3201
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Bacaksiz A, Uyarel H, Jafarov P, Kucukbuzcu S. Iatrogenic renal artery stenosis after renal sympathetic denervation. Int J Cardiol 2014; 172:e389-90. [PMID: 24461484 DOI: 10.1016/j.ijcard.2013.12.270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 12/30/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmet Bacaksiz
- BezmiÂlem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Huseyin Uyarel
- BezmiÂlem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Parviz Jafarov
- BezmiÂlem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Sitki Kucukbuzcu
- BezmiÂlem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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3202
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Lee HY, Sakuma I, Ihm SH, Goh CW, Koh KK. Statins and renin-angiotensin system inhibitor combination treatment to prevent cardiovascular disease. Circ J 2014; 78:281-7. [PMID: 24401609 DOI: 10.1253/circj.cj-13-1494] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypercholesterolemia and hypertension are common risk factors for cardiovascular disease (CVD). Updated guidelines emphasize target reductions of overall cardiovascular risks. Experimental studies have shown reciprocal relationships between insulin resistance (IR) and endothelial dysfunction. Hypercholesterolemia and hypertension have a synergistic deleterious effect on IR and endothelial dysfunction. Unregulated renin-angiotensin system (RAS) is important in the pathogenesis of atherosclerosis and hypertension. Various strategies with different classes of antihypertensive medications to reach target goals have failed to reduce residual CVD risk further. Of interest, treating moderate cholesterol elevations with low-dose statins in hypertensive patients reduced CVD risk by 35-40% further. Therefore, statins are important in reducing CVD risk. Unfortunately, statin therapy causes IR and increases the risk of type 2 diabetes mellitus. RAS inhibitors improve both endothelial dysfunction and IR. Further, cross-talk between hypercholesterolemia and RAS exists at multiple steps of IR and endothelial dysfunction. In this regard, combined therapy with statins and RAS inhibitors demonstrates additive/synergistic effects on endothelial dysfunction and IR in addition to lowering cholesterol levels and blood pressure when compared with either monotherapy in patients. This is mediated by both distinct and interrelated mechanisms. Therefore, combined therapy with statins and RAS inhibitors may be important in developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity to prevent CVD.
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Affiliation(s)
- Hae-Young Lee
- Division of Cardiology, Seoul National University College of Medicine
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3203
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Myers MG. Eliminating the Human Factor in Office Blood Pressure Measurement. J Clin Hypertens (Greenwich) 2014; 16:83-6. [DOI: 10.1111/jch.12252] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Martin G. Myers
- Division of Cardiology; Schulich Heart Program; Sunnybrook Health Sciences; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
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3204
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Bushman B. Promoting Exercise as Medicine for Prediabetes and Prehypertension. Curr Sports Med Rep 2014; 13:233-9. [DOI: 10.1249/jsr.0000000000000066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3205
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Miranda Muñoz G, Zarca Díaz de la Espina M, Mora Fernández C, Sánchez de la Nieta M, Ferreras García I, Rivera Hernández F. Estenosis de arteria subclavia: importancia de medir la presión arterial en ambas extremidades y su asociación con el riesgo cardiovascular. HIPERTENSION Y RIESGO VASCULAR 2014. [DOI: 10.1016/j.hipert.2013.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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3206
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Jayalath VH, de Souza RJ, Sievenpiper JL, Ha V, Chiavaroli L, Mirrahimi A, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Beyene J, Kendall CW, Jenkins DJ. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens 2014; 27:56-64. [PMID: 24014659 PMCID: PMC5391775 DOI: 10.1093/ajh/hpt155] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current guidelines recommend diet and lifestyle modifications for primary prevention and treatment of hypertension, but do not encourage dietary pulses specifically for lowering blood pressure (BP). To quantify the effect of dietary pulse interventions on BP and provide evidence for their inclusion in dietary guidelines, a systematic review and meta-analysis of controlled feeding trials was conducted. METHODS MEDLINE, EMBASE, Cochrane Library, and CINAHL were each searched from inception through 5 May 2013. Human trials ≥3 weeks that reported data for systolic, diastolic, and/or mean arterial BPs were included. Two reviewers independently extracted data and assessed methodological quality and risk of bias of included studies. Effect estimates were pooled using random effects models, and reported as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (χ2 test) and quantified (I2). RESULTS Eight isocaloric trials (n = 554 participants with and without hypertension) were included in the analysis. Dietary pulses, exchanged isocalorically for other foods, significantly lowered systolic (MD = −2.25 mm Hg (95% CI, −4.22 to −0.28), P = 0.03) and mean arterial BP (MD = −0.75 mm Hg (95% CI, −1.44 to −0.06), P = 0.03), and diastolic BP non-significantly (MD = −0.71 mm Hg (95% CI, −1.74 to 0.31), P = 0.17). Heterogeneity was significant for all outcomes. CONCLUSIONS Dietary pulses significantly lowered BP in people with and without hypertension. Higher-quality large-scale trials are needed to support these findings. CLINICAL TRIAL REGISTRATION NCT01594567
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Affiliation(s)
- Viranda H. Jayalath
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John L. Sievenpiper
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Ha
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arash Mirrahimi
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marco Di Buono
- Heart and Stroke Foundation of Ontario, Toronto, Ontario, Canada
| | - Adam M. Bernstein
- Wellness Institute of the Cleveland Clinic, Lyndhurst, Ohio
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Lawrence A. Leiter
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Penny M. Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Vladimir Vuksan
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Cyril W.C. Kendall
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition Division of Nutrition and Dietetics, University of Saskatchewan Saskatoon Saskatchewan, Canada
| | - David J.A. Jenkins
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
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3207
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Lorber D. Importance of cardiovascular disease risk management in patients with type 2 diabetes mellitus. Diabetes Metab Syndr Obes 2014; 7:169-83. [PMID: 24920930 PMCID: PMC4043722 DOI: 10.2147/dmso.s61438] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is commonly accompanied by other cardiovascular disease (CVD) risk factors, such as hypertension, obesity, and dyslipidemia. Furthermore, CVD is the most common cause of death in people with T2DM. It is therefore of critical importance to minimize the risk of macrovascular complications by carefully managing modifiable CVD risk factors in patients with T2DM. Therapeutic strategies should include lifestyle and pharmacological interventions targeting hyperglycemia, hypertension, dyslipidemia, obesity, cigarette smoking, physical inactivity, and prothrombotic factors. This article discusses the impact of modifying these CVD risk factors in the context of T2DM; the clinical evidence is summarized, and current guidelines are also discussed. The cardiovascular benefits of smoking cessation, increasing physical activity, and reducing low-density lipoprotein cholesterol and blood pressure are well established. For aspirin therapy, any cardiovascular benefits must be balanced against the associated bleeding risk, with current evidence supporting this strategy only in certain patients who are at increased CVD risk. Although overweight, obesity, and hyperglycemia are clearly associated with increased cardiovascular risk, the effect of their modification on this risk is less well defined by available clinical trial evidence. However, for glucose-lowering drugs, further evidence is expected from several ongoing cardiovascular outcome trials. Taken together, the evidence highlights the value of early intervention and targeting multiple risk factors with both lifestyle and pharmacological strategies to give the best chance of reducing macrovascular complications in the long term.
