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

The aim of this study was to determine the prevalence and profile of renal artery stenosis (RAS) in NIDDM population with severe hypertension. 60 consecutive NIDDM with severe HT (> or = 3 hypotensive drugs), 42 F/18 M (SR: 2.8), mean age: 66.6 +/- 6.5 years, diabetes duration: 14.1 +/- 6 years have had metabolic, ABPM and renal investigations: color duplex scan (CDS) (with renal us): n = 60, and/or arteriography: n = 17). 13 (21.5%) renal artery stenosis > or = 70%: 8 unilateral/5 bilateral were proved by arteriography. We compared classic HT (n = 47) versus renovascular HT (n = 13). There was no difference for age (years): 64.8 +/- 8 versus 70.6 +/- 6.4, HT duration (years): 11.6 +/- 6.8 versus 12.3 +/- 6. B.M.I.: 31.5 +/- 6 versus 27.6 +/- 3.3, HBA1C (%): 8.9 +/- 2.2 versus 8.8 +/- 0.9, cholesterol (mmol/L): 5.7 +/- 1.3 versus 5.5 +/- 0.6. Significant difference (p < 0.05) was noticed for S.R. (F/M): 2.9 versus 1.16, diabetes duration (years): 11.7 +/- 5 versus 16.5 +/- 8, frequency of retinopathy (%): 30 versus 61, smoking (%): 10 versus 40, triglycerides (mmol/L): 1.9 +/- 1.1 versus 2.6 +/- 1.1, and (p < 0.01) for blood pressure level (mmHg) (SBP: 142 +/- 20 vs 155 +/- 7, DBP: 81 +/- 13 vs 87 +/- 10, MBP: 103 +/- 16 vs 111 +/- 6), frequency (%) of HT escape (> or = 140/SBP, > or = 90/DBP) on ABPM: 40 versus 75 and 24 versus 40, insulin requirence (%): 36 versus 69, macroangiopathy (%): 51 versus 100 (coronaropathy: 34 vs 61, legs arteritis: 21 vs 69, carotid stenosis: 17 vs 30) and for renal function: frequency (%) of micro-macroalbuminuria: 36 versus 92 creatinaemia (mmol/L): 80 +/- 24 versus 124 +/- 44, creatinaemia clearance (mmL/min): 65 +/- 30 versus 40 +/- 12 while are found 5 renal insufficiencies (> or = 120 mmol/L). In NIDDM population with severe HT, renovascular HT is frequent (21.5%), and RAS must be evocated in unstable HT and/or renal injury with macro angiopathy, old NIDDM (> 15 years), requiring insulin. Colour duplex scan (+ renal US) mays lead to arteriography to confirm renal artery stenosis.
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PMID:[Prevalence and profile of renovascular disease in type II diabetic patients with severe hypertension]. 940 9

In Caucasian subjects, an insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with coronary artery disease (CAD) and fatal myocardial infarction. The underlying mechanism(s) of this association is not fully understood. Pima Indians have a low incidence of nonfatal and fatal CAD despite a high prevalence of diabetes. In Pima Indians, circulating ACE levels are related to ACE genotype, but the frequency of the D allele is significantly lower than in Caucasians. A lower frequency of the D allele may underlie a low risk of CAD in this population. We examined the relationship of the ACE genotype and plasma ACE level with electrocardiographic evidence of CAD (Tecumseh criteria), hypertension, and metabolic variables associated with insulin resistance in 305 (146 men and 159 women aged 47+/-9.0 years) Pima Indians characterized for the ACE I/D genotype. The distribution of ACE genotypes was unrelated to diabetes and obesity. Fasting plasma insulin, plasminogen activator inhibitor-1 (PAI-1) activity, plasma triglyceride concentrations, and systolic (SBP) and diastolic (DBP) blood pressure were not significantly different between the three ACE genotypes among nondiabetic and diabetic subjects. There was no significant association of ACE genotype with electrocardiographic evidence of CAD or with hypertension. Plasma ACE concentrations were not significantly different between nondiabetic and diabetic subjects (median, 77 [range, 21 to 1691 v 83 [7 to 238] IU/mL, P=NS). In all subjects, plasma ACE levels were associated weakly with plasma triglyceride (partial r=.20, P < .01) and total cholesterol (partial r=.13, P <.03) concentrations, but not with fasting plasma insulin or PAI-1 activity. In diabetic subjects, ACE levels were related to fasting plasma glucose concentrations (partial r=.15, P=.07). These findings would suggest that ACE gene I/D polymorphism is unlikely to be a major determinant of susceptibility to CAD in Pima Indians. Plasma ACE levels, but not ACE genotype, correlated with lipids, plasma glucose, and blood pressure, suggesting that elevated plasma ACE levels may contribute to the link between insulin resistance and CAD disease or may be a consequence of it.
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PMID:Angiotensin-1-converting enzyme (ACE) gene polymorphism, plasma ACE levels, and their association with the metabolic syndrome and electrocardiographic coronary artery disease in Pima Indians. 959 57

