Epidemiology of hypertension and its relationship with type 2 diabetes and obesity in eastern Morocco

Current Insight into Novel Delivery Approaches of Resveratrol for Improving Therapeutic Efficacy and Bioavailability with its Clinical Updates

Resveratrol (RSV) is a polyphenolic phytoalexin, and belongs to the stilbene family. RSV has several therapeutic activities such as cardioprotective, anticancer, and antioxidant. Apart from its therapeutic benefits, its pharmacological uses are limited due to low solubility, poor bioavailability, and short biological halflife. A researcher continuously focuses on overcoming the limitations of RSV through nanotechnology platforms to get the optimum health benefits. In this context, nanocarriers are pioneering to overcome these drawbacks. Nanocarriers possess high drug loading capacity, thermal stability, low production cost, longer shelflife, etc. Fortunately, scientists were proficient in delivering resveratrol-based nanocarriers in the present scenario. Nanocarriers can deliver drugs to the target sites without compromising the bioavailability. Thus, this review highlights how the latest nanocarrier systems overcome the shortcomings of RSV, which will be good for improving therapeutic efficacy and bioavailability. Moreover, recent updates on resveratrol-based novel formulations and their clinical trials have been addressed to manage several health-related problems.

Single-Pill Combination to Improve Hypertension Treatment: Pharmaceutical Industry Development

Multiple illness is an increasingly common phenomenon. Its consequence is the need for polytherapy, which is particularly common among people suffering from arterial hypertension. The development of combined preparations (containing at least two API-active pharmaceutical ingredients) dedicated to the treatment of hypertension is a response to increased compliance, especially in elderly patients. In our work, we describe in particular the possibilities of using β-adrenergic receptors blockers and angiotensin-converting enzyme inhibitors in combinations. The combinations of APIs are used as single pills in patients with arterial hypertension with concomitant diseases such as hyperlipidemia; blood coagulation problems and diabetes mellitus were also discussed successively. Pharmacoeconomic analysis for the API combinations shown is also presented. As a final conclusion, numerous benefits of using the combined preparations should be indicated, especially by the elderly and/or in patients with coexistence of other diseases.

Prevalence and risk factors of chronic complications among patients with type 2 diabetes mellitus in Morocco: a cross-sectional study

Introduction

microvascular and macrovascular complications of type 2 diabetes mellitus (T2DM) are one of the major causes of morbidity and mortality worldwide among patients with T2DM. This study aims to estimate the prevalence of these chronic complications and identify the associated risk factors among Moroccan patients with T2DM.

Methods

this cross-sectional study was conducted on 505 T2DM patients followed by the healthcare Centers of the Casablanca-Settat region from January 2017 to July 2018. The socio-demographic, anthropometric, biochemical, and clinical data were recorded using a structured survey. For statistical analysis, SPSS version 20 is used. Univariate and multivariate logistic regression analyses are used to determine the risk factors associated with chronic complications of T2DM.

Results

among the 505 Moroccan patients with T2DM, 84.98% were women. The average age of the patients was 57.27±10.74 years. Diabetic eye disease was the most frequent complication (29.5%) followed by cardiovascular diseases (CVDs) (22.4%), kidney disease in diabetes (9.8%), diabetes foot (2.8%), and neuropathy (1.8%). Logistic regression analysis showed that the CVDs was associated with hypertension (OR: 2.41; 95% CI: 1.11-5.22; p=0.026), hypolipidemia treatment (OR: 2.20; 95% CI: 1.06-4.59; p=0.034), insulin use (OR= 0.39; 95%CI: 0.15-0.96, p=0.043) and LDL-C (OR: 1.01; 95% CI: 1-1.02; p=0.035) in T2DM patients. However, the major risk factors for the development of kidney disease in T2DM patients were a lack of regular physical activity (OR: 3.77; 95% CI: 1.22-11.67; p=0.021), hypolipidemia treatment (OR: 8.31; 95% CI: 1.86-36.97; p=0.005), and high serum creatinine (OR: 1.33; 95% CI: 1.16-1.53; p≤0.001). In addition, LDL-C levels were found to be a significant risk factor for diabetes eye disease (OR: 1.01; 95% CI: 1.00-1.03; p=0.008).

Conclusion

this study shows that the increased duration of diabetes, insulin use, lack of regular physical exercise, hypertension, hypolipidemia treatment, high serum creatinine, and LDL-C were significant risk factors for chronic complications of T2DM in Moroccan patients.