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Affiliation(s)
- Daniel Lorber
- Division of Endocrinology, New York Hospital Queens, Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA
- Correspondence: Daniel Lorber, Division of Endocrinology, New York Hospital Queens, 5945 161st Street, Flushing, New York, NY 11365, USA, Tel +1 718 762 3111, Fax +1 718 353 6315, Email
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3208
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Hayashi S, Yamada H, Bando M, Hotchi J, Ise T, Yamaguchi K, Iwase T, Soeki T, Wakatsuki T, Tamaki T, Sata M. Augmentation Index Does Not Reflect Risk of Coronary Artery Disease in Elderly Patients. Circ J 2014; 78:1176-82. [DOI: 10.1253/circj.cj-13-1422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shuji Hayashi
- Ultrasound Examination Center, Tokushima University Hospital
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Mika Bando
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Junko Hotchi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Iwase
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Toshiaki Tamaki
- Department of Pharmacology, Institute of Health Biosciences, University of Tokushima Graduate School
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital
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3209
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3210
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Affiliation(s)
- Giuseppe Mancia
- From the Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca and Istituto Auxologico Italiano, Milano, Italy (G.M.); Clinica Medica,Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); and Multimedica, Sesto SanGiovanni (Milano), Italy (G.G.)
| | - Guido Grassi
- From the Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca and Istituto Auxologico Italiano, Milano, Italy (G.M.); Clinica Medica,Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (G.G.); and Multimedica, Sesto SanGiovanni (Milano), Italy (G.G.)
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3211
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Yildiz S, Toprak H, Aydin S, Bilgin M, Oktay V, Abaci O, Kocas C. The association of breast arterial calcification and metabolic syndrome. Clinics (Sao Paulo) 2014; 69:841-6. [PMID: 25627997 PMCID: PMC4286665 DOI: 10.6061/clinics/2014(12)09] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We investigated the relationship between metabolic syndrome and breast arterial calcification detected via mammography in a cohort of postmenopausal subjects. METHODS Among 837 patients referred to our radiology department for mammographic screening, 310 postmenopausal females (105 patients with and 205 patients without breast arterial calcification) aged 40 to 73 (mean 55.9 ± 8.4) years were included in this study. The groups were compared with respect to clinical characteristics and metabolic syndrome criteria. Univariate and multivariate analyses identified the factors related to breast arterial calcification. RESULTS Age, postmenopausal duration and the frequencies of diabetes mellitus, hypertension and metabolic syndrome were significantly higher in the subjects with breast arterial calcification than in those without (p<0.05). Multivariate analysis indicated that age (OR=1.3, 95% CI=1.1-1.6, p=0.001) and metabolic syndrome (OR=4.0, 95% CI=1.5-10.4, p=0.005) were independent predictors of breast arterial calcification detected via mammography. The independent predictors among the features of metabolic syndrome were low levels of high-density lipoproteins (OR=8.1, 95% CI=1.0-64.0, p=0.047) and high blood pressure (OR=8.7, 95% CI=1.5-49.7, p=0.014). CONCLUSIONS The likelihood of mammographic detection of breast arterial calcification increases with age and in the presence of hypertension or metabolic syndrome. For patients undergoing screening mammography who present with breast arterial calcification, the possibility of metabolic syndrome should be considered. These patients should be informed of their cardiovascular risk factors and counseled on appropriate lifestyle changes.
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Affiliation(s)
- Seyma Yildiz
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Huseyin Toprak
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Sinem Aydin
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Mehmet Bilgin
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Veysel Oktay
- Istanbul Universty, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Okay Abaci
- Istanbul Universty, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Cuneyt Kocas
- Istanbul Universty, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
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3212
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Martin Martins J, do Vale S, Martins AF. Mild Adrenal Steroidogenic Defects and ACTH-Dependent Aldosterone Secretion in High Blood Pressure: Preliminary Evidence. Int J Endocrinol 2014; 2014:295724. [PMID: 25580122 PMCID: PMC4279432 DOI: 10.1155/2014/295724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Adrenal glands play a major role in the control of blood pressure and mild defects of steroidogenesis and/or inappropriate control of mineralocorticoid production have been reported in high blood pressure (HBP). Patients and Methods. We used a specific protocol for the evaluation of 100 consecutive patients with inappropriate or recent onset HBP. Specific methods were used to confirm HBP and to diagnose secondary forms of HBP. In addition we tested adrenal steroidogenesis with the common cosyntropin test, modified to include the simultaneous measurement of renin and aldosterone besides 17-hydroxyprogesterone (17OHP) and 11-deoxycortisol (S). Results. Secondary forms of HBP were diagnosed in 32 patients, including 14 patients with primary hyperaldosteronism (PA) (14%) and 10 patients with pheochromocytoma (10%). Mild defects of the 21-hydroxylase (21OHD) and 11-hydroxylase (11OHD) enzymes were common (42%). ACTH-dependent aldosterone secretion was found in most patients (54%) and characteristically in those with mild defects of adrenal steroidogenesis (>60%), PA (>75%), and otherwise in patients with apparent essential HBP (EHBP) (32%). Discussion. Mild defects of adrenal steroidogenesis are common in patients with HBP, occurring in almost half of the patients. In those patients as well as in patients with apparent EHBP, aldosterone secretion is commonly dependent on ACTH.
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Affiliation(s)
- João Martin Martins
- Endocrine Department, Hospital Santa Maria and Lisbon Medical School, Professor Egas Moniz Avenue, 1649-028 Lisbon, Portugal
- Serviço de Endocrinologia, Hospital de Santa Maria, Piso 6, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- *João Martin Martins:
| | - Sónia do Vale
- Endocrine Department, Hospital Santa Maria and Lisbon Medical School, Professor Egas Moniz Avenue, 1649-028 Lisbon, Portugal
- Serviço de Endocrinologia, Hospital de Santa Maria, Piso 6, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Ana Filipa Martins
- Endocrine Department, Hospital Santa Maria and Lisbon Medical School, Professor Egas Moniz Avenue, 1649-028 Lisbon, Portugal
- Serviço de Endocrinologia, Hospital de Santa Maria, Piso 6, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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3213
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3214
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3215
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Tsioufis C, Mahfoud F, Mancia G, Redon J, Damascelli B, Zeller T, Schmieder RE. What the interventionalist should know about renal denervation in hypertensive patients: a position paper by the ESH WG on the interventional treatment of hypertension. EUROINTERVENTION 2014; 9:1027-35. [DOI: 10.4244/eijv9i9a175] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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3216
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Nilsson PM. U-shaped Relationship of Blood Pressure to CVD Risk and Relevance to Treatment Goals in Diabetes. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-013-0369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3217
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Abstract
Antiplatelet therapy, and low-dose acetylsalicylic acid (ASA) in particular, is recommended in hypertensive patients with previous cardiovascular events and is considered in hypertensive patients with reduced renal function or a high cardiovascular (CV) risk, provided blood pressure is well-controlled. Acetylsalicylic acid is not recommended in low-to-moderate risk hypertensive patients in whom absolute benefit and harm are equivalent. Further trials evaluating antithrombotic therapy including newer agents in hypertension are needed. Women at high and moderate risk of pre-eclampsia are advised to take a low dose of ASA daily from 12 weeks of gestation until delivery. In addition to their lipid-lowering effects, statins induce a small blood pressure reduction. The 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines recommend using statin therapy in hypertensive patients at moderate-to-high CV risk to achieve the target low-density lipoprotein (LDL) cholesterol value <3 mmol/l (115 mg/dl). For individuals with manifest CV disease or at very high CV risk, a more aggressive LDL target of <1.8 mmol/l (70 mg/dl) is recommended.
