chronic Kidney Disease (CKD) is a major public health problem worldwide. There is limited literature on a model to project the number of people with CKD. This study projects the number of residents with CKD in Singapore by 2035 using a Markov model.

METHODS

A Markov model with nine mutually exclusive health states was developed according to the clinical course of CKD, based on a discrete time interval of 1 year. The model simulated the transition of cohorts across different health states from 2007 to 2035 using prevalence, incidence, mortality, disease transition, and disease detection rates.

RESULTS

From 2007 to 2035, the number of residents with CKD is projected to increase from 316,521 to 887,870 and the prevalence from 12.2% to 24.3%. Patients with CKD stages 1-2 constituted the largest proportion. The proportion of undiagnosed cases will decline from 72.1% to 56.4%, resulting from faster progression to higher CKD stages and its eventual detection.

CONCLUSION

By 2035, about one-quarter of the Singapore residents are expected to have CKD. National policies need to focus on primary disease prevention and early disease detection to avoid delayed treatment of CKD which eventually leads to end-stage renal disease.

Polymorphisms in DNA repair genes increase the risk for type 2 diabetes mellitus and hypertension

We investigated the effect of polymorphisms in four DNA repair genes, viz. RAD18 Arg302Gln (G>A) (rs373572), XPD Asp312Asn (G>A) (rs1799793), APE1 Asp148Glu (T>G) (rs3136820), and OGG1 Ser326Cys (C>G) (rs1052133) on the risk for type 2 diabetes mellitus (T2DM) and hypertension (HT) in association with smoking, tobacco chewing, and alcohol consumption in a population from Northeast India. The study subjects were comprised of 70 patients suffering from both T2DM and HT and 83 healthy controls. Genotyping was performed using ARMS-PCR for XPD Asp312Asn (G>A) and PCR-CTPP for RAD18 Arg302Gln (G>A), APE1 Asp148Glu (T>G) and OGG1 Ser326Cys (C>G). The RAD18 Gln/Gln genotype was found to significantly increase the risk for T2DM and HT by 30 fold. Significant high risk was observed for individuals with XPD Asn/Asn-RAD18 Arg/Gln genotypes. Smoking was found to be the single most important independent risk factor for T2DM and HT. This study concludes that RAD18 Arg302Gln and XPD Asp312Asn polymorphisms might increase the risk for T2DM and HT in association with smoking, tobacco chewing, and/or alcohol consumption, while APE1 Asp148Glu (T>G) and OGG1 Ser326Cys (C>G) polymorphisms do not contribute to such risk.

Differential sex effects of systolic blood pressure and low-density lipoprotein cholesterol on type 2 diabetes: Life course data from the Bogalusa Heart Study

BACKGROUND

There may be sex-specific cardiometabolic mechanisms early in life that affect the development of type 2 diabetes mellitus (T2DM) through mid-adulthood. However, few studies have examined whether early life course interactions between cardiometabolic risk factors and sex are associated with incident T2DM.

METHODS

This study followed 7725 children (3834 [49.6%] females, 3891 [50.4%] males) from the Bogalusa Heart Study through mid-adulthood to examine whether low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), or systolic blood pressure (SBP) differentially affect the risk of T2DM for females versus males. Potential sex interactions were tested after adjusting for age, race, triglycerides, smoking, follow-up time, puberty stage, use of birth control, and enrollment year.

RESULTS

Mean (± SD) age at baseline was 9.4 ± 3.5 years. There were 176 cases of T2DM (cumulative incidence = 2.3%) during a median follow-up of 9.1 years. In females versus males, LDL-C and SBP were differentially associated with T2DM (P ≤ 0.001 and P = 0.017, respectively). The relationships of BMI and HDL-C with T2DM were non-differential between females and males (P = 0.79 and P = 0.27, respectively).

CONCLUSIONS

This study is the first to show evidence of sex-specific differential effects of LDL-C and SBP on the risk of T2DM from childhood to adulthood. Greater LDL-C places girls at disproportionally higher risk of T2DM as women, whereas greater SBP differentially exposes boys to a greater risk of T2DM as men. Additional studies within existing child cohorts are needed to confirm and investigate the mechanisms underlying these differential effects.

Glycated hemoglobin correlates with arterial stiffness and endothelial dysfunction in patients with resistant hypertension and uncontrolled diabetes mellitus

This study aimed to evaluate the effects of glycated hemoglobin (HbA_1c ) on flow-mediated dilation, intima-media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN-controlled diabetes mellitus and RHTN-uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA_1c <7.0% (RHTN-controlled diabetes mellitus: n = 98) and HbA_1c ≥7.0% (RHTN-uncontrolled diabetes mellitus: n = 122). Intima-media thickness and flow-mediated dilation were measured by high-resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid-femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN-uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN-uncontrolled diabetes mellitus. Intima-media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA_1c was an independent predictor of flow-mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA_1c may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function.

