Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Efficacy and acceptability of perindopril (Coversyl) in general practice were evaluated in 23,460 hypertensive patients (52.9% women) during an open six month trial. Patients had essential mild to moderate hypertension (94 mmHg < supine DBP < 115 mmHg) associated or not with obesity (34%), diabetes (12%), hypercholesterolemia (36%), smoking habits (24%). Mean hypertension duration was 6.5 years, 70 p. cent of patients were 50 to 69 years old and 12 p. cent 70 years old or more. Perindopril was started at 4 mg except in older and patients with renal insufficiency (2 mg). If supine DBP remained > 90 mmHg the dose was doubled up to 8 mg/day, then a thiazide diuretic was added. Monotherapy was held in 90 p. cent of cases all along the study, more than 8 over 10 times at 2 or 4 mg/day. Normalized patients (DBP < or = 90 mmHg) were 69.87 and 95 p. cent respectively at the first, third and sixth month. Mean supine SBP and DBP decrease were 27.3 and 18.0 mmHg. Antihypertensive activity was similar in patients taking psychotrope or non steroidal anti-inflammatory agents and in others, as well as in older (> or = 70 years), diabetics and obeses, however with a significantly more frequent bitherapy in these last three sub-groups. Cough, a well known side effect of ACEI led to withdrawal in only 2.6 p. cent of cases. Withdrawals for side-effect were more frequent in older patients (6.1%), in those taking psychotrope (5.3%) or non steroidal anti-inflammatory agents (6.0%) than in diabetics (4.1%) or the others (4.1%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Antihypertensive action, clinical and biological acceptability of perindopril: main results in 23,460 patients with mild to moderate hypertension treated for 6 months in general practice]. 848 Sep 86

The aim of this study is to elucidate the clinical significance of estimating renal size in non-insulin-dependent diabetes mellitus (NIDDM). Renal size was compared in 57 NIDDM patients with persistent normoalbuminuria [group I; 19 cases, albumin excretion rate (AER) < 20 micrograms/min], microalbuminuria (group II; 24 cases, AER = 20-200 micrograms/min), or macroalbuminuria (group III; 14 cases, AER > 200 micrograms/min). Three groups were matched for age and diabetes duration. Renal size was estimated using drip-infusion pyelography according to Simon's method (mean kidney length/height of second lumbar spine and disc; renal ratio, RR). Thirteen patients with persistent microalbuminuria (10 normotensive and 3 hypertensive) were traced during at least 3 years. Angiotensin-converting enzyme inhibitor (enalapril) was used in 11 cases. The results are as follows: (1) Renal size in groups II (RR, 3.47 +/- 0.28; cited as mean +/- SD) and III (3.62 +/- 0.32) significantly increased compared with that in group I (3.26 +/- 0.20) (p < 0.01 and p < 0.001, respectively). No statistical differences could be detected between groups II and III. (2) As a whole, good metabolic (glycosylated hemoglobin, HbA1) and hemodynamic (systolic blood pressure, SBP) control was achieved during the last 12 months (HbA1, 8.4% +/- 0.9%; SBP, 122 +/- 8 mm Hg). There was no significant correlation between RR and creatinine clearance, HbA1, SBP, or diastolic blood pressure during the first and last 12 months. Initial RR significantly correlated with AER during the last 12 months (r = 0.651, p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
J Diabetes Complications
PMID:Renal hypertrophy as a prognostic index for the progression of diabetic renal disease in non-insulin-dependent diabetes mellitus. 848 47