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Affiliation(s)
- Renata Cífková
- Head of Department, Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague; International Clinical Research Center, Brno, Czech Republic
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3218
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Carotid artery intima-media thickness in hypertensive patients with obstructive sleep apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 839:61-6. [PMID: 25315618 DOI: 10.1007/5584_2014_45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this study we determined the relationship between the severity of obstructive sleep apnea (OSA) and body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), and carotid intima-media thickness (cIMT) in 30 hypertensive male patients, aged 30-70, with newly diagnosed OSA (15 with moderate OSA - Group A, and 15 with severe OSA - Group B) and 20 non-OSA hypertensive individuals (Group C). We revealed significant differences in cIMT between Groups B and C (0.9 ± 0.3 vs. 0.6 ± 0.1 mm and 1.0 ± 0.4 vs. 0.6 ± 0.2 mm in the right and left common carotid arteries, respectively; p <0.05). Increased carotid intima-media thickness in severe OSA was accompanied by higher systolic and diastolic blood pressures compared with both moderate OSA and control subjects. We conclude that in severe OSA increased blood pressure goes in tandem with the thickness of carotid intima-media, which helps explain increased cardiovascular risk in these patients.
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3219
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Chmiel C, Senn O, Rosemann T, Del Prete V, Steurer-Stey C. CoCo trial: Color-coded blood pressure Control, a randomized controlled study. Patient Prefer Adherence 2014; 8:1383-92. [PMID: 25346595 PMCID: PMC4206524 DOI: 10.2147/ppa.s68213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inadequate blood pressure (BP) control is a frequent challenge in general practice. The objective of this study was to determine whether a color-coded BP booklet using a traffic light scheme (red, >180 mmHg systolic BP and/or >110 mmHg diastolic BP; yellow, >140-180 mmHg systolic BP or >90-110 mmHg diastolic BP; green, ≤140 mmHg systolic BP and ≤90 mmHg diastolic BP) improves BP control and adherence with home BP measurement. METHODS In this two-group, randomized controlled trial, general practitioners recruited adult patients with a BP >140 mmHg systolic and/or >90 mmHg diastolic. Patients in the control group received a standard BP booklet and the intervention group used a color-coded booklet for daily home BP measurement. The main outcomes were changes in BP, BP control (treatment goal <140/90 mmHg), and adherence with home BP measurement after 6 months. RESULTS One hundred and twenty-one of 137 included patients qualified for analysis. After 6 months, a significant decrease in systolic and diastolic BP was achieved in both groups, with no significant difference between the groups (16.1/7.9 mmHg in the intervention group versus 13.1/8.6 mmHg in the control group, P=0.3/0.7). BP control (treatment target <140/90 mmHg) was achieved significantly more often in the intervention group (43% versus 25%; P=0.037; number needed to treat of 5). Adherence with home BP measurement overall was high, with a trend in favor of the intervention group (98.6% versus 96.2%; P=0.1). CONCLUSION Color-coded BP self-monitoring significantly improved BP control (number needed to treat of 5, meaning that every fifth patient utilizing color-coded self-monitoring achieved better BP control after 6 months), but no significant between-group difference was observed in BP change. A markedly higher percentage of patients achieved BP values in the normal range. This simple, inexpensive approach of color-coded BP self-monitoring is user-friendly and applicable in primary care, and should be implemented in the care of patients with arterial hypertension.
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Affiliation(s)
- Corinne Chmiel
- Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland
- Correspondence: Corinne Chmiel, Institute of General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091 Zürich, Switzerland, Tel +41 04 4255 9855, Fax +41 04 4255 90 97, Email
| | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland
| | - Thomas Rosemann
- Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland
| | - Valerio Del Prete
- Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland
| | - Claudia Steurer-Stey
- Institute of General Practice and Health Services Research, University of Zurich, Zürich, Switzerland
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3220
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Kojima I, Ninomiya T, Hata J, Fukuhara M, Hirakawa Y, Mukai N, Yoshida D, Kitazono T, Kiyohara Y. A Low Ankle Brachial Index is Associated with an Increased Risk of Cardiovascular Disease: The Hisayama Study. J Atheroscler Thromb 2014; 21:966-73. [DOI: 10.5551/jat.22608] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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3221
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Ando K, Nitta K, Rakugi H, Nishizawa Y, Yokoyama H, Nakanishi T, Kashihara N, Tomita K, Nangaku M, Takahashi K, Isshiki M, Shimosawa T, Fujita T. Comparison of the antialbuminuric effects of benidipine and hydrochlorothiazide in Renin-Angiotensin System (RAS) inhibitor-treated hypertensive patients with albuminuria: the COSMO-CKD (COmbination Strategy on Renal Function of Benidipine or Diuretics TreatMent with RAS inhibitOrs in a Chronic Kidney Disease Hypertensive Population) study. Int J Med Sci 2014; 11:897-904. [PMID: 25013370 PMCID: PMC4081312 DOI: 10.7150/ijms.9026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/14/2014] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study evaluated the non-inferiority of renoprotection afforded by benidipine versus hydrochlorothiazide in hypertensive patients with chronic kidney disease (CKD). METHODS In this prospective, multicenter, open-labeled, randomized trial, the antialbuminuric effects of benidipine and hydrochlorothiazide were examined in renin-angiotensin system (RAS) inhibitor-treated patients with blood pressure (BP) readings of ≥ 130/80 mmHg and ≤ 180/110 mmHg, a urinary albumin to creatinine ratio (UACR) of ≥ 300 mg/g, and an estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min/1.73m(2). Patients received benidipine (n = 176, final dose: 4.8 mg/day) or hydrochlorothiazide (n = 170, 8.2 mg/day) for 12 months. RESULTS Benidipine and hydrochlorothiazide exerted similar BP- and eGFR-decreasing actions. The UACR values for benidipine and hydrochlorothiazide were 930.8 (95% confidence interval: 826.1, 1048.7) and 883.1 (781.7, 997.7) mg/g at baseline, respectively. These values were reduced to 790.0 (668.1, 934.2) and 448.5 (372.9, 539.4) mg/g at last observation carried forward (LOCF) visits. The non-inferiority of benidipine versus hydrochlorothiazide was not demonstrated (benidipine/hydrochlorothiazide ratio of LOCF value adjusted for baseline: 1.67 (1.40, 1.99)). CONCLUSIONS The present study failed to demonstrate the non-inferiority of the antialbuminuric effect of benidipine relative to that of hydrochlorothiazide in RAS inhibitor-treated hypertensive patients with macroalbuminuria.