Health benefits of resveratrol: Evidence from clinical studies

Resveratrol is a polyphenolic nutraceutical that exhibits pleiotropic activities in human subjects. The efficacy, safety, and pharmacokinetics of resveratrol have been documented in over 244 clinical trials, with an additional 27 clinical trials currently ongoing. Resveretrol is reported to potentially improve the therapeutic outcome in patients suffering from diabetes mellitus, obesity, colorectal cancer, breast cancer, multiple myeloma, metabolic syndrome, hypertension, Alzheimer's disease, stroke, cardiovascular diseases, kidney diseases, inflammatory diseases, and rhinopharyngitis. The polyphenol is reported to be safe at doses up to 5 g/d, when used either alone or as a combination therapy. The molecular basis for the pleiotropic activities of resveratrol are based on its ability to modulate multiple cell signaling molecules such as cytokines, caspases, matrix metalloproteinases, Wnt, nuclear factor-κB, Notch, 5'-AMP-activated protein kinase, intercellular adhesion molecule, vascular cell adhesion molecule, sirtuin type 1, peroxisome proliferator-activated receptor-γ coactivator 1α, insulin-like growth factor 1, insulin-like growth factor-binding protein 3, Ras association domain family 1α, pAkt, vascular endothelial growth factor, cyclooxygenase 2, nuclear factor erythroid 2 like 2, and Kelch-like ECH-associated protein 1. Although the clinical utility of resveratrol is well documented, the rapid metabolism and poor bioavailability have limited its therapeutic use. In this regard, the recently produced micronized resveratrol formulation called SRT501, shows promise. This review discusses the currently available clinical data on resveratrol in the prevention, management, and treatment of various diseases and disorders. Based on the current evidence, the potential utility of this molecule in the clinic is discussed.

Antihypertensive and vasorelaxant effects of aqueous extract of Artemisia campestris L. from Eastern Morocco

ETHNOPHARMACOLOGICAL RELEVANCE

Artemisia campestris L. (Asteraceae) has many traditional uses, among which treatment of diabetes and hypertension.

AIM OF THE STUDY

This study was conducted in order to confirm the antihypertensive and hypotensive effects of A. campestris L. aqueous extract (AcAE) and to explore the underlying mechanism of action of its vasorelaxant effect, besides the acute toxicity. Also, the chemical composition of AcAE was investigated.

MATERIAL AND METHODS

the chemical content of AcAE was determined by using HPLC and NMR techniques. The antihypertensive effect was assessed indirectly by tail-cuff method on L-NAME induced hypertensive rats, while the hypotensive action was monitored intravenously by invasive method on normotensive rats. The vasorelaxant effect and vascular mechanism of action were studied in the presence of antagonists and blockers on aorta isolated from normotensive rats. On the other side, the acute toxicity was studied by oral feeding of extract to the mice.

RESULTS

The global phytochemical profile of AcAE reveals the presence of several polyphenols as main components. A. campestris L. infusion was characterized by mono- and di-cinnamoyl compounds, with 3,5-dicaffeoylquinic (isochlorogenic A) acid being the main compound, followed by 5-caffeoylquinic (chlorogenic) acid. Vicenin-2 (apigenin 6,8-di-C-glucoside) appeared to be the most abundant compound among flavonoids. The daily treatment with AcAE at 150mg/kg/day prevented the installation of hypertension on L-NAME hypertensive rats, and reduced SBP from 172mmHg up to 144mmHg. At the dose 40mg/kg, AcAE provoked reduction of systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP), without affecting the heart rate. Also, AcAE (10^-2-2mg/ml) relaxed the precontracted aorta by 95.8±1.3%. The denudation and preincubation of aorta with atropine, calmidazolium, L-NAME, hydroxycobalamin, ODQ, 8-RP-Br-PET-cGMP, thapsigargin and verapamil attenuated the vasorelaxant response, while the pre-treatment with 4-AP, TEA, glibenclamide and BaCl₂ did not alter this effect. The oral administration of AcAE (0-6g/kg) reveals no mortality or toxicity.

CONCLUSIONS

our study proved that AcAE possess an important antihypertensive, hypotensive and vasorelaxant effect, which is mediated via calmodulin-NO-cGC-PKG pathway, and via inhibition of calcium influx through voltage-operated calcium channels and activation of intracellular calcium mobilization into sarcoplasmic reticulum. Therefore, our findings give first evidence about the traditional use of A. campestris L. as antihypertensive plant.

Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care

BACKGROUND

Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco.

METHODS

This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years.

RESULTS

A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40-60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m²]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target.

CONCLUSIONS

More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

Association between FTO gene polymorphism (rs9939609 T/A) and cancer risk: a meta-analysis

Obesity is a risk factor of cancer. Several genes have been found to play an important role in aetiology of obesity and tumourigenesis. Recently, some studies suggested that rs9939609 polymorphism might be significantly associated with cancer risk, while the results of some other studies were controversial. Databases with time limitation from January 1984 to April 2015 were searched. The pooled odds ratio (OR) with 95% confidence interval was calculated to assess the associations, and subgroup meta-analyses were performed according to the type of cancer and ethnicity of the study populations. Overall, the significant association between rs9939609 polymorphism and cancer risk was found in homozygote model and recessive model. As to subgroup classified by cancer type, there was significant association in endometrial cancer and pancreatic cancer, while no statistical significance was detected in other kind of cancers. Besides, in the subgroup analysis of ethnicity, our results indicated that rs9939609 polymorphism was significantly associated with cancer risk in Asians. The rs9939609 polymorphism may be involved the susceptibility of endometrial cancer and pancreatic cancer, especially in Asian populations. Thus, rs9939609 may be a potential biomarker in early diagnosis or gene therapy target of endometrial cancer and pancreatic cancer.

