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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 3-centre study was done to analyse the results of 70 patients with end-stage renal disease caused by diabetic nephropathy and treated with CAPD. Fifty patients had insulin-dependent diabetes (mean age 42, mean duration of diabetes 24 yr); 20 had non-insulin-dependent diabetes (mean age 61, mean duration 15 yr). Total treatment time was 1563 months and ranged from one to 83 months (median 18). Patient survival was 86% at 1 yr and 33% at 4 yr. Technique survival was 87% and 63%. Cox's multiple hazard regression analysis showed that age above 45 yr (relative risk 2.2), systolic hypertension (2.6) and cardiac disease (2.2) at the start of CAPD were associated with shorter patient survival. Metabolic control was good. Haemoglobin rose during the first 3 months. Plasma creatinine concentration increased with time, probably due to the loss of residual renal function. HbA1c levels were in the normal range for 60% of the patients. Mean hospital stay was 42 days per year, 26 as a consequence of vascular complications and 16 due to peritonitis and catheter-related problems. We conclude that CAPD is a good renal replacement modality for patients with diabetic renal failure. The patient survival is dependent on age, systolic hypertension and cardiac disease at the start of CAPD.
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PMID:Continuous ambulatory peritoneal dialysis (CAPD) in patients with diabetic nephropathy. 192 96

Clinical, electrocardiographic and echocardiographic findings of 69 subjects aged 80 years or over were analyzed in order to assess the prevalence of left ventricular mass, hyperlipidemia, hypertension and cigarette smoking. Of the 69 subjects studied, 41 had no symptoms or sign of cardiovascular disease, 28 had one or more cardiac symptoms (NYHA stage 2-4). 25 had electrocardiographic evidence of left ventricular hypertrophy and there were no differences between the asymptomatic and symptomatic groups. Echocardiographically, the left ventricular mass index ranged between 103 to 247 g/m2 in men and 170 to 251 g/m2 in women. In 36 subjects with high left ventricular mass index, the ventricular septal thicknesses ranged from 12 mm to 15 mm in 19 subjects, and posterior wall thicknesses ranged from 12 mm to 16 mm in 17 subjects. Of the 58 patients with an adequate echocardiogram, 47 had clinically diagnosed hypertension (81%). In our study population, a prevalence of left ventricular hypertrophy (62%), isolated systolic hypertension (26%), definite hypertension (33.3%), high LDL-cholesterol (63%), low HDL-cholesterol (26%), abnormal Q wave (16%), cigarette smoking (47.8%) and diabetes mellitus (1.4%) were found.
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PMID:Left ventricular mass index and prevalence of heart disease in the population aged 80 years and over. 214 63

To quantify the association of abnormal glucose tolerance with hypertension and postural hypotension, 2480 men and women aged 50-89 yr from a defined population were evaluated by oral glucose tolerance and measurements of supine, seated, and standing blood pressure. In both sexes, adults with impaired glucose tolerance or non-insulin-dependent diabetes mellitus (NIDDM) had increased mean blood pressure compared with those with normal glucose tolerance. These differences were both statistically (P less than 0.05) and clinically (3-12 mmHg) significant and were independent of age, obesity, and the use of antihypertensive medication. Age-adjusted rates of systolic hypertension and isolated systolic hypertension were also higher in subjects with impaired glucose tolerance or NIDDM compared with those with normal glucose tolerance. Diastolic blood pressures and rates of diastolic hypertension were minimally higher in adults with impaired glucose tolerance and NIDDM. In both sexes, systolic blood pressure correlated significantly with fasting plasma glucose and 2-h postchallenge plasma glucose even after adjustment for age and obesity. Postural hypotension occurred in 7% of all subjects and did not vary significantly according to glucose tolerance.
Diabetes Care 1990 Feb
PMID:Abnormal glucose tolerance and hypertension. 235 Oct 10

This study was initiated to assess the efficacy and safety of celiprolol in a large number of hypertensive patients. Patients received a once-daily dose of 200 mg celiprolol for the first 3 weeks. If blood pressure was not lowered satisfactorily, the investigator was asked to raise the dose to 300 mg celiprolol or add a diuretic for the next 3 weeks. The study included 2,694 patients, 2,311 of whom were evaluable over a period of 3 weeks, 1,876 over 6 weeks. On admission 10% had isolated systolic hypertension, 38% mild diastolic hypertension, 35% moderate diastolic hypertension, and 17% severe diastolic hypertension. Concomitant diseases were diabetes mellitus, chronic obstructive airway disease, and peripheral arterial disease. BP was lowered in patients with hypertension of all degrees of severity. There was no obvious relation between efficacy and age or with duration of disease. Only 229 patients received 300 mg celiprolol; 223 patients additionally received a diuretic. Heart rate decreased by a mean of 8 beats/min and was lowered mostly in patients with tachycardia. In no case did heart rate fall below 50. Side effects were rare and in most cases not serious. Treatment was discontinued owing to suspected adverse effects in 58 patients (2.15%). In conclusion, celiprolol administered for up to 6 weeks appeared to be safe in the management of hypertension.
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PMID:Results of the Austrian celiprolol postmarketing surveillance study. 242 58

Hypertension is more common in persons with both insulin-dependent and noninsulin-dependent diabetes. Pathophysiologic mechanisms that result in an increased prevalence of essential hypertension in noninsulin-dependent diabetes, premature diastolic hypertension in insulin-dependent diabetes, and systolic hypertension in both forms of diabetes are described. Aggressive treatment of the hypertension associated with diabetic nephropathy will result in a deceleration of renal decompensation. The commonly used antihypertensives that successfully treat hypertension in the non-diabetic population often have unacceptable side effects in the diabetic population. Rational approaches to the treatment of diabetic hypertension in general and in circumstances unique to the hypertensive diabetic individual are described.
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PMID:Hypertension in the person with diabetes. 265 May 43