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Affiliation(s)
- Katsuyuki Ando
- 1. Division of Molecular Cardiovascular Metabolism, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- 2. Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiromi Rakugi
- 3. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Nishizawa
- 4. Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hitoshi Yokoyama
- 5. Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Takeshi Nakanishi
- 6. Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naoki Kashihara
- 7. Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Kimio Tomita
- 8. Department of Nephrology, Graduate School of Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Masaomi Nangaku
- 9. Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Katsutoshi Takahashi
- 9. Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masashi Isshiki
- 9. Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tatsuo Shimosawa
- 10. Department of Clinical Laboratory, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshiro Fujita
- 11. Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
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3222
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Drozdz D, Kawecka-Jaszcz K. Cardiovascular changes during chronic hypertensive states. Pediatr Nephrol 2014; 29:1507-16. [PMID: 24026758 PMCID: PMC4147208 DOI: 10.1007/s00467-013-2614-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 08/03/2013] [Accepted: 08/21/2013] [Indexed: 01/19/2023]
Abstract
It is well established that elevated blood pressure constitutes a major risk factor for coronary heart disease, arrythmias, heart failure, cerebrovascular disease, peripheral artery disease and renal failure. Blood pressure level and the duration of arterial hypertension (HTN) impact target organ damage. Many studies in adults have demonstrated the role of antihypertensive therapy in preventing cardiovascular (CV) events. The so-called hard end-points, such as death, myocardial infarction (MI) or stroke, are rarely seen in children, but intermediate target organ damage, including left ventricular hypertrophy, increased intima-media thickness and microalbuminuria, is already detectable during childhood. The goal of antihypertensive treatment is to reduce the global risk of CV events. In the adult population stratification of CV risk is based on blood pressure level, risk factors, subclinical target organ damage and established CV and kidney disease. Increased CV risk begins early in the course of kidney disease, and CV diseases are the most frequent cause of morbidity and mortality in patients with chronic kidney disease (CKD). Children with CKD are especially prone to the long-term effects of CV risk factors, which result in high morbidity and mortality in young adults. To improve the outcome, pediatric and adult CKD patients require nephro- and cardioprotection.
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Affiliation(s)
- Dorota Drozdz
- Dialysis Unit, Jagiellonian University Medical College, 265 Wielicka Str., 30-663, Krakow, Poland,
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology and Hypertension, Jagiellonian University Medical College, 17 Kopernika Str., 31-501 Krakow, Poland
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3223
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The effect of continuous positive airway pressure therapy on blood pressure and arterial stiffness in hypertensive patients with obstructive sleep apnea. Sleep Breath 2013; 18:635-40. [PMID: 24362941 DOI: 10.1007/s11325-013-0926-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/08/2013] [Accepted: 12/09/2013] [Indexed: 12/21/2022]
Abstract
AIM We aimed to evaluate the effect of continuous positive airway pressure (CPAP) therapy on blood pressure (BP) and arterial stiffness in hypertensive patients with obstructive sleep apnea (OSA). PATIENTS AND METHODS We studied 38 hypertensive patients who suffered from severe OSA. Ambulatory BP measurement was performed at baseline and after at least 3 months of uninterrupted CPAP therapy. In 19 of these patients, we also measured pulse wave velocity (PWV) at baseline, after the first night of CPAP therapy and at 3 months. Fifteen normotensive subjects without OSA comprised the control group. RESULTS CPAP therapy reduced systolic BP from 141.5 ± 12.1 to 133.5 ± 9.7 mmHg (p = 0.007) and diastolic BP from 87.8 ± 6.8 to 83 ± 5.4 mmHg (p = 0.004). CPAP also reduced the PWV from 8.81 ± 1.4 to 8.18 ± 1 m/s after the first night of CPAP therapy (p = 0.003) and to 7.37 ± 1 m/s at 3 months (p = 0.007). CONCLUSIONS To the best of our knowledge, this is the first study demonstrating that CPAP therapy in hypertensive patients with OSA improves arterial stiffness from the first night and that this favorable effect is maintained for at least 3 months of CPAP use. A reduction in BP was also observed, even though BP control was not always achieved.
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3224
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Tadic M, Cuspidi C, Sljivic A, Andric A, Ivanovic B, Scepanovic R, Ilic I, Jozika L, Marjanovic T, Celic V. Effects of the metabolic syndrome on right heart mechanics and function. Can J Cardiol 2013; 30:325-31. [PMID: 24484912 DOI: 10.1016/j.cjca.2013.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/08/2013] [Accepted: 12/08/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS). METHODS This cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ≥ 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. RESULTS 2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (-24 ± 5 vs -27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation. CONCLUSIONS RV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy
| | - Aleksandra Sljivic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Anita Andric
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Branislava Ivanovic
- Clinical Centre of Serbia, Clinic of Cardiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Radisav Scepanovic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Irena Ilic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Ljilja Jozika
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Tamara Marjanovic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Vera Celic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
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3225
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Ruilope LM. Understanding visit-to-visit blood pressure variability. J Clin Hypertens (Greenwich) 2013; 16:8-9. [PMID: 24329997 DOI: 10.1111/jch.12231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luis M Ruilope
- Instituto de Investigación, Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain
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3226
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Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, Flack JM, Carter BL, Materson BJ, Ram CVS, Cohen DL, Cadet JC, Jean-Charles RR, Taler S, Kountz D, Townsend RR, Chalmers J, Ramirez AJ, Bakris GL, Wang J, Schutte AE, Bisognano JD, Touyz RM, Sica D, Harrap SB. Clinical Practice Guidelines for the Management of Hypertension in the Community. J Clin Hypertens (Greenwich) 2013; 16:14-26. [DOI: 10.1111/jch.12237] [Citation(s) in RCA: 508] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Michael A. Weber
- State University of New York; Downstate College of Medicine; Brooklyn NY
| | - Ernesto L. Schiffrin
- Department of Medicine; Sir Mortimer B. Davis Jewish General Hospital; McGill University; Montreal Canada
| | - William B. White
- Calhoun Cardiology Center; University of Connecticut; Farmington CT
| | - Samuel Mann
- Department of Medicine; Weil Cornell College of Medicine; New York NY
| | - Lars H. Lindholm
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
| | | | - John M. Flack
- Department of Medicine; Wayne State University; Detroit MI
| | - Barry L. Carter
- Department of Pharmacy Practice and Science; University of Iowa; Iowa City IA
| | - Barry J. Materson
- Department of Medicine; University of Miami Miller School of Medicine; Miami FL
| | | | - Debbie L. Cohen
- Department of Medicine; University of Pennsylvania School of Medicine; Philadelphia PA
| | | | | | - Sandra Taler
- Department of Medicine; Mayo Clinic; Rochester MN
| | - David Kountz
- Jersey Shore University Medical Center; Neptune NJ
| | | | - John Chalmers
- George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit; University Hospital; Favaloro Foundation; Buenos Aires Argentina
| | - George L. Bakris
- ASH Comprehensive Hypertension Center; University of Chicago Medicine; Chicago IL
| | - Jiguang Wang
- The Shanghai Institute of Hypertension; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Aletta E. Schutte
- Hypertension in Africa Research Team; North West University; Potchefstroom South Africa
| | - John D. Bisognano
- Department of Medicine; University of Rochester Medical Center; Rochester NY
| | - Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | | | - Stephen B. Harrap
- Department of Physiology; University of Melbourne; Melbourne Vic Australia
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3227
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Bönner G. [Hypertension new guidelines--new strategies?]. MMW Fortschr Med 2013; 155:45-47. [PMID: 24724273 DOI: 10.1007/s15006-013-2513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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3228
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Rafiq K, Sherajee SJ, Hitomi H, Nakano D, Kobori H, Ohmori K, Mori H, Kobara H, Masaki T, Kohno M, Nishiyama A. Calcium channel blocker enhances beneficial effects of an angiotensin II AT1 receptor blocker against cerebrovascular-renal injury in type 2 diabetic mice. PLoS One 2013; 8:e82082. [PMID: 24339994 PMCID: PMC3858271 DOI: 10.1371/journal.pone.0082082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022] Open
Abstract
Recent clinical trials have demonstrated that combination therapy with renin-angiotensin system inhibitors plus calcium channel blockers (CCBs) elicits beneficial effects on cardiovascular and renal events in hypertensive patients with high cardiovascular risks. In the present study, we hypothesized that CCB enhances the protective effects of an angiotensin II type 1 receptor blocker (ARB) against diabetic cerebrovascular-renal injury. Saline-drinking type 2 diabetic KK-Ay mice developed hypertension and exhibited impaired cognitive function, blood-brain barrier (BBB) disruption, albuminuria, glomerular sclerosis and podocyte injury. These brain and renal injuries were associated with increased gene expression of NADPH oxidase components, NADPH oxidase activity and oxidative stress in brain and kidney tissues as well as systemic oxidative stress. Treatment with the ARB, olmesartan (10 mg/kg/day) reduced blood pressure in saline-drinking KK-Ay mice and attenuated cognitive decline, BBB disruption, glomerular injury and albuminuria, which were associated with a reduction of NADPH oxidase activity and oxidative stress in brain and kidney tissues as well as systemic oxidative stress. Furthermore, a suppressive dose of azelnidipine (3 mg/kg/day) exaggerated these beneficial effects of olmesartan. These data support the hypothesis that a CCB enhances ARB-associated cerebrovascular-renal protective effects through suppression of NADPH oxidase-dependent oxidative stress in type 2 diabetes.
