Spécificités de la prise en charge de l’hypertension artérielle chez le patient diabétique sub-saharien

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OBJECTIVE

We sought to evaluate ginger's cardiovascular and metabolic effects (Zingiberofficinale) add-on therapy in type 2 diabetes patients over six weeks.

METHODS

We performed a single-arm clinical trial. In well-to-moderately controlled Type 2 diabetic patients with unchanged treatment for at least three months, the intervention consisted of 6-week add-on oral supplementation of powdered ginger extracts in capsules at a dose of 399 mg three times per day. Transthoracic Doppler echocardiography, ambulatory blood pressure monitoring (ABPM), glycatedhaemoglobin (HbA1c), lipid profile, kidney and liver function analysis were performed at initial and final visits, with a follow-up visit on day 21. Adherence to treatment, palatability and safety were also assessed.

RESULTS

Overall, 21 participants (16 females) were included in the analysis. We found a non-significant decrease of E' wave from 0.05[0.04-0.09] to 0.06[0.05-0.7]cm/s, A-wave from 0.8[0.6-0.8] to 0.7[0.6-0.8] cm/s, and E-wave from 0.6[0.5-0.7] to 0.5[0.425-0.6]cm/s. There was a significant reduction of HbA1c from 49.7[47.0-57.4] to 44.3[38.8-53.0] mmol/mol and triglycerides from 1.6[1.4-1.9] to 1.2[0.9-1.8] mmol/l. A 5% decrease or more was observed for diurnal DBP, diurnal MAP and 24-hour DBP.

CONCLUSION

Zingiberofficinale used as add-on therapy tend to improve diastolic function, blood pressure and lipid profile of type 2 diabetes patients. Further studies are needed to define the dosage and duration of this supplementary treatment accurately.

TRIAL REGISTRATION NUMBER

NCT04222738.

Short-term effects of perindopril-amlodipine vs perindopril-indapamide on blood pressure control in sub-Saharan type 2 diabetic individuals newly diagnosed for hypertension: A double-blinded randomized controlled trial

Poor blood pressure (BP) control contributes to complications in sub-Saharan African (SSA) type 2 diabetic individuals. Experts have advocated the use of combination therapies for effective BP control in these patients. The suggested combinations should include a RAAS antagonist and either a CCB or a thiazide diuretic; however, their efficacy is yet to be established in SSA. We investigated the short-term effects of two combination therapies on BP control in SSA type 2 diabetic individuals. This was a double-blinded randomized controlled trial conducted at the Yaoundé Central Hospital (Cameroon) from October 2016 to May 2017. We included type 2 diabetic patients, newly diagnosed for hypertension. After baseline assessment and 24-hour ABPM, participants were allocated to receive either a fixed combination of perindopril + amlodipine or perindopril + indapamide for 42 days. Data analyses followed the intention-to-treat principle. We included fifteen participants (8 being females) in each group. Both combinations provided good circadian BP control after 6 weeks with similar efficacy. Twenty-four-hour SBP dropped from 144 to 145 mm Hg vs 128 to 126 mm Hg with perindopril-amlodipine and perindopril-indapamide, respectively (P = 0.003 for both groups). Twenty-four-hour DBP dropped from 85 to 78 mm Hg (P = 0.013) vs 89 to 79 mm Hg (P = 0.006) in the same respective groups. No significant adverse effect was reported. A fixed initial combination of perindopril-amlodipine or perindopril-indapamide achieved similar effective BP control after 6 weeks in SSA type 2 diabetic individuals with newly diagnosed hypertension. Therefore, these combinations can be used interchangeably in this indication.