Diabetes may be associated with systolic hypertension secondary to atherosclerosis, renal hypertension secondary to diabetic nephropathy, and essential hypertension. The latter is by far the most prevalent, and a wealth of epidemiologic data suggests that such an association is independent of age and obesity. Considerable evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive subjects, whether obese or of normal body weight, are compared to age- and weight-matched normotensive controls, a heightened plasma insulin response to a glucose challenge is found consistently. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the use of the glucose clamp technique coupled with tracer glucose infusion and indirect calorimetry, it can be shown that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal, and is directly correlated with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms--sodium retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and altered muscle fiber composition. Physiologic maneuvers such as caloric restriction in the overweight individual and regular physical exercise can improve tissue sensitivity to insulin; good preliminary evidence shows that these measures can also lower blood pressure in both normotensive and hypertensive individuals. A strong case can therefore be made for the use of physiologic intervention in the treatment of essential hypertension.
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PMID:The association of essential hypertension and diabetes. 268 84

Diabetes and hypertension are independent risk factors of coronary heart disease as well as of other cardiovascular diseases, and their combination substantially enhances the risk. Hypertension is twice to four times as frequent in diabetics than in the non-diabetic population. The most frequent form is essential hypertension which affects the relatively most numerous group of the II diabetics but may occur also in type I diabetics. Insulin dependent diabetics suffer more frequently from "renal diabetic hypertension" and tend to develop hyporeninaemic hypoaldosteronism. Other types of hypertension found in diabetics are systolic hypertension and hypertension with orthostatic hypotension. In an effort to improve the adverse prognosis of diabetics with hypertension it is essential to pay systematic attention to early detection of high blood pressure, its differential diagnosis and treatment, and to detect, and if possible eliminate, other risk factors of cardiovascular diseases.
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PMID:[Special problems in diabetics with hypertension]. 280 Mar 85

High blood pressure is unquestionably a risk factor for premature morbidity and mortality, especially from coronary artery disease and stroke. Risk of clinical manifestations of coronary artery disease increases dramatically if other risk factors, such as a history of cigarette smoking, hypercholesterolemia, left ventricular hypertrophy, and diabetes, are present in addition to hypertension. Therefore, management must include measures to control these risk factors as well as reduce blood pressure. In patients with hypercholesterolemia or diabetes, some antihypertensive drugs must be used with extreme caution or avoided altogether because of possible side effects. Although systolic pressure is an important prognostic factor, there is currently no evidence that treatment of isolated systolic hypertension is beneficial.
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PMID:How to manage other risk factors in patients with hypertension. 281 10

This multicenter study was initiated to assess the efficacy and safety of celiprolol in a large number of hypertensive patients. Patients received a once daily dose of 200 mg celiprolol for the first 3 weeks. If blood pressure was not lowered satisfactorily after this period, the investigator was asked to rise the dose to 300 mg celiprolol or to add a diuretic for the next 3 weeks. The study included 2694 patients, 2311 of whom were evaluable over a period of 3 weeks, 2077 over 6 weeks. On admission 10% showed isolated systolic hypertension, 38% were in WHO I, 35% in WHO II and 17% in WHO III. Hypertension was known for more than 1 year in 57%, for even more than 5 years in 28%. Concomitant diseases were diabetes mellitus, chronic obstructive airways disease, peripheral arteries disease; digitalis comedication in 211 patients. BP was lowered significantly in all degrees of severity of hypertension. There was no obvious connection between efficacy and age nor with duration of disease. Only 229 patients received 300 mg celiprolol during the second period of treatment, 223 patients got additionally a diuretic. Heart rate decreased by a mean of 8 bpm and was lowered mostly in patients with tachycardia. Patients with a heart rate of 60 bpm or below showed a slight increase in heart rate. In no case heart rate fell below 50. Side effects were rare and in most cases not serious. Treatment was discontinued due to suspected side effects in 58 patients only (2.15%). We conclude, that celiprolol is a safe and efficacious drug in the management of hypertension.
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PMID:[Results of the selectol field study in Austria]. 293 60

In a District General Hospital Diabetic Clinic 40.0% of a random sample of diabetics under the age of 65 years of age were hypertensive. Black patients (48.9%) had greater (p less than 0.05) prevalence of hypertension than Whites (37.5%) and Asians (35.4%). Hypertension was more prevalent in females (49.1%) than males (33.0%) (p less than 0.001) in each ethnic group except Asians, and patients not receiving insulin had greater prevalence (45.6%) than those on insulin (30.7%) (p less than 0.001), except black diabetics where the reverse was found. There was a positive relationship between age and systolic (p less than 0.00001) and diastolic blood pressure (p less than 0.00001) and a negative association between duration of diabetes and diastolic blood pressure (p less than 0.004) on multiple regression analysis but no relationship was noted between blood pressure and either weight or blood glucose. Forty-six percent of all hypertensives were receiving conventional anti-hypertensive drug therapy; 38.7% were normotensive with similar results in each ethnic group and between the sexes. Isolated systolic hypertension was the commonest form of hypertension (48.3%) with isolated diastolic hypertension (4.9%) the rarest. These findings were observed regardless of the ethnic group or gender. Although in the majority of cases hypertension was mild these data confirm the importance of routine blood pressure measurement in diabetic patients.
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PMID:Prevalence of hypertension in white, black and Asian diabetics in a district hospital diabetic clinic. 295 97


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