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Affiliation(s)
- Kazi Rafiq
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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3229
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Chalmers J, Arima H, Woodward M, Mancia G, Poulter N, Hirakawa Y, Zoungas S, Patel A, Williams B, Harrap S. Effects of combination of perindopril, indapamide, and calcium channel blockers in patients with type 2 diabetes mellitus: results from the Action In Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial. Hypertension 2013; 63:259-64. [PMID: 24324048 DOI: 10.1161/hypertensionaha.113.02252] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of the present analysis was to determine the effects of a fixed combination of perindopril and indapamide in combination with calcium channel blockers (CCBs) in patients with type 2 diabetes mellitus. The Action in Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial was a factorial randomized controlled trial. A total of 11 140 patients with type 2 diabetes mellitus were randomly assigned to fixed combination of perindopril-indapamide (4/1.25 mg) or placebo. Effects of randomized treatment on mortality and major cardiovascular outcomes were examined in subgroups defined by baseline use of CCBs. Patients on CCB at baseline (n=3427) constituted a higher risk group compared with those not on CCB (n=7713), with more extensive use of antihypertensive and other protective therapies. Active treatment reduced the relative risk of death by 28% (95% confidence interval, 10%-43%) among patients with CCB at baseline compared with 5% (-12% to 20%) among those without CCB (P homogeneity=0.02) and 14% (2%-25%) for the whole population. Similarly, the relative risk reduction for major cardiovascular events was 12% (-8% to 28%) versus 6% (-10% to 19%) for those with and without CCB at baseline although the difference was not statistically significant (P homogeneity=0.38). There was no detectable increase in adverse effects in those receiving CCB. The combination of perindopril and indapamide with CCBs seems to provide further protection against mortality in patients with type 2 diabetes mellitus.
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Affiliation(s)
- John Chalmers
- The George Institute for Global Health, PO Box M201, Camperdown, NSW 2050, Australia.
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3230
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Acar NS, Uzman S, Toptas M, Vahapoglu A, Akkoc I, Dinc SC. Spinal anesthesia with hyperbaric bupivacaine: a comparison of hypertensive and normotensive patients. Med Sci Monit 2013; 19:1109-13. [PMID: 24304744 PMCID: PMC3862143 DOI: 10.12659/msm.889412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hypotension is the most common problem with spinal anesthesia. This prospective study aimed to compare normotensive and hypertensive patients with respect to the hemodynamic effects of spinal anesthesia performed with hyperbaric bupivacaine. Material/Methods Sixty patients who were scheduled to undergo various elective operations under spinal anesthesia were included into the study. The patients were separated into 2 groups: hypertensive patients constituted Group H (n=30) and normotensive patients constituted Group N (n=30). After fluid loading, spinal anesthesia was performed with 3.5 ml 0.5% hyperbaric bupivacaine. Demographic characteristics and incidence of hypotension and bradycardia were compared. Systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) and heart rate (HR) were also compared before and after spinal anesthesia. Results There was no significant difference between the groups with respect to demographic characteristics, maximal height of sensory block, incidences of hypotension and bradycardia, and the amount of fluids infused (p>0.05). In the hypertensive patient group, the SBP, DBP, and MBP values were significantly higher than in the normotensive patient group at all measurement times (p<0.05). Comparison within the groups did not reveal any significant differences in either group compared to the basal values (p>0.05). There were no significant differences in HR between or within groups (p>0.05). Conclusions There was no significant difference between normotensive and hypertensive patients in the incidences of hypotension caused by spinal anesthesia with 0.5% hyperbaric bupivacaine.