Overall obesity and central fat distribution are frequently accompanied by hyperglycemia, hypertension (HTN) and coronary heart disease (CHD) observed in developed nations and in South Asian migrants. This study attempts to estimate the prevalence of CHD and HTN and to assess the related risks among the newly diagnosed diabetics in the developing communities. From a total of 3583 non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) subjects, the authors investigated 693 (M = 295, F = 398) randomly selected non-smokers of age 30-60 years. WHO diagnostic criteria were used for NIDDM and IGT. Systolic and diastolic hypertension (sHTN and dHTN) were defined as systolic blood pressure (SBP) > or = 140 and diastolic (DBP) > or = 90 mmHg. Diagnosis of CHD was based on electrocardiogram either on rest or on stress or both when equivocal. The overall prevalence of CHD in the NIDDM subjects was 18.6%. The prevalence rates of sHTN and dHTN were 23.2 and 13.6%, respectively. CHD and HTN did not differ significantly between male and female and between urban and rural subjects. CHD prevalence was significantly higher in the higher tertiles of age, SBP and DBP (P < 0.001, for all cases). Logistic regression showed that only the increasing age, high waist-to-hip ratio (WHR) and high BP were the independent risks for CHD. For sHTN, the independent risks were increased age and high body mass index (BMI) (kg/m2). Regardless of sex and area, increased prevalence of CHD and HTN were found in the newly diagnosed diabetic subjects. Increased age, central obesity and HTN were the independent risks for CHD while advancing age and overall obesity was related to sHTN.
Diabetes Res Clin Pract 1998 Feb
PMID:Blood pressure and coronary heart disease in NIDDM subjects at diagnosis: prevalence and risks in a Bangladeshi population. 959 85

We retrospectively investigated the incidence and prognosis of and risk factors for cerebrovascular events in 1,064 patients with chronic uremia who received maintenance hemodialysis (HD) for more than 3 months during 24 years in our dialysis units in Miyazaki, Japan. Cerebrovascular events developed in 98 patients (9.2%). The confirmed incidences of cerebral hemorrhage (CH) and infarction were 8.7 and 3.7 per 1,000 patient-years, respectively. Of the 56 patients with CH, 40 (71.4%) died within 3 months of the onset of CH. Ganglio-thalamic lesion was observed in 32 (80.0%) of 40 patients with CH confirmed by a brain computed tomography. The incidence of polycystic kidney disease was higher in the CH group than in the overall HD population (12.5% v 3.9%, P < 0.01). Of the 13 patients with diabetes mellitus and nephrosclerosis, nine (69.2%) developed CH within 36 months of the initiation of HD; 11 (78.6%) of 14 patients with chronic glomerulonephritis developed CH after 36 months. CH developed in six patients (15.0%) within 6 hours of a previous HD session. We compared laboratory values, the supine blood pressure, and electrocardiographic (ECG) findings in 35 patients with CH and a control group (66 patients) matched in age, sex, basal renal disease, age at the initiation of HD, and the duration of HD. Data were obtained before and after HD 3 to 4 months before the first attack of CH. The systolic and diastolic blood pressure (SBP, DBP) before and after HD were significantly higher in the CH group than in the control group (pre-HD SBP: 171 +/- 22.5 v 154 +/- 19.3 mm Hg, P < 0.001; pre-HD DBP: 89 +/- 13.6 v 81 +/- 9.6 mm Hg, P < 0.001). The incidence of left ventricular hypertrophy was higher, and the Kt/V was significantly lower (1.23 +/- 0.26 v 1.38 +/- 0.34, P < 0.05) in the CH group than in the control group. However, there were no significant differences in the serum levels of albumin and cholesterol or the total dose of heparin during HD sessions between groups. In conclusion, the incidence of CH was high, and its prognosis was poor, in patients undergoing maintenance HD. Reversible risk factors include hypertension and possibly the amount of HD prescribed, but not anticoagulation with heparin.
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PMID:Incidence, outcome, and risk factors of cerebrovascular events in patients undergoing maintenance hemodialysis. 963 44