Atherosclerosis in diabetic subjects is improved by the reduced repair capacity of endothelial damage and by the increased platelet aggregation, peculiar to diabetic pathology. The contemporary presence of high blood pressure, diabetes and lipoidoproteinosis, increasing the possibility of cardiovascular damage, also under well-controlled blood pressure values, certainly increases the risk of atherosclerosis. However we have valued the presence of lipoidoproteinosis in 52 of our diabetic-hypertensive patients in a follow-up of 40 months. The patients have been split in to two groups of 26 patients each, one being treated with nifedipine, the other to with captopril. The data obtained have been compared with the data for the two control groups (non diabetic patients). The selection has been carried out according to established criteria. We have investigated: glycaemia, total cholesterol, HDL-C, LDL-C, triglycerides, tot. Chol./HDL-C, LDL-C/HDL-C. During follow-up the blood pressure values were significantly reduced (p < 0.01) (captopril: delta SBP = -13.88, delta DBP = -12.38, nifedipine: delta SBP = -22.03, delta DBP = -21.35). In the nifedipine group lipoidoproteinosis has been more marked: delta% glicaemia = +17.69, delta% cholesterolemia = +20.11; delta% CFR = +18.57; LDL-C = +35.11; delta% VRF = +34.61, while in the patients treated with captopril we have had the following results: delta% glycaemia = +15.43; delta% cholesterolemia = +16.36; delta% LDL-C = +26.68. The control group with nifedipine treatment have shown only increased values of cholesterolemia: delta% = +4.80, moreover in the control group treated with captopril we have observed a reduction of VRF: delta% = -15. A significant relationship between total cholesterolemia and glycaemia in the group with nifedipine treatment (p < 0.01) and captopril (p < 0.01) has been reported. This study could appear to underline the autonomic nervous system activation by nifedipine which does not affect lipoidoproteinosis in diabetic hypertensive subjects. This would seem to confirm on the contrary, the utility of captopril in the treatment of atherosclerotic subjects, as diabetic hypertensive patients.
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PMID:[Glyco-lipid changes in hypertensive diabetic patients undergoing treatment with nifedipine and captopril]. 849 63

To evaluate the effect of blood pressure (BP) on the left ventricular mass index (LVMI), 66 children with IDDM 13 +/- 3 years of age were studied and compared with 58 healthy age-matched siblings. The 24 h BP recordings disclosed that children with diabetes had higher DBP (68 vs. 65 mm Hg, P = 0.002), especially at night (60 vs. 55 mm Hg, P = 0.00007), with a minimisation of the normal nocturnal hypotension (-9.9 vs. -12.4 mm Hg, P = 0.04). Their LVMI was higher (79 vs. 71 g/m2, P = 0.02); it was independent of BP values and variability (P = NS), but it was positively correlated with heart rate (r = -0.46, P = 0.0005). In the control group, LVMI was significantly correlated with the mean SBP (r = 0.46, P = 0.0005); with its variability (r = 0.32, P = 0.02) and, to a lower extent, with heart rate (r = -0.29, P = 0.03). It is concluded that in children with diabetes mellitus the participation of BP in myocardial hypertrophy is not so obvious, although the BP load is increased. The increase of the LVMI occurs early in life and before the onset of hypertension.
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PMID:Myocardial trophic effects of blood pressure in children with insulin-dependent diabetes mellitus. 852 78

We studied 24-h ambulatory blood pressure (SBP, DBP), actual glycemic control assessed from seven blood glucose measurements, 16-h daytime and 8-h nighttime urinary excretion of albumin (UAE) and retinol-binding protein (URBP) in 20 normoalbuminuric (group A, nighttime UAE < 20 micrograms/min) and 20 microalbuminuric and low-proteinuric type I diabetic patients (group B, nighttime UAE 20-500 micrograms/min) matched for age and diabetes duration. Glycemic control was similar in the two groups. Daytime and nighttime SBP and DBP were higher in group B compared to group A (p < 0.01). Nighttime decrease in SBP and DBP correlated with nighttime decrease in UAE in group B (p < 0.05, p < 0.001), but not in group A. There was no correlation between BP and actual glycemic control in either group. We found higher daytime and nighttime URBP in group B compared to group A (p < 0.05). We conclude that, in microalbuminuric and low-proteinuric patients, daytime and nighttime BP was elevated but still in the normal or borderline range, and nighttime decrease in BP correlated with nighttime decrease in UAE but not with actual glycemic control. Increased URBP in these patients suggests slightly impaired proximal tubular function in early stages of diabetic nephropathy.
J Diabetes Complications
PMID:24-h ambulatory blood pressure, daytime and nighttime urinary albumin and retinol-binding protein excretion in type I diabetic patients. 857 35