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Affiliation(s)
- Nermin Sardogan Acar
- Department of Anesthesiology and Reanimation, Sincan State Hospital, Ankara, Turkey
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3231
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Abstract
BACKGROUND Peripheral arterial disease (PAD) causes considerable morbidity and mortality. Hypertension is a risk factor for PAD. Treatment for hypertension must be compatible with the symptoms of PAD. Controversy regarding the effects of beta-adrenoreceptor blockade for hypertension in patients with PAD has led many physicians to stop prescribing beta-adrenoreceptor blockers. Little is known about the effects of other classes of anti-hypertensive drugs in the presence of PAD. This is the second update of a Cochrane review first published in 2003. OBJECTIVES To determine the effects of anti-hypertensive drugs in patients with both raised blood pressure and symptomatic PAD in terms of the rate of cardiovascular events and death, symptoms of claudication and critical leg ischaemia, and progression of atherosclerotic PAD as measured by ankle brachial index (ABI) changes and the need for revascularisation (reconstructive surgery or angioplasty) or amputation. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Cochrane Peripheral Vascular Diseases Group Specialised Register (last searched March 2013) and CENTRAL (2013, Issue 2). SELECTION CRITERIA Randomised controlled trials (RCTs) of at least one anti-hypertensive treatment against placebo or two anti-hypertensive medications against each other, with interventions lasting at least one month. Trials had to include patients with symptomatic PAD. DATA COLLECTION AND ANALYSIS Data were extracted by one author (DAL) and checked by the other (GYHL). Potentially eligible studies were excluded when the results presentation prevented adequate extraction of data and enquiries to authors did not yield raw data. MAIN RESULTS Eight RCTs were included with a total of 3610 PAD patients. Four studies compared a recognised class of anti-hypertensive treatment with placebo and four studies compared two anti-hypertensive treatments with each other. Studies were not pooled due to the variation of the comparisons and the outcomes presented. Overall the quality of the available evidence was unclear, primarily as a result of a lack of detail in the study reports on the randomisation and blinding procedures and incomplete outcome data. Two studies compared angiotensin converting enzyme (ACE) inhibitors against placebo. In one study there was a significant reduction in the number of cardiovascular events in patients receiving ramipril (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.58 to 0.91; n = 1725). In the second trial using perindopril (n = 52) there was a marginal increase in claudication distance but no change in ABI and a reduction in maximum walking distance. A trial comparing the calcium antagonist verapamil versus placebo in patients undergoing angioplasty (n = 96) suggested that verapamil reduced restenosis (per cent diameter stenosis (± SD) 48.0% ± 11.5 versus 69.6% ± 12.2; P < 0.01), although this was not reflected in the maintenance of a high ABI (0.76 ± 0.10 versus 0.72 ± 0.08 for verapamil versus placebo). Another study (n = 80) demonstrated no significant difference in arterial intima-media thickness (IMT) in men receiving the thiazide diuretic hydrochlorothiazide (HCTZ) compared to those receiving the alpha-adrenoreceptor blocker doxazosin (-0.12 ± 0.14 mm and -0.08 ± 0.13 mm, respectively; P = 0.66). A study (n = 36) comparing telmisartan to placebo found a significant improvement in maximum walking distance at 12 months with telmisartan (median (interquartile range (IQR)) 191 m (157 to 226) versus 103 m (76 to 164); P < 0.001) but no differences in ABI (median (IQR) 0.60 (0.60 to 0.77) versus 0.52 (0.48 to 0.67)) or arterial IMT (median (IQR) 0.08 cm (0.07 to 0.09) versus 0.09 cm (0.08 to 0.10)). Two studies compared the beta-adrenoreceptor blocker nebivolol with either the thiazide diuretic HCTZ or with metoprolol. Both studies found no significant differences in intermittent or absolute claudication distance, ABI, or all-cause mortality between the anti-hypertensives. A subgroup analysis of PAD patients (n = 2699) in a study which compared a calcium antagonist-based strategy (verapamil slow release (SR) ± trandolapril) to a beta-adrenoreceptor blocker-based strategy (atenolol ± hydrochlorothiazide) found no significant differences in the composite endpoints of death, non-fatal myocardial infarction or non-fatal stroke with or without revascularisation (OR 0.90, 95% CI 0.76 to 1.07 and OR 0.96, 95% CI 0.82 to 1.13, respectively). AUTHORS' CONCLUSIONS Evidence on the use of various anti-hypertensive drugs in people with PAD is poor so that it is unknown whether significant benefits or risks accrue. However, lack of data specifically examining outcomes in PAD patients should not detract from the overwhelming evidence on the benefit of treating hypertension and lowering blood pressure.
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Affiliation(s)
- Deirdre A Lane
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, UK, B18 7QH
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3232
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Sola J, Proenca M, Ferrario D, Porchet JA, Falhi A, Grossenbacher O, Allemann Y, Rimoldi SF, Sartori C. Noninvasive and Nonocclusive Blood Pressure Estimation Via a Chest Sensor. IEEE Trans Biomed Eng 2013; 60:3505-13. [DOI: 10.1109/tbme.2013.2272699] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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3233
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Wakabayashi I. Associations between heavy alcohol drinking and lipid-related indices in middle-aged men. Alcohol 2013; 47:637-42. [PMID: 24239151 DOI: 10.1016/j.alcohol.2013.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 12/14/2022]
Abstract
The ratio of triglycerides to HDL cholesterol (TG/HDL-C ratio) and lipid accumulation product (LAP: a continuous marker of lipid over-accumulation determined by waist circumference and triglycerides) have been proposed to be good predictors of cardiovascular disease. The aim of this study was to clarify the relationships between heavy alcohol drinking and lipid-related indices including TG/HDL-C ratio, LAP, and ratio of LDL cholesterol to HDL cholesterol (LDL-C/HDL-C ratio). The subjects were middle-aged male nondrinkers and heavy drinkers (ethanol intake: ≥66 g per drinking day, which is 2-3 times or more than the generally recommended border level of daily alcohol consumption of 20-30 g). The levels of each lipid-related index after adjustment for age, smoking, and regular exercise were compared among nondrinkers, occasional heavy drinkers, and regular heavy drinkers. Log-transformed TG/HDL-C ratio was significantly higher in occasional heavy drinkers (mean ± standard error: 0.445 ± 0.014) than in nondrinkers (0.388 ± 0.004) and regular heavy drinkers (0.359 ± 0.013), and was not significantly different in nondrinkers and regular heavy drinkers. Log-transformed LAP was significantly higher in occasional heavy drinkers (1.51 ± 0.02) and regular heavy drinkers (1.44 ± 0.02) than in nondrinkers (1.34 ± 0.01), and was significantly higher in occasional heavy drinkers than in regular heavy drinkers. LDL-C/HDL-C ratio was significantly lower in occasional heavy drinkers (2.41 ± 0.04) and regular heavy drinkers (1.72 ± 0.04) than in nondrinkers (2.62 ± 0.01) and was significantly lower in regular heavy drinkers than in occasional heavy drinkers. Results of logistic regression analysis, using odds ratios for high lipid indices of occasional or regular heavy drinkers vs. nondrinkers, agreed with the above results of analysis of covariance. Occasional heavy drinkers showed more detrimental and less favorable levels of the lipid indices than did regular heavy drinkers, and thus heavy drinking, even if occasional, should be avoided to prevent cardiovascular disease.
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3234
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3235
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Affiliation(s)
- Eoin O’Brien
- From the Department of Molecular Pharmacology, The Conway Institute, University College Dublin, Ireland (E.O.B.); Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.P.); and Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.)
| | - Gianfranco Parati
- From the Department of Molecular Pharmacology, The Conway Institute, University College Dublin, Ireland (E.O.B.); Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.P.); and Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.)
| | - George Stergiou
- From the Department of Molecular Pharmacology, The Conway Institute, University College Dublin, Ireland (E.O.B.); Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.P.); and Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.)
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3236
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Fernemark H, Jaredsson C, Bunjaku B, Rosenqvist U, Nystrom FH, Guldbrand H. A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes. PLoS One 2013; 8:e79324. [PMID: 24312178 PMCID: PMC3842308 DOI: 10.1371/journal.pone.0079324] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/19/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets. OBJECTIVE To study postprandial effects of three diets, during a single day, in NIDDM. METHODS A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision. RESULTS Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 ± 2.2, of Mediterranean-style diet: 8.12 ± 5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003). CONCLUSIONS The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective. TRIAL REGISTRATION ClinicalTrials.gov NCT01522157 NCT01522157.