Diabetes and new-onset atrial fibrillation in a hypertensive population

AIM

The association of diabetes with new-onset atrial fibrillation (AF) remains controversial. Hypertension may partly explain the risk association ascribed to diabetes. We studied the role and characteristics of diabetes in hypertensive patients with no ischemic vascular disease.

METHODS

Records of 262,892 persons from the Information System for the Development of Research in Primary Care in Catalonia (Spain) were examined from July 2006 to December 2011. Included participants were ≥55-years-old and hypertensive with no ischemic heart disease, stroke, or peripheral artery disease. We used Cox proportional hazards regression to model incidences in the diabetic and non-diabetic subgroups of our population, and among diabetic patients, diabetes duration and pharmacological treatment, hemoglobin A1C, and body mass index.

RESULTS

New-onset AF incidence in diabetic patients was 13.3 per 1000 person-years (mean follow-up: 4.3 years). In non-diabetic patients, it was 10.4 per 1000 person-years (mean follow-up: 4.1 years). Diabetes hazard ratio (HR) for new-onset AF was 1.11 (95% confidence interval (CI): 1.06-1.16). Diabetic patients also diagnosed with obesity had an HR of 1.41 (95% CI: 1.22-1.64).

CONCLUSION

Diabetes was modestly associated with new-onset AF in hypertensive patients with no ischemic vascular disease. Among diabetic patients, only obesity reached significance in its association with this arrhythmia.

Association of methylenetetrahydrofolate reductase gene (C677T) with the risk of hypertension in Morocco

Background

Hypertension is a multifactorial disease caused by the interaction between genetic and environmental factors. Mutations in the methylenetetrahydrofolate reductase gene (MTHFR) have been known to be associated with the risk of cardiovascular disease as well as hypertension. This case–control study was conducted out to measure the association of the polymorphism C677T of MTHFR with the risk of hypertension.

Methods

Polymerase chain reaction followed by restriction fragment analysis length was used to identify MTHFR C677T genotypes in patients 101 patients and 102 age and sex matched healthy controls. Odds ratio with 95 % confidence interval was used to assess the risk of association.

Results

The distribution of demographic and clinical features of patients showed no particular trend (p > 0.05). However, the frequency of homozygous 677T allele was higher in patients with a family history of heart disease (30.4 vs. 9 %, p = 0.031). Interestingly, the mutant 677TT genotype was significantly associated with the susceptibility of hypertension when compared to the wild type 677CC genotype (OR 5.4, CI 1.4–19.8, p = 0.008). In addition, the recessive model 677TT vs. 677CC/CT was found to be associated with the risk of hypertension (OR 5.3, CI 1.5–19.1, p = 0.005). However, the dominant model was not associated with the risk of hypertension in our cohort (OR 1.3, CI 0.7–2.2, p = 0.4).

Conclusions

Based on our findings, the homozygous mutant for 677TT of MTHFR gene is associated with the risk of hypertension in our population. Further studies with larger sample sizes are needed to confirm the results of this study.

Habitual Sleep Duration and Risk of Childhood Obesity: Systematic Review and Dose-response Meta-analysis of Prospective Cohort Studies

A meta-analysis of cross-sectional studies found that shorter-time sleep was correlated with increased risk of obesity in children. However, findings from prospective cohort studies were inconsistent. PubMed and other data resources were searched through May 2015. Twenty-five eligible studies were identified including 56,584 children and adolescents with an average 3.4-year follow-up. Compared with children having the longest sleep duration (~12.2 hours), kids with the shortest sleep duration (~10.0 hours) were 76% more likely to be overweight/obese (pooled odds ratio [OR]: 1.76; 95% confidence interval [CI]: 1.39, 2.23); and had relatively larger annual BMI gain (pooled β coefficient: 0.13; 95% CI: 0.01, 0.25 kg/m²). With every 1 hour/day increment in sleep duration, the risk of overweight/obesity was reduced by 21% (OR: 0.79; 95% CI: 0.70, 0.89); and the annual BMI gain declined by 0.05 kg/m² (β = −0.05; 95% CI: −0.09, −0.01). The observed associations were not appreciably modified by region, baseline age or the length of follow-up. Accumulated literature indicates a modest inverse association between sleep duration and the risk of childhood overweight/obesity. Further research is needed to determine the age and gender specified optimal hours of sleep and ideal sleep pattern with respect to obesity prevention in children.