Diabetes mellitus and hypertension: a dual threat

PURPOSE OF REVIEW

The following is a review of the current concepts on the relationship between hypertension (HTN) and diabetes mellitus with a focus on the epidemiology and cardiovascular prognostic implications of coexistent HTN and diabetes mellitus, shared mechanisms underlying both conditions and pathophysiology of increased risk of cardiovascular disease, treatment of HTN in individuals with diabetes mellitus, and effects of anti-diabetic medications on blood pressure (BP).

RECENT FINDINGS

Diabetes mellitus and HTN often coexist in the same individual. They share numerous risk factors and underlying pathophysiologic mechanisms, most important of which are insulin resistance and inappropriate activation of the rennin-angiotensin-aldosterone system. Recently updated guidelines recommend a BP goal of 140/90 mmHg in most individuals with diabetes mellitus. A new class of anti-diabetic medications, sodium-glucose co-transporter 2 inhibitors, has shown favorable effects on BP.

SUMMARY

HTN affects the majority of individuals with diabetes mellitus. Coexistence of diabetes mellitus and HTN, especially if BP is not well controlled, dramatically increases the risk of morbidity and mortality from cardiovascular disease. BP control is an essential part of management of patients with diabetes mellitus, because it is one of the most effective ways to prevent vascular complications and death.

Multicomponent Exercise Improves Hemodynamic Parameters and Mobility, but Not Maximal Walking Speed, Transfer Capacity, and Executive Function of Older Type II Diabetic Patients

The present study aimed to investigate the effects of a 6-month multicomponent exercise program (MCEP) on functional, cognitive, and hemodynamic parameters of older Type 2 diabetes mellitus (T2DM) patients. Moreover, additional analyses were performed to evaluate if T2DM patients present impaired adaptability in response to physical exercise when compared to nondiabetic volunteers. A total of 72 T2DM patients and 72 age-matched healthy volunteers (CG) were recruited and submitted to functional, cognitive, and hemodynamic evaluations before and after six months of a MCEP. The program of exercise was performed twice a week at moderate intensity. Results indicate T2DM and nondiabetic patients present an increase in mobility (i.e., usual walking speed) after the MCEP. However, improvements in maximal walking speed, transfer capacity, and executive function were only observed in the CG. On the other hand, only T2DM group reveals a marked decline in blood pressure. In conclusion, data of the current study indicate that a 6-month MCEP improves mobility and reduce blood pressure in T2DM patients. However, maximal walking speed, transfer capacity, and executive function were only improved in CG, indicating that T2DM may present impaired adaptability in response to physical stimulus.

Cardiovascular Risk Factors in a Suburban Community in Nigeria

The burden of hypertension, a silent killer, continues to increase in low- and middle-income countries. This study evaluated blood pressure (BP) in healthy adults to determine their risk of developing hypertension and to reduce associated morbidity of the disease. Overall, 182 subjects aged >16 years participated in the study. Systolic (SBP) and diastolic blood pressure (DBP) was measured after a resting period using mercury sphygmomanometer. Random blood glucose (RBG) concentration was also determined. Regression models were used to determine risk of high BP with p values < 0.05 indicating statistical difference. Prehypertension was present in 36.8% population and high BP in 31% individuals with hypertensive symptoms. DBP ≥ 90 mmHg was prevalent in the undiagnosed group, while diabetes comorbidity was detected in only 4 individuals. High BP or diabetes was not detected in those <20 year olds. Age > 35 years was an independent risk (likelihood ratio: 22.56, p < 0.0001); this increases to 26.48 (p < 0.0001) in the presence prediabetes and RBG > 100 mg/dl. Undiagnosed hypertension rate is high in the study area, and urgent interventions for large scale screening and management of the disease are required to reduce the burden of hypertension in Nigeria.