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Affiliation(s)
- Hanna Fernemark
- Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Christine Jaredsson
- Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Bekim Bunjaku
- Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Ulf Rosenqvist
- Department of Internal Medicine, Motala Hospital, Motala, Sweden
| | - Fredrik H. Nystrom
- Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Hans Guldbrand
- Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden
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3237
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Wakabayashi I. Relationship between smoking and metabolic syndrome in men with diabetes mellitus. Metab Syndr Relat Disord 2013; 12:70-8. [PMID: 24266721 DOI: 10.1089/met.2013.0110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Metabolic syndrome is a potent risk factor for cardiovascular disease and is often complicated in patients with diabetes. The aim of this study was to determine whether and how smoking is related to metabolic syndrome in patients with diabetes. METHODS Subjects were men with diabetes (n=2675) who had been diagnosed as a result of health examinations at their workplaces. They were divided into nonsmokers, light smokers (≤ 20 cigarettes per day) and heavy smokers (>20 cigarettes per day). The relationships of smoking with metabolic syndrome and its components, including obesity, high blood pressure, and dyslipidemia [high triglycerides and/or low high-density lipoprotein cholesterol (HDL-C)] in nondrinkers, light drinkers (<22 grams of ethanol per day), and heavy drinkers (≥ 22 grams of ethanol per day) were investigated by logistic regression analysis with adjustment for age, regular exercise, and drug therapy for diabetes. RESULTS In nondrinkers with diabetes, the odds ratio (OR) versus nonsmokers for metabolic syndrome was significantly higher in heavy smokers (2.47 [95% confidence interval (CI) 1.43-4.25]) but not different in light smokers [1.03 (95% CI 0.71-1.49)] when compared with the reference level of 1.00. In the light and heavy drinker groups, the ORs versus nonsmokers for metabolic syndrome were not significantly different from the reference level in the smoker groups, except for a significantly lower OR of light smokers in the heavy drinker group [0.69 (95% CI 0.53-0.90)]. In nondrinkers, the ORs of heavy smokers versus nonsmokers for large waist circumference [1.64 (95% CI 1.01-2.68)], high triglycerides [1.78 (95% CI 1.12-2.81)], and low HDL-C [3.20 (95% CI 1.99-5.14]), but not the OR for high blood pressure [1.02 (95% CI 0.60-1.72)], were significantly higher than the reference level. CONCLUSION In nondrinkers with diabetes, there is a positive association between heavy smoking and metabolic syndrome, which is mainly due to higher risks of central obesity and dyslipidemia, such as hypertriglyceridemia and low HDL cholesterolemia, in heavy smokers than in nonsmokers.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine , Nishinomiya, Hyogo, Japan
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3238
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Gómez-Huelgas R, Martínez-Castelao A, Artola S, Górriz JL, Menéndez E. [Treatment of type 2 diabetes mellitus in patients with chronic kidney disease. Grupo de Trabajo para el Documento de Consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica]. Med Clin (Barc) 2013; 142:85.e1-10. [PMID: 24268912 DOI: 10.1016/j.medcli.2013.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 02/06/2023]
Abstract
Chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) are highly prevalent chronic diseases, which represent an important public health problem and require a multidisciplinary management. T2DM is the main cause of CKD and it also causes a significant comorbidity with regard to non-diabetic nephropathy. Patients with diabetes and kidney disease represent a special risk group as they have higher morbi-mortality as well as higher risk of hypoglycemia than diabetic individuals with a normal kidney function. Treatment of T2DM in patients with CKD is controversial because of the scarcity of available evidence. The current consensus report aims to ease the appropriate selection and dosage of antidiabetic treatments as well as the establishment of safety objectives of glycemic control in patients with CKD.
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Affiliation(s)
| | - Alberto Martínez-Castelao
- Sociedad Española de Nefrología (SEN), Grupo Español de Estudio de la Nefropatía Diabética (GEENDIAB), España
| | - Sara Artola
- Red de Grupos de Estudio de la Diabetes en Atención Primaria (redGDPS), España
| | - José Luis Górriz
- Sociedad Española de Nefrología (SEN), Grupo Español de Estudio de la Nefropatía Diabética (GEENDIAB), España
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3239
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Coll-de-Tuero G, González-Vázquez S, Rodríguez-Poncelas A, Barceló MA, Barrot-de-la Puente J, Penedo MG, Pose-Reino A, Pena-Seijo M, Saez M. Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up. ACTA ACUST UNITED AC 2013; 8:83-93. [PMID: 24239162 DOI: 10.1016/j.jash.2013.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/20/2013] [Accepted: 10/02/2013] [Indexed: 11/16/2022]
Abstract
There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- Research Unit, Institut d'Assistència Sanitària, IAS, Girona, Spain; CIBER of Epidemiology and Public Health, CIBERESP, Spain; Department of Medical Sciences, University of Girona, Girona, Spain
| | - Sonia González-Vázquez
- Artificial Vision and Pattern Recognition Group, VARPA, Department of Computing, University of A Coruña, Spain
| | | | - María Antònia Barceló
- CIBER of Epidemiology and Public Health, CIBERESP, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain
| | | | - Manuel G Penedo
- Artificial Vision and Pattern Recognition Group, VARPA, Department of Computing, University of A Coruña, Spain
| | - Antonio Pose-Reino
- Internal Medicine Service, Hospital de Conxo, Santiago de Compostela, Spain
| | - Marta Pena-Seijo
- Internal Medicine Service, Hospital de Conxo, Santiago de Compostela, Spain
| | - Marc Saez
- CIBER of Epidemiology and Public Health, CIBERESP, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain.
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3240
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Abstract
Hypertension resistant to lifestyle interventions and antihypertensive medications is a common problem encountered by physicians in everyday practice. It is most often defined as a blood pressure remaining ≥ 140/90 mmHg despite the regular intake of at least three drugs lowering blood pressure by different mechanisms, one of them being a diuretic. It now appears justified to include, unless contraindicated or not tolerated, a blocker of the renin-angiotensin system and a calcium channel blocker in this drug regimen, not only to gain antihypertensive efficacy, but also to prevent or regress target organ damage and delay the development of cardiorenal complications. A non-negligible fraction of treatment-resistant hypertension have normal "out of office" blood pressures. Ambulatory blood pressure monitoring and/or home blood pressure recording should therefore be routinely performed to identify patients with true resistant hypertension, i.e. patients who are more likely to benefit from treatment intensification.
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Affiliation(s)
- Bernard Waeber
- Division of Pathophysiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne , Lausanne , Switzerland
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3241
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3242
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New blood pressure control goals, more rational but facilitating therapeutic inertia? : reply. J Hypertens 2013; 31:2463. [PMID: 24220595 DOI: 10.1097/hjh.0000000000000005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3243
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Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2013; 63:636-646. [PMID: 24239664 DOI: 10.1016/j.jacc.2013.09.063] [Citation(s) in RCA: 1234] [Impact Index Per Article: 112.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/13/2013] [Accepted: 09/22/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors. BACKGROUND Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups. METHODS We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. RESULTS Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups. CONCLUSIONS Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.