We analysed the association of body mass index (BMI) with blood pressure (BP) at baseline, whether BMI predicts the incidence of anti-hypertensive drug treatment during a 12-year follow-up and whether this risk is independent of the original BP level and, finally, how diabetes associates with the incidence of anti-hypertensive drug treatment. The study population comprised 15,438 men and women in eastern Finland aged between 30 and 59 years who were not using anti-hypertensive drug treatment during baseline surveys in 1972 and 1977. At baseline BP increased linearly by increasing BMI. The proportion of hypertensive subjects, defined as either DBP > or = 95 mm Hg or SBP > or = 160 mm Hg, was 18% among the leanest men, BMI < 20 kg/m2, but 61% among the most obese, BMI > or = 30 kg/m2. Among women these proportions were 11% and 54%, respectively. Among the normotensive subjects at baseline, the BMI associated risk ratio of the incidence of anti-hypertensive drug treatment, adjusted for age and study year, was 1.14 (per kg/m2; P < 0.001) in men and 1.11 (P < 0.001) in women. After a further adjustment for DBP and SBP at baseline, risk ratios were 1.13 (P < 0.001) and 1.07 (P < 0.001), respectively. Diabetes associated with the risk of anti-hypertensive drug treatment independently from BMI, DBP and SBP. Because BMI correlates with BP cross-sectionally, and it also predicts the future increase in BP independently from the baseline BP, excess weight is undoubtedly one of the most important risk factors for hypertension. Weight control is the most natural primary intervention method in the inter-relation of obesity, hypertension and diabetes and in the prevention of subsequent cardiovascular diseases.
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PMID:Body mass index, blood pressure, diabetes and the risk of anti-hypertensive drug treatment: 12-year follow-up of middle-aged people in eastern Finland. 857 2

We studied 24-h ambulatory systolic and diastolic blood pressure (SBP, DBP), 16-h daytime and 8-h nighttime urinary excretion of albumin (UAE) and retinol-binding protein (URBP) in 20 type 1 diabetic patients (group 1) with normoalbuminuria (UAE < 20 micrograms/min) and 20 type 1 diabetic patients (group 2) with microalbuminuria and low proteinuria (UAE 20-500 micrograms/min). The groups were comparable in age, diabetes duration and actual glycaemic control. Daytime and nighttime SBP and DBP were higher in group 2 compared to group 1 (p < 0.01). Nighttime decrease in SBP and DBP correlated with nighttime decrease in UAE in group 2 (p < 0.05, p < 0.001). There was no correlation between BP and actual glycemic control in either group. Daytime UAE was found in group 2 by 20% higher than nighttime UAE. We found higher daytime and nighttime URBP in group 2 compared to group 1 (p < 0.05). We conclude, that microalbuminuric and low-proteinuric patients had elevated BP and nighttime decrease in BP correlated with nighttime decrease in UAE but not with actual glycemic control. Increased URBP in these patients suggests impaired proximal renal tubular function in early stages of diabetic nephropathy.
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PMID:[Diurnal changes in blood pressure, albuminuria and urinary excretion of retinol-binding protein in type I diabetics]. 862 57

We are actively seeking methods to prevent and to limit the progression of angiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM). In the present study, we conducted a clinical and epidemiological survey to clarify the clinical factors responsible for the development and progression of diabetic microangiopathy (MI) and macroangiopathy (MA). A total of 107 patients (58 female and 49 male) were randomly selected from 145 NIDDM patients. Twenty-four patient variables were selected for analysis. We identified PWV, UAI, RETINOP, MCV-T, SCV-S, MCV-P, SBP, and DBP as responsible factors and carried out stepwise multiple regression analyses. The following explanatory variables were found to be significant: age > SCV-S (P < 0.0001) for the criterion variable PWV, BUN > HbA1c > MCV-P > HT-drug > HDL-C (P < 0.0001) for log(e) UAI, DM-thera > SBP (P < 0.0001) for RETINOP, MCV-P (P < 0.0001) for MCV-T, IRI > SBP > MCV-P > S-CR (P < 0.0002) for SCV-S, MCV-T > SCV-S > DM-thera (P < 0.0001) for MCV-P, DBP > HT-drug > BUN > MCV-P (P < 0.0001) for SBP, and SBP > PWV > sex (P < 0.0001) for DBP. In summary, responsible factors for MI and MA in NIDDM had metabolic and blood pressure factors in common. Moreover, MI was a responsible factor for MA, which becomes a responsible factor for MI because it is a responsible factor for blood pressure factors. Thus, all the responsible factors for MA represented by MI and PWV had metabolic and blood pressure factors in common. The results of this study suggest that metabolic and blood pressure factors must be controlled to prevent and to limit the progression of diabetic MI and MA in NIDDM patients.
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PMID:Significance of metabolic and blood pressure factors in relation to microangiopathy and macroangiopathy in patients with non-insulin-dependent diabetes mellitus. 867 6

