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

Hypertension in the elderly features differently from its younger counterpart in terms of diagnosis, associated condition, atypical manifestation, management and complication. Epidemiological study in this increasing age group in the community is, therefore, needed. 334 elderly subjects living in various parts of Bangkok were randomly recruited by appointment at 7 geriatric day centers situated in local health offices of Bangkok Metropolitan Authority. Each subject received blood tests before being interviewed and measured by digital sphygmomanometer. Blood pressure and heart rate changes were recorded during lying, sitting and standing. The prevalence of hypertension was 36.5 per cent, 33.2 per cent were already aware of its existence while 3.3 per cent were newly detected by the survey. Isolated systolic hypertension, a unique subtype found in the elderly, was 4.5 per cent of all or 37.5 per cent among the hypertensive group. The associated medical conditions among the case group were diabetes mellitus 22.9 per cent, hyperlipidemia 13.9 per cent, hyperuricemia 33.3 per cent and heart disease 18.0 per cent. As far as postural hypotension is concerned, 14.8 per cent of case group whereas 11.3 per cent of the control group were affected. On the other hand, the symptom of postural dizziness was found to be 31.1 per cent and 55.2 per cent in the case and control group respectively. Following the statistical logistic regression analysis, the independent associated factors in the hypertension group were: history of hyperlipidemia, increased serum uric acid and poor heart rate response after standing. These findings, as parts of the multiple pathology and potential complications prevalent among this group, should be of concern by any physician looking after the elderly.
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PMID:Hypertension in the elderly: a community study. 962 17

In this retrospective study, the prevalence of chronic microangiopathic complications was determined in 474 Chinese patients with non-insulin dependent diabetes mellitus (NIDDM) who presented within 1 year of diagnosis to the diabetes clinic from January 1990 to December 1996. Mean age (+/- S.E.) was 53.6 (+/- 0.6) years. The overall prevalence of retinopathy was 21.9%. A significant increase was observed from 1990 to 1994 (P < 0.005), with the prevalence being 14.8, 13.0, 24.5, 32.3 and 35.4%, respectively, in consecutive years. A decreasing prevalence was seen from 1994 to 1996 (P < 0.001), being 8.2 and 7.4% in 1995 and 1996, respectively. A total of 95% of patients had nonproliferative retinopathy--proliferative retinopathy was found in 5% only. The overall prevalence of clinical nephropathy (proteinuria > 0.5 g/day) was 3.7%. Clinical neuropathy (increased vibration perception threshold) was found in 12.8% of patients. Patients with retinopathy and neuropathy were older (P < 0.0001 and P < 0.005, respectively) than those without the complications and systolic hypertension was more prevalent in patients with retinopathy (P < 0.05). In conclusion, a high prevalence of diabetic microangiopathic complications, especially of retinopathy, is present in newly diagnosed NIDDM patients in our population. It remains to be determined whether the changing prevalence of retinopathy at diagnosis bears any relationship to the increasing public awareness of diabetes and its complications in Hong Kong in recent years. Examination for chronic microangiopathic complications should be carried out in all newly diagnosed NIDDM patients.
Diabetes Res Clin Pract 1998 Mar
PMID:Changing prevalence of retinopathy in newly diagnosed non-insulin dependent diabetes mellitus patients in Hong Kong. 964 50