Daily sodium intake influences the relationship between angiotensin-converting enzyme gene insertion/deletion polymorphism and hypertension in older adults

The angiotensin-converting enzyme insertion/deletion (I/D) gene polymorphism has been widely reported as being associated with hypertension; however, most studies do not consider environmental/behavioral factors. This study aimed to investigate the relationship among angiotensin-converting enzyme insertion/deletion gene polymorphism, environmental/behavioral factors, and hypertension in community-dwelling elderly individuals. All community-dwelling older adults from Aiquara, Bahia, Brazil, were invited to take part in this study. After exclusions, 234 elderly participants were submitted to a data collection, which included sociodemographics, lifestyle and health status questionnaires, clinical assessment, and blood withdrawal. From the blood samples, the gene polymorphism was identified through polymerase chain reaction and patients grouped as II or D allele carriers (ID and DD genotypes). Hypertension was defined by self-report of the condition and confirmed by antihypertensive drug treatment. Chi-square test was used to identify differences in the proportions distributed between groups of each dependent variable (ie, genotype, diagnosis of hypertension, and blood pressure state from medicated patients with hypertension). The prevalence of hypertension was 59.3% and was associated with diabetes mellitus and obesity, but not with angiotensin-converting enzyme insertion/deletion gene polymorphism. However, carriers of the II genotype, a salt-sensitivity genotype, exhibited a significantly greater estimated sodium intake. In addition, among medicated elderly patients with hypertension, II genotype carriers exhibited poor blood pressure control, despite similar antihypertensive drug treatment in D allele carriers, while exhibiting a greater estimated sodium intake. Our results provide new evidence regarding the interaction of genetic and environmental/behavioral factors in the genesis of hypertension among elderly patients, as well as in blood pressure control in medicated elderly patients with hypertension.

Increased plasma and adipose tissue levels of ANGPTL8/Betatrophin and ANGPTL4 in people with hypertension

Background

Hypertension is a risk factor for both cardiovascular diseases (CVDs) and type 2 diabetes (T2D). Angiopoietin-like proteins (ANGPTLs), mainly ANGPTL3, ANGPTL4 and ANGPTL8, are associated with increased plasma lipid content due to their role in regulating the activity of lipoprotein lipase, a key enzyme in metabolism of the lipoprotein in circulation. Dyslipidaemia is a risk factor for hypertension development; however, the roles of ANGPTL3, ANGPTL4 and ANGPTL8 in subjects with hypertension have not yet been established. This study compared the plasma and adipose tissue levels of ANGPTL3, ANGPTL4 and ANGPTL8 in age- and body mass index-matched subjects with and without hypertension.

Methods

A total of 119 subjects, including 69 hypertensive and 50 non-hypertensive subjects, were enrolled. ANGPTL3, ANGPTL4 and ANGPTL8 plasma levels were measured by ELISA, whereas their levels in adipose tissue were assessed via real-time PCR.

Results

We found that ANGPTL4 (202.49 ± 17.44 ng/mL vs. 160.64 ± 10.36 ng/mL, p = 0.04) and ANGPTL8 levels (2310.96 ± 194.88 pg/mL vs. 1583.35 ± 138.27 pg/mL, p = 0.001) were higher in hypertensive subjects than non-hypertensive subjects. However, ANGPTL3 levels were not significantly different between the two populations. Similarly, ANGPTL4 and ANGPTL8 levels were also elevated in subjects with T2D and hypertension than in those with T2D but not hypertension. Additionally, people with highest tertiles of ANGPTL8 had higher odds of having hypertension (odd ratio [OR] = 3.8, 95% confidence interval [CI] = (1.5-9.8), p-Value = 0.005. Similar to its plasma levels, ANGPTL4 and ANGPTL8 were higher in adipose tissue.

Conclusions

In conclusion, our data illustrate that ANGPTL4 and ANGPTL8 levels in both plasma and adipose tissues are increased in subjects with hypertension. The elevated levels of ANGPTL4 and ANGPTL8 in hypertensive subjects highlight their potential involvement, their potential role as biomarkers for hypertension and their therapeutic value in hypertension given their roles in regulating lipid metabolism.

Inflammation and oxidative stress markers in diabetes and hypertension

Background

Inflammation and oxidative stress are important factors associated with chronic disease such as essential hypertension (HTN) and type 2 diabetes mellitus (T2DM). However, the association of inflammation and oxidative stress in HTN with T2DM as a comorbidity is inconclusive due to the multifactorial nature of these cardiometabolic diseases.

Methodology

The influence of pathophysiological factors include genetics, age of patient, and disease progression change throughout the lifespan and require further investigation. The study population included 256 participants attending a rural health screening program who were tested for markers of inflammation, oxidative stress, and coagulation/fibrinolysis. Demographic and clinical variables included, age, gender, systolic and diastolic blood pressures, blood glucose, hemoglobin A1c, estimated glomerular filtration rate, and cholesterol profile. Data were tested for normality, and nonparametric statistics were applied to analyze the sample with significance set at p<0.05.