It is widely accepted that abdominal obesity presents with exaggerated insulin secretion, insulin resistance and a trend toward glucose intolerance. Hypertension is frequently associated to abdominal obesity, and hyperinsulinism could play a role in its pathogenesis. Some studies reported that Ca-antagonists positively influence insulin sensitivity and glucose tolerance in obese patients with normal or elevated blood pressure. However, other studies reported worsening of metabolic balance during treatment with Ca-antagonists in hypertensive non-insulin-dependent diabetes mellitus (NIDDM) patients and in normal subjects. We studied 19 patients with abdominal obesity, mild hypertension and insulin resistance on balanced, mild hypocaloric diet (1400 Kcal), to verify the effects of the Ca-antagonist nifedipine on both basal and oral glucose tolerance test (OGTT)-induced glucose and insulin levels as well as on IGF-I basal and DHEA-S levels and fat mass (FM). To achieve this goal, 10 hypertensive obese subjects (HOB-NIFE, 3 males, 7 females, mean age +/- SD 44.6 +/- 1.7 yr; body mass index (BMI) 37.1 +/- 2.5 Kg/m2, WHR 0.95 +/- 0.02) received 3-month treatment with nifedipine (Adalat Crono 30 Bayer, 1 tab daily) while other 9 hypertensive obese (HOB, 3 males, 6 females, 42 +/- 2.4 yr, BMI 35.8 +/- 1.8 Kg/m2, WHR 0.91 +/- 0.03) were studied during diet only. The same parameters were studied also in 8 normotensive obese patients (OB: 3 males, 5 females, 48.1 +/- 2.1 yr, BMI 35.8 +/- 2.4 Kg/m2, WHR 0.90 +/- 0.03) on the same balanced hypocaloric diet. Basal systolic (SBP) and diastolic (DBP) blood pressure levels in HOB-NIFE and HOB were similar. At baseline, all groups had similar basal and OGTT-induced glucose, insulin and glucose insulin ratio (GIR) levels as well as IGF-I and DHEA-S levels. After 3 months BMI fell to the same extent in all groups (p < 0.05 vs baseline) while WHR and FFM/FM ratio did not change. SBP and DBP decreased HOB-NIFE (p < 0.02) but also during diet alone in both HOB and OB, though to a lesser extent (p < 0.05). Both basal and OGTT-stimulated glucose and insulin levels as well as IGF-I and DHEA-S levels were not modified in HOB-NIFE as well as in HOB and OB. In conclusion, our data indicate that nifedipine treatment does not modify glucose tolerance as well as insulin secretion and sensitivity, IGF-I and DHEA-S levels in hypertensive abdominal obese patients. Thus, nifedipine treatment has no detrimental effects on endocrine-metabolic balance in hypertensive obese patients.
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PMID:Effects of 3-month nifedipine treatment on endocrine-metabolic parameters in patients with abdominal obesity and mild hypertension. 963 24