The prevalence of abnormally elevated albumin excretion rate (> 30 mg/24 h) is approximately 40% in insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients. Diabetes has become the leading cause of end-stage renal failure in the US, Japan and Europe. Approximately 90% of the direct and indirect cost of caring for diabetic patients are spent on the complications of diabetes. Identification of patients at high risk of developing diabetic nephropathy is possible by screening for microalbuminuria (30-300 mg/24 h). Elevated urinary albumin excretion rate indicates a substantially increased mortality risk in diabetic patients. Randomised controlled trials in normotensive IDDM and NIDDM patients with persistent microalbuminuria indicate that ACE inhibitors diminish urinary albumin excretion rate, postpone it and may even prevent progression to clinical overt nephropathy. These findings indicate that screening and intervention programs are likely to have life saving effects and lead to considerable economic savings. Systemic blood pressure elevation to a hypertensive level is an early and frequent phenomenon in diabetic nephropathy. Furthermore, nocturnal blood pressure elevation (non-dippers) occurs more frequently in patients with nephropathy. Systemic blood pressure elevation and to a lesser degree albuminuria accelerate the progression of diabetic nephropathy. Effective blood pressure reduction with non-ACE-inhibitors and/or ACE-inhibitors frequently in combination with diuretics: (a) reduces albuminuria; (b) delays the progression of nephropathy; (c) postpones renal insufficiency; and (d) improves survival in IDDM and NIDDM patients with diabetic nephropathy. A specific renal protective effect of ACE-inhibitors in diabetic nephropathy has been demonstrated in IDDM patients with moderately reduced kidney function (s-creatinine > 133 mumol/l) while the data conflict with NIDDM patients. Antihypertensive treatment for diabetic nephropathy simultaneously extends life and saves money. Finally, reduced risk of fatal and non-fatal cardiovascular events have been demonstrated when diabetic patients with isolated systolic hypertension are treated with blood pressure lowering agents. Absolute risk reduction with active treatment compared to placebo was twice as great for the diabetic versus non-diabetic patients (101/1000 versus 51/1000 randomised participants at the 5-year follow-up), reflecting the higher risk of diabetic patients. In conclusion, early detection and aggressive treatment of arterial hypertension with ACE-inhibitors, long acting calcium antagonist and low dose diuretics as first line drugs are highly warranted in diabetic patients with or without diabetic renal disease.
Diabetes Res Clin Pract 1998 Apr
PMID:Is antihypertensive treatment the same for NIDDM and IDDM patients? 964 59

One of the important recent advances in stroke prevention is the demonstration that warfarin can substantially reduce the risk for stroke in patients with atrial fibrillation (AF). On average, patients with AF have a stroke risk of 4.5% per year. Anticoagulation reduces this to around 1.5% per year, a 70% relative risk reduction. The presence of additional risk factors, such as a recent stroke or transient ischemic attack, hypertension (particularly systolic hypertension), congestive heart failure, or diabetes, greatly increases stroke risk. Patients with any of these risk factors have a stroke risk of 8% per year or more. In contrast, patients under age 75 with none of these risk factors have a low risk for stroke (around 1% per year) when treated with aspirin. This risk stratification may help in identifying which patients with AF benefit most from anticoagulation. Anticoagulation has also been shown to prevent stroke in patients with other cardioembolic sources, including acute anterior wall myocardial infarction (particularly with echocardiographic evidence of thrombus), prosthetic heart valves, and dilated cardiomyopathies.
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PMID:Anticoagulation for prevention of stroke. 974 27

During recent decades the importance of perceiving isolated systolic hypertension (ISH) in cardiovascular pathophysiology has been changed from a benign condition to the major cardiovascular risk factor. Aging is per se associated with the deterioration in arterial compliance through both structural and functional changes in large arteries which mainly involves the intima and media. The observed changes result in a decrease of the lumen-to-wall ratio, the overall lumen cross-sectional area and an increase of arterial stiffness which especially involve the aorta and other elastic arteries. In addition to the structural changes in vessel walls, aging is associated with certain functional changes such as an increase in sympathetic system activity probably due to the age-related decreased sensitivity of beta-receptors. While the function of arterial wall alpha-receptors remains intact, in elderly subjects a shift towards arterial vasoconstriction can be observed. In many of the published studies the definition of ISH was based on the criterion 160/95 mm Hg or 160/90 mm Hg while in recognition of the high risk associated with systolic blood pressure (SBP) the WHO/ISH guidelines and Report of the Sixth Joint National Committee on Hypertension indicated that ISH should be diagnosed with SBP as > or =140 mm Hg and diastolic BP (DBP) as <90 mm Hg. Thus the setting down of normal values of SBP will lead to an earlier diagnosis and treatment of ISH. Several prospective studies, such as the US Hypertension Detection and Follow-up Programme, confirmed this and the Multiple Risk Factor Intervention Trial demonstrated that for any given level of DBP, higher SBP was associated with an increase in cardiovascular risk. Moreover, data from the Framingham Study show that ISH was associated not only with increased mortality but also cardiovascular morbidity. Risk of non-fatal stroke and myocardial infarction was increased three and two-times respectively in the presence of ISH. Three major up-to-date studies that included patients with ISH have been published. In concordance to the previously published SHEP and MCR trials, the most recent, the Systolic Hypertension in the Elderly Trial (SYST-EUR), demonstrated that active treatment significantly reduces the risk of stroke and all fatal and non-fatal cardiac end-points, including sudden death. Of note, these benefits were demonstrated with new anti-hypertensive classes such as dihydropiridyne calcium channel blocker (nitrendipine) and the angiotensin-converting enzyme inhibitor (enalapril). The necessity to carefully balance the benefits and risks of anti-hypertensive therapy in the elderly indicates that patients with suspected ISH should undergo careful BP measurements on at least three different occasions before the diagnosis is established and an orthostatic reaction should be evaluated. If non-pharmacological procedures fail, drug therapy should be considered, especially in elderly patients with a SBP over 160 mm Hg, since their risk of complications is markedly higher. Pharmacological treatment should also be strongly considered in patients with a SBP between 140 and 160 mm Hg with such concomitant cardiovascular risk factors as diabetes, angina pectoris, and left ventricular hypertrophy. The drug regimen should be simple, starting with a low dose of a single drug that is titrated slowly. The selection of the first-line anti-hypertensive agent should be based on a careful assessment of pathophysiological and clinical parameters in each individual geriatric patient.
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PMID:Isolated systolic hypertension: pathophysiology, consequences and therapeutic benefits. 978 91