Results

Of the inflammatory markers, interleukin-1β (IL-1β) and IL-10 were significantly different between the control and hypertensive group (p<0.03) and between the HTN+T2DM compared to the HTN group (p<0.05). Significant results for oxidative stress were observed for urinary 8-iso-PGF₂α and insulin-like growth factor 1 (IGF-1) between the control and the HTN+T2DM group (p<0.01). Glutathione (GSH) was also significant between the HTN and HTN+T2DM group (p<0.05). Investigation of the progression of HTN also found significant changes in the inflammatory markers IGF-1, monocyte chemoattractant protein 1 (MCP-1), and (MCP-1/IGF-1)*IL-6 (p<0.05).

Conclusion

This study demonstrated that 8-iso-PGF₂α and erythrocyte GSH may be clinically useful for assessing HTN and HTN with T2DM as a comorbidity, while significant changes in the inflammatory profile were also observed with HTN progression.

Children's migration and lifestyle-related chronic disease among older parents 'left behind' in india

Lifestyle-related chronic diseases such as cardiovascular diseases and diabetes are now the leading causes of death and disability in India. Interestingly, those Indian states with the highest prevalence of lifestyle-related chronic disease among older adults are also found to have the highest rates of international or internal out-migration. This paper investigates the association between having migrant (adult) children and older parents’ lifestyle-related chronic disease in India. Bi-variate and multivariate analysis are conducted using data from a representative sample of 9507 adults aged 60 and older in seven Indian states from the UNFPA project ‘Building Knowledge Base on Ageing in India’. The results show that for any of the diagnosed conditions of hypertension, diabetes and heart disease, the prevalence among older people with a migrant son is higher than among those without. More specifically, the odds ratio of reporting a lifestyle-related chronic disease is higher among older adults with at least one adult son living in another district, State or outside India than those with their children living closer. This study contributes empirical evidence to the academic and policy debate about the consequences of globalization and urbanization for older people's health status generally, and particularly their risk for reporting chronic diseases that relate to changes in their lifestyle.

•

The prevalence of chronic disease is high among ‘left behind’ older parents in India.

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Children's out-migration and (or) migration within different states and (or) different districts are risk factors.

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Selected chronic diseases include diagnosed hypertension, diabetes and heart disease.

•

More research is required on the health consequences of globalization and urbanization.

Blood glucose and pressure controls in diabetic kidney disease: Narrative review of adherence, barriers and evidence of achievement

AIMS

To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control.

METHODS

Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience.

RESULTS

There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes.

CONCLUSIONS

It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage.

Time course of angiotensin II dependent vascular and metabolic effects of preeclampsia

Pregnancy is characterized by a blunted pressor response to angiotensin II that is progressively lost during preeclampsia complicated pregnancies. Renin angiotensin system (RAS) plays a pivotal role in cardiovascular and renal function but its role in normal and pathological pregnancy is far from being clarified. It is not as clear if hypertension and particularly pregnancy-induced hypertension as the initial event, can trigger some of the metabolic syndrome components, and if these changes are angiotensin II mediated. The aim of this study was to determine the time course of angiotensin II contribution to the vascular and eventual metabolic changes of preeclampsia. An experimental model was developed by reducing feto-placental circulation through a subrenal aorta coarctation before pregnancy in rats. Control and pregnant (preeclamptic) animals were treated with captopril (5mg/kgpo) or saline solution for 21, 14 or 7days before delivery, and their body weight, plasma glucose andblood pressure were registered. Phenylephrine (Phe) induced contraction was evaluated using isolated aorta rings. Preeclampsia increased blood pressure (2nd and 3rd wk) but also weight (3rd wk) and glucose values (2nd and 3rd week). Captopril (for 21 or 14days) treatment prevented increases in blood pressure and plasma glucose but not in body weight. Also, captopril treatment significantly increased aorta contractility. These results provide evidence that cardiovascular and metabolic disturbances of preeclampsia appear simultaneously and are angiotensin II dependent.

Services aimed at achieving desirable clinical outcomes in patients with chronic kidney disease and diabetes mellitus: A narrative review

There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered. This involved evidence from PubMed-listed articles published between 1993 and 2016 including original research studies, focusing on randomised controlled trials and prospective studies where possible, systematic and other review articles, meta- analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia, American Diabetes Association, the Department of Health, The Royal College of Pathologists of Australasia, and The Australasian College of Emergency Medicine. Based on the literature reviewed, it is yet unknown as to how effective programs, such as diabetes inpatient services, endocrine out-patient services, and cardiac rehabilitation services, are at achieving guideline recommendations. It is also not clear how or whether clinicians are encumbered by complexities in their efforts of adhering to DM, HT, and glucose control recommendations, and the potential reasons for clinical inertia. Future studies are needed to ascertain the extent to which required BP and glucose control in patients is achieved, and whether clinical inertia is a barrier.