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Affiliation(s)
- Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
| | - Melissa Spears
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Chris Boustred
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Simon G Anderson
- Institute of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - Emelia J Benjamin
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Pierre Boutouyrie
- INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - James Cameron
- Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia
| | - Chen-Huan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - J Kennedy Cruickshank
- King's College & King's Health Partners, St. Thomas' & Guy's Hospital, London, United Kingdom
| | - Shih-Jen Hwang
- Branch of Population Sciences, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Stephane Laurent
- INSERM U 970, Paris-Descartes University, Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - João Maldonado
- Instituto de Investigação e Formação Cardiovascular, Penacova, Portugal
| | | | - Samer S Najjar
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland; MedStar Heart Research Institute, Washington, DC
| | - Anne B Newman
- Center for Aging and Population Health, Pittsburgh, Pennsylvania
| | - Mitsuru Ohishi
- Department of Geriatric Medicine, Osaka University, Osaka, Japan
| | - Bruno Pannier
- Centre d'Investigations Preventives et Cliniques, Paris, France
| | - Telmo Pereira
- Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute and Boston University's Framingham Heart Study, Department of Medicine, Boston University, Boston, Massachusetts
| | - Tomoki Shokawa
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Francis Verbeke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Kang-Ling Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tine Willum Hansen
- Research Center for Prevention and Health, Glostrup Hospital, Glostrup and Steno Diabetes Center, Glostrup, Denmark
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Ian B Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, United Kingdom
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3244
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Lenz T. [Current management of renal artery stenosis]. Internist (Berl) 2013; 54:1443-9. [PMID: 24217529 DOI: 10.1007/s00108-013-3324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary kidney, renal insufficiency (ischemic kidney disease) or rarely pulmonary flush edema may occur. Renal artery stenosis may be treated by revascularization, using either percutaneous (balloon angioplasty, stenting) or less common open surgical procedures, both with excellent primary patency rates. However, randomized trials of renal artery angioplasty or stenting have failed to demonstrate a longer-term benefit with regard to blood pressure control and renal function over medical management alone (except for fibromuscular disease). Furthermore, endovascular procedures are associated with substantial risks. It has not yet been demonstrated that renal revascularization leads to a prolongation of event-free survival. Careful patient selection is essential to maximize the potential benefit.
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Affiliation(s)
- T Lenz
- KfH Nierenzentrum, Maxstr. 48, 67059, Ludwigshafen, Deutschland,
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3245
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Monge M, Lorthioir A, Bobrie G, Azizi M. New drug therapies interfering with the renin–angiotensin–aldosterone system for resistant hypertension. J Renin Angiotensin Aldosterone Syst 2013; 14:285-9. [DOI: 10.1177/1470320313513408] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Matthieu Monge
- Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- Inserm, Clinical Investigation Centre 9201, Paris, France
| | - Aurélien Lorthioir
- Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
| | - Guillaume Bobrie
- Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
| | - Michel Azizi
- Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- Inserm, Clinical Investigation Centre 9201, Paris, France
- Université Paris-Descartes, Paris, France
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3246
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Burnier M, Vuignier Y, Wuerzner G. State-of-the-art treatment of hypertension: established and new drugs. Eur Heart J 2013; 35:557-62. [DOI: 10.1093/eurheartj/eht465] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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3247
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Cuspidi C, Muiesan ML, De Luca N, Salvetti M, Agabiti-Rosei E, Schillaci G. Echocardiography in Hypertension: a Call for Standardization from the Working Group on Heart and Hypertension of the Italian Society of Hypertension. High Blood Press Cardiovasc Prev 2013; 21:53-61. [DOI: 10.1007/s40292-013-0030-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/13/2013] [Indexed: 12/12/2022] Open
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3248
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Kario K, Robbins J, Jeffers BW. Titration of amlodipine to higher doses: a comparison of Asian and Western experience. Vasc Health Risk Manag 2013; 9:695-701. [PMID: 24235839 PMCID: PMC3821790 DOI: 10.2147/vhrm.s50077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this retrospective analysis, data pooled from two Phase III/IV open-label Asian studies were used to quantify the additional blood pressure efficacy achieved when titrating amlodipine from 5 mg to 10 mg in mild/moderate hypertensive patients, and compared to data pooled from three Western studies. The primary efficacy end point was the change from baseline in sitting systolic blood pressure (SBP) and diastolic blood pressure (DBP) to the specified time point (4–8 weeks, depending on the trial). For the Asian analysis (n=174), both mean SBP and DBP were significantly decreased at the final visit (SBP −13.3 mmHg, 95% confidence interval [CI] −15.5 to −11.0; DBP −9.2 mmHg, 95% CI −10.6 to −7.8; both P<0.0001). These results were similar to the Western analysis (n=369; SBP −11.5 mmHg, 95% CI −13.1 to −10.0; DBP −6.3, 95% CI −7.1 to −5.5; both P<0.0001). In summary, titration of amlodipine from 5 mg to 10 mg significantly decreased both SBP and DBP in Asian patients with mild-to-moderate hypertension.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University, Shimotsuke, Japan
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3249
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Sjöblom P, Nystrom FH, Länne T, Engvall J, Östgren CJ. Microalbuminuria, but not reduced eGFR, is associated with cardiovascular subclinical organ damage in type 2 diabetes. DIABETES & METABOLISM 2013; 40:49-55. [PMID: 24200881 DOI: 10.1016/j.diabet.2013.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/19/2013] [Accepted: 09/23/2013] [Indexed: 12/29/2022]
Abstract
AIM This study explored the association between reduced estimated glomerular filtration rate (eGFR) and microalbuminuria vs. subclinical organ damage in patients with type 2 diabetes. METHODS Data from middle-aged patients with type 2 diabetes (n=706) treated in primary care were analyzed for microalbuminura, defined as a urinary albumin/creatinine ratio (uACR)≥3.0mmol/mol, and reduced eGFR, defined as<60mL/min/1.73m(2), in relation to blood pressure, pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima-media thickness (IMT) and lumen diameter (LD). RESULTS Patients with microalbuminuria had significantly higher 24-h ambulatory systolic blood pressure (ASBP) compared with subjects with uACR<3mg/mmol: 137 vs. 128mmHg (P<0.001). There were no differences in ASBP in patients with eGFR<60mL/min/1.73m(2). However, patients with vs. without microalbuminuria had increased PWV (11.4 vs. 10.1m/s; P<0.001), LVMI (134.4 vs. 118.6g/m(2); P<0.001), LD (7.01±0.93 vs. 6.46±0.74mm; P<0.001) and IMT (0.78 vs. 0.74mm; P=0.047), respectively. The associations between uACR vs. PWV and LVMI were more robust after adjusting for age, diabetes duration, ASBP, HbA1c, LDL-cholesterol, and antihypertensive and lipid-lowering therapy compared with uACR vs. IMT. There were no statistically significant differences in PWV, LVMI or IMT between patients with reduced (<60mL/min/1.73m(2)) vs. normal eGFR. CONCLUSION Levels of urinary albumin excretion, but not reduced eGFR, were associated with increased arterial stiffness, left ventricular mass and atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
- P Sjöblom
- Skärblacka Primary Health Care Centre, Stationsvägen 2, 61732 Skärblacka, Sweden; Department of Local Care Finspång, County Council of Östergötland, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - F H Nystrom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Endocrinology and Metabolism, Linköping University Hospital, Linköping, Sweden
| | - T Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - J Engvall
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, County Council of Östergötland, Linköping, Sweden
| | - C J Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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3250
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Lackland DT. How will the growing threat of resistant hypertension impact the future treatment of high blood pressure? Expert Rev Cardiovasc Ther 2013; 11:1541-6. [DOI: 10.1586/14779072.2013.851002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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