Hypertension is an important risk factor for cardiovascular disease (CVD) in patients with normal renal function. After reviewing over two decades of clinical trial data and an even longer history of epidemiologic data, multiple consensus panels worldwide have made recommendations for the aggressive treatment of hypertension using both lifestyle modification and drug therapy. These data and recommendations provide the basis of the recommendations for preventing CVD in patients with renal disease. Most patients should have elevated blood pressure (BP) lowered to less than 140 mm Hg systolic and less than 90 mm Hg diastolic. Earlier and more aggressive intervention is recommended in high-risk hypertensive patients with risk factors (especially diabetes mellitus) or evidence of target organ damage or clinical CVD. Lifestyle changes are indicated as either initial therapy or concomitant therapy in all hypertensive patients to lower BP and to normalize other CVD risk factors. There is general agreement that clinical outcome data from controlled clinical trials should guide the selection of antihypertensive agents. Currently, these data are only available for thiazide diuretics and beta-blockers for most hypertensive patients with normal renal function and for the dihydropyridine calcium channel blockers in older hypertensive patients with isolated systolic hypertension. However, data may support the use of other agents in hypertensives with selected comorbidity (eg, ACE inhibitors in heart failure, beta-blockers after myocardial infarction, and so forth). However, with only 25% of hypertensive patients controlled to less than 140/90 mm Hg, achieving blood pressure control remains the most important goal in managing hypertension in this population.
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PMID:Prevention of cardiovascular disease in hypertensive patients with normal renal function. 982 Apr 66

The Systolic Hypertension in Europe (Syst-Eur) study investigated whether antihypertensive treatment could decrease the risk of cardiovascular complications in elderly patients with isolated systolic hypertension. Patients > or = 60 years were randomly assigned to treatment with the dihydropyridine calcium antagonist nitrendipine (n = 2,398), with the addition of enalapril and hydrochlorothiazide if needed, or to matching placebo (n = 2,297). In the intent-to-treat analysis, the between-group difference in blood pressure was 10.1/4.5 mm Hg (p < 0.001). Active treatment decreased the total incidence of stroke (the primary endpoint) by 42% (p = 0.003), of all cardiac endpoints by 26% (p = 0.03), and of all cardiovascular endpoints combined by 31% (p < 0.001). Cardiovascular mortality was somewhat lower with active treatment (-27%, p = 0.07); all-cause mortality was not significantly different (-14%; p = 0.22). For total (p = 0.009) and cardiovascular (p = 0.09) mortality, the benefit of antihypertensive treatment weakened with advancing age and for total mortality it decreased with lower systolic blood pressure at entry (p = 0.05). The benefits of active treatment were not independently related to gender or to the presence of cardiovascular complications at entry. Antihypertensive therapy was at least as effective in patients with diabetes as in those without diabetes at entry. Further analyses suggested benefit in patients who were taking nitrendipine as monotherapy. Per-protocol analysis largely confirmed the intent-to-treat results. Active treatment decreased all strokes by 44% (p = 0.004), all cardiac endpoints by 26% (p = 0.05), and all cardiovascular endpoints by 32% (p < 0.001). Total mortality was decreased by 26% (p = 0.05), but the similar reduction in cardiovascular mortality did not reach significance in this analysis. It is concluded that stepwise antihypertensive drug treatment starting with nitrendipine improves prognosis in elderly patients with isolated systolic hypertension.
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PMID:Treatment of isolated systolic hypertension in the elderly: further evidence from the systolic hypertension in Europe (Syst-Eur) trial. 982 39

