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)

The association between homocysteine and sustained hypertension (HT) has been studied. The aim of this study was to assess homocysteine levels in white coat hypertension (WCH) as an indicator of increased risk in the development of cardiovascular diseases. WCH was defined as clinical hypertension and a daytime ambulatory blood pressure of < 135/85 mmHg. Plasma levels of homocysteine were determined in patients with WCH, hypertension, and normotension (NT). The study group included 100 subjects, 33 with WCH (16 males, 17 females) aged 49.1 +/- 1.9; 35 sustained hypertensives (17 males,18 females) aged 48.5 +/- 1.7 and 32 normotensive control subjects (15 males, 17 females) aged 48.8 +/- 2.2. The subjects were matched for age, gender, and body mass index. Patients with a smoking habit, dyslipidemia, or diabetes mellitus were not included in the study. Homocysteine levels were analyzed by ELISA. Plasma homocysteine levels were significantly higher in the WCH group compared to the controls (12.32 +/- 1.07 versus 5.35 +/- 1.38 micromol/L; P < 0.001) and the WCH group had significantly lower homocysteine values than the hypertensives (19.03 +/- 0.76 micromol/L P < 0.001). Total cholesterol and tri-glycerides were not different among the groups. There were no statistically significant differences in urinary albumin excretion (UAE) or creatinine clearance between the three groups. Hypertensive retinopathy was observed in the WCH group, but was less severe and less frequent compared to HTs. LVMI was greater in the WCH group compared to the NTs, but significantly less than HTs. The data demonstrate that WCH is associated with high levels of homocysteine. The increase in homocysteine level in WCH is not as high as in SHT. Since an elevated plasma homocysteine level is a strong risk factor for coronary artery disease and there was target organ damage in our WCH group, we conclude that WCH should not be considered to be an innocent trait.
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PMID:Hyperhomocysteinemia: an additional risk factor in white coat hypertension. 1587 8

Hypertensive retinopathy refers to a spectrum of retinal microvascular signs that develop in response to elevated blood pressure. These signs are broadly divided into localized signs (focal retinal arteriolar narrowing, arteriovenous nicking, retinal haemorrhages, cotton wool spots, hard exudates and microaneurysms) and diffuse signs (generalized retinal arteriolar narrowing, arterial wall opacification and optic disc oedema). Although their association with systemic morbidity was recognized more than a century ago, the prognostic significance of hypertensive retinopathy has not received much attention. In large part, this is because clinical assessment of hypertensive retinopathy signs with the direct fundoscopy has proven imprecise. Data from large population-based studies in the past decade, using retinal photographic methods to define hypertensive retinopathy signs, have provided new insights into the epidemiology, systemic associations and clinical significance of hypertensive retinopathy. These studies show that hypertensive retinopathy signs are common (up to 14% of adults aged 40 years and older, even in those without clinical diabetes or hypertension) and are strongly associated with blood pressure. Various retinopathy signs predict the risk of stroke, congestive heart failure and cardiovascular mortality, independent of blood pressure and other risk factors. These data suggest that patients with hypertensive retinopathy signs may benefit from a careful cardiovascular evaluation, and appropriate risk reduction therapy if indicated. Future advances in digital retinal imaging technology will allow researchers and clinicians to better chart and monitor the vascular effects of hypertension.
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PMID:Fred Hollows lecture: hypertensive retinopathy - a journey from fundoscopy to digital imaging. 1687 33

Although assessment of hypertensive retinopathy signs has been recommended for determining end-organ damage and stratifying vascular risk in persons with hypertension, its value remains unclear. In this study, we examine whether hypertensive retinopathy predicts the long-term risk of stroke in those with hypertension. A total of 2907 participants with hypertension aged 50 to 73 years at the 1993 to 1995 examination, who had gradable retinal photographs, no history of diabetes mellitus, stroke, and coronary heart disease at baseline and data on incident stroke, were included from the Atherosclerosis Risk in Communities (ARIC) Study. Retinal photographs were assessed for hypertensive retinopathy signs and classified as none, mild, and moderate/severe. Incident events of any stroke, cerebral infarction, and hemorrhagic stroke were identified and validated. After a mean follow-up period of 13.0 years, 165 persons developed incident stroke (146 cerebral infarctions and 15 hemorrhagic strokes). After adjusting for age, sex, blood pressure, and other risk factors, persons with moderate hypertensive retinopathy were more likely to have stroke (moderate versus no retinopathy: multivariable hazard ratios, 2.37 [95% confidence interval, 1.39-4.02]). In participants with hypertension on medication with good control of blood pressure, hypertensive retinopathy was related to an increased risk of cerebral infarction (mild retinopathy: hazard ratio, 1.96 [95% confidence interval, 1.09-3.55]; and moderate retinopathy: hazard ratio, 2.98 [95% confidence interval, 1.01-8.83]). Hypertensive retinopathy predicts the long-term risk of stroke, independent of blood pressure, even in treated patients with hypertension with good hypertension control. Retinal photographic assessment of hypertensive retinopathy signs may be useful for assessment of stroke risk.
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PMID:Hypertensive retinopathy and risk of stroke. 2394 Jan 99

Systemic hypertension affects approximately 25 % of the population worldwide and is the most important preventable risk factor for cardiovascular diseases. Hypertension-related fundus abnormalities can be classified into hypertensive retinopathy, choroidopathy, and optic neuropathy. Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer. The use of a detailed grading system based on the severity of vascular constriction is not practicable as arteriosclerotic changes are common among elderly people. Therefore, early stages with pure vascular pathology should be differentiated from severe forms of hypertensive retinopathy with parenchymal changes of the fundus. Screening the retina for hypertensive changes is essential in cases of severe systemic hypertension, acute visual impairment, diabetes mellitus and pregnancy.
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PMID:[Hypertensive changes of the fundus]. 2412 78

Systemic hypertension is widely spread in the general population. It is recognised as a major risk factor for cardiovascular morbidity and mortality. Hypertensive retinopathy is the most common manifestation. Initial changes are retinal arteriolar vasoconstriction and findings such as flame or blot hemorrhages, cotton wool spots and hard exsudates resulting from localised retinal ischemia. Ocular complications of high blood pressure (HBP) are subconjunctival hemorrhages and retinal vein occlusions. Hypertensive retinopathy contributes to worsening of diabetic retinopathy. Less common but more threatening are ischemic optic neuropathy and retinal arterial occlusions. Screening is recommended in case of severe systemic hypertension, diabetes, or any complain of recent visual disturbances.
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PMID:[Hypertension and the eye]. 2685 52