The objective of the present study was to assess the relationship between microalbuminuria (Malb) and left ventricular hypertrophy (LVH), when levels of ambulatory BP was token in to account as a confounder factor. Patients with essential hypertension, aged 25 to 50 years old, never treated with antihypertensive drugs, were included in the study. The inclusion criteria were: (a) absence of diabetes, renal disease or urinary tract infection; (b) urinary albumin excretion (UAE) estimated in urine of 24 hours in two separate days; (c) echocardiography suitable for measurement of left ventricular mass (LVM); and (d) good quality ambulatory blood pressure monitoring during 24 hours. UAE was measured using a immunonephelometric assay (Behring Institute) and Malb was considered when UAE 30 to 300 mg/24 hours during the two days. LVM was calculated by the Devereaux formula and referred to height (LVMI g/m). AMBP was performed using an oscilometric device (Spacelabs 90202 or 90207) during a regular working day. Readings were programmed every 20 minutes between 6 a.m. to midnight and thereafter every 30 minutes. The average BP during a 24 hour period was calculated. One hundred and fifty one patients (96 male, mean age 37 +/- 8 years, body mass index 27.7 +/- 3.7 g/m2) were included. The average values of office BP was 148 +/- 15/96 +/- 8 mm Hg, and the average BP during 24 hours was 137 +/- 13/88 +/- 12 mm Hg. UAE was 30.1 +/- 52.3 mg/24 hr and the LVMI 140.6 +/- 44.1 g/m. The percentage of Malb patients was 28% and those with LVH 34%. A significant relationship between UAE and office and ambulatory SBP and DBP was observed. LVMI was also significantly related to ambulatory SBP and DBP, a relationship that was not found for office BP. In a multiple regression model, significant relationship between UAE and LVMI emerged, independent of diastolic ambulatory BP, age and sex (P < 0.04). In conclusion; we observed a significant relationship between UAE and LVMI, in part, independent of blood pressure. The fact that Malb is associated with the presence of LVH, supports the idea that Malb is a risk marker in essential hypertensive patients.
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PMID:Microalbuminuria, left ventricular mass and ambulatory blood pressure in essential hypertension. 874 18

In patients with essential hypertension, correlations have been reported between the albumin excretion rate (AER) and ambulatory and casual blood pressure. Microalbuminuria has been indicated as a possible predictor of cardiovascular morbidity and mortality. The objective of this trial was to evaluate the effect of quinapril, an angiotensin converting enzyme inhibitor with high tissue affinity for the enzyme, on the AER in patients with mild to moderate essential hypertension and no evidence of diabetes mellitus. In this 12 week, 24 center study, quinapril was administered to 213 patients and titrated to 10, 20, or 40 mg/day alone or 20 mg/day plus 12.5 mg/day hydrochlorothiazide. Overall, blood pressure was reduced from 155.2 +/- 18.1/101.8 +/- 6.7 mm HG (mean +/- SD) to 144.4 +/- 17.8/92.3 +/- 8.9 mm HG (P = .0001) and AER decreased from 20.6 +/- 24.3 mg/24 h to 14.5 +/- 15.4 mg/24 h (P = .0001). The BP reductions were significant in all age groups. AER at endpoint was reduced 37.5% in elderly, 29.8% in middle-aged, and 11.8% in young patients from 32.5 +/- 45.0 mg/24 h, 19.1 +/- 20.9 mg/24 h, and 16.1 +/- 16.9 mg/24 h, respectively. The AER decreased in 60% of patients who had normal AER (0 to 30 mg/24 h), in 79% of those who had microalbuminuria (30 to 300 mg/24 h), and in 90% of those who had proteinuria (> 300 mg/24 h) at baseline. Baseline log-AER correlated with SBP (P = .0126, R = 0.19) and creatinine clearance (P = .026, R = 0.17), while endpoint log-AER correlated with SBP (P = .0015, R = 0.25) and DBP (P = .03, R = 0.17). In summary, we showed, in a large group of patients with mild to moderate essential hypertension and no evidence of diabetes mellitus, that quinapril not only lowers BP significantly but also reduces microalbuminuria.
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PMID:Effect of quinapril on the albumin excretion rate in patients with mild to moderate essential hypertension. Multicenter Study Group. 878 79


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