The results of 2 recently published studies have been interpreted as suggesting that calcium antagonists are unsafe for the management of hypertension in patients with diabetes. These 2 studies, the Fosinopril versus Amlodipine Cardiovascular Events Randomized Trial (FACET) and Appropriate Blood Pressure Control in Diabetes (ABCD), showed that angiotensin-converting enzyme (ACE) inhibitors may be preferable to calcium antagonists for managing hypertension in diabetic patients; they do not, however, show any harm attributable to calcium antagonists. Indeed, results of the FACET study suggest that the combination of an ACE inhibitor and a calcium antagonist is effective antihypertensive therapy. This suggestion is supported by findings in the Systolic Hypertension in Europe (Syst-Eur) Study, which revealed outstanding benefits of either a calcium antagonist alone or a calcium antagonist combined with an ACE inhibitor among diabetic patients with hypertension. The premature termination of the hypertensive arm of the ABCD study was puzzling because, although 2 of 13 subgroups of 1 of the 5 possible secondary endpoints in this part of the trial were apparently favorably affected by the use of the ACE inhibitor rather than the calcium antagonist, such a finding was compatible with chance alone. If the results of the FACET and ABCD studies are considered in the context of the best available data arising from large randomized controlled trials, one may conclude that calcium antagonists are not harmful or contraindicated in hypertensive patients with diabetes and that the combination of an ACE inhibitor and a calcium antagonist is effective for the management of hypertension in diabetic patients.
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PMID:Calcium antagonists and the diabetic patient: a response to recent controversies. 982 44

Hypertension is a major modifiable risk factor for cardiovascular diseases. After decades of improvement, population surveys demonstrate disturbing downward trends in the rates of awareness, treatment, and control of this disorder in recent years. Over this same time period, there has been a slight increase in the incidence of strokes, and a steady rise in the incidence of end-stage renal disease and the prevalence of congestive heart failure, conditions in which hypertension plays a prominent role. Results of recent studies support the possibility that lifestyle modifications may be effective for prevention of hypertension. Treatment of established hypertension involves lifestyle modifications and drug therapies designed to control blood pressure and reduce overall cardiovascular risk. Both threshold blood pressure levels for initiating drug therapy and goal blood pressure levels with treatment are individually determined based on the presence or absence of additional cardiovascular risk factors and hypertension target organ injury or clinical cardiovascular disease. Recent clinical trials support the value of lower goal blood pressures for patients with diabetes, heart failure, and renal disease. The presence or absence of comorbid conditions often determines specific drug choices. Diuretics and beta-blockers remain the drugs of choice in uncomplicated hypertension. Additional studies confirm the benefits of treating isolated systolic hypertension in the elderly. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provides a practical, evidence-based resource to help health care providers meet the public health challenges of preventing and controlling hypertension.
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PMID:A review of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 1019 76

From the follow-up examination of 1329 out of 4420 type 2 (non-insulin-dependent) diabetes followed for 17 years, the incidence of micro and macrovascular complications (proteinuria and nephropathy, symptoms of leg vascular disease, ischemic heart disease, and cerebrovascular events, was estimated and related to the levels of baseline-risk variables using logistic regression. For new cases of proteinuria and heavy proteinuria, hyperglycemia was the common predictor (alongside diastolic hypertension, smoking and overweight); hyperglycemia and glycosuria were among significant predictors of leg vascular disease (with duration of diabetes, smoking, male sex, diastolic hypertension, and proteinuria). On the other hand, systolic hypertension and male sex prevailed among factors predicting both ischemic heart disease (with high cholesterol and overweight), and stroke. The data confirm the higher involvement of diabetic milieu in micro than macrovascular incidents, with diabetic foot disease placed in between.
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PMID:[Risk factors of the incidence of late vascular complications of diabetes]. 1033 28


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