The NIDDM patient, willingly with high blood pressure and atheroma, has frequently an abnormal renal function. Must a renal artery stenosis (RAS) be searched as a determining or favorising cause? We have searched RAS by color duplex scan, in 60 consecutive NIDDM patients with altered renal function (creatinine clearance < or = 60 mL/min). Metabolic blood pressure (ABPM), cardiovascular and renal investigations have been realised. The population was composed of 22F/38M with middle age: 70.7 +/- 6.2 yrs, diabetic duration: 11.6 +/- 8 yrs, the plasma creatinine was: 161 +/- 78 mumol/L and clearance: 40 +/- 13 mL/min. Thirty eight had albuminuria, 28 had plasma creatinine > or = 150 mumol/L. All patients had high blood pressure. Significative RAS (> or = 70%) was detected in 15 patients (25%) by color duplex scan and proved with arteriography (n = 10) or angio NMR (n = 5). Twelve (80%) had unilateral stenosis (4 thrombosis), 3 (20%) bilateral stenosis. Renal US lead the diagnosis in 10 patients (66%): unilateral or bilateral hypotrophy. Those 15 patients had these following characteristics: 4F/11M (sex R : 0.36), middle age: 70.8 +/- 7.2 yrs, diabetic duration: 14.3 +/- 7.5 yrs, HbA1c was at 8.4 +/- 2%, 8 (53%) patients require insuline and 5 have retinopathy, plasma creatinine was at 169 +/- 6 mumol/L; 32% of patients with plasma creatinine > or = 150 mumol/L had RAS (n = 9/60%), creatinine clearance was at 38 +/- 12 mL/min (7/47% < or = 30 mL/min), 9 (60%) had macroalbuminuria and 5 (33%) microalbuminuria. All hypertensive patients were treated (mean SBP: 148 +/- 16, mean DBP: 82 +/- 7 mmHg) and had 62 +/- 28% SBP escape and 33 +/- 19% DBP escape. Ten had severe hypertension (at least 3 hypotensive drugs), 12 received CEI; 8 (53%) were smokers; 14 (93%) had one or more macroangiopathies (10/66% coronary heart diseases, 7/46% lower limbs arteritis, 6/40% carotid atheroma); 13 of these macroangiopathies are severe. In conclusion, renal failure (especially evolutive and/or treated with CEI) in NIDDM must call up a RAS (25%) specially in elderly males with a long diabetes duration, severe hypertension and macroangiopathies. This patient profile must lead to a color duplex scan to confirm the diagnosis already suspected by the renal echography.
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PMID:[Renal artery stenosis and chronic renal failure in NIDDM]. 974 69

Hyperinsulinemia and impaired insulin action are familial and predictive of Type 2 diabetes onset. Since high levels of insulin are characteristic of our general (venezuelan)hispanic population, the purpose of this investigation was to identify early metabolic defects in a group of healthy first degree relatives of Type 2 diabetic patients. We studied 46 (29 women and 17 men; ages ranging 18-66 y) first degree relatives of Type 2 diabetic patients comparing them with 22 (12 women and 10 men; ages ranging 22-60 y) subjects who had no family history of diabetes. All subjects underwent resting blood pressure and anthropometric measurements; a 75 g oral glucose tolerance test with determination of glucose and insulin and a fasting lipid profile. The relatives of Type 2 diabetic patients had higher tricipital (TC) and subscapular (SC) skinfolds, and elevated DBP in relation to the control group. The skinfolds elevation was more evident in women, while in men the elevation in DBP predominates. None of the relatives had glucose intolerance, however, the glucose-stimulated insulin response was elevated at all points in men as well as in women. No difference was observed in the HOMA values for IR and beta cell function, or in the delta I30/delta G30 ratio. The lipid profile showed a marked elevation in TG levels in men as well as in women, with low HDL-C values in men. No other lipid abnormalities were observed. Correlation analysis revealed strong association between BMI and WHR with skinfolds and several parameters of the carbohydrate metabolism in women, but not in men. IR in women was possitively associated with skinfolds, SBP and lipid parameters and beta cell function with VLDL-C. Adult relatives of Type 2 diabetic venezuelan patients from hispanic origin had, early in their lives, several parameters of the metabolic syndrome as hyperinsulinemia, obesity, dyslipidemia and high blood pressure. These alterations were more prominent in women, group in which the association among BMI, WHR and IR were statistically significant respect to SBP, DBP, basal insulin, insulin/glucose ratio, TG and HDL-C.
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PMID:Women relatives of Hispanic patients with type 2 diabetes are more prone to exhibit metabolic disturbances. 1039 Sep 51

Distribution patterns of blood pressure were studied in a randomised sample of 10,215 school children (5,709 boys 4,506 girls) in the age group 5-14 years in Delhi. The mean values of systolic and diastolic blood pressure (SBP and DBP) increased with age in both sexes. The cut-off points for high blood pressure were based on average SBP and/or DBP values of 95th percentile or greater for each age. The values for SBP ranged from 70 mm Hg to 140 mm Hg and for DBP from 36 mm Hg to 100 mm Hg for the age group 5-9 years. In the age group 10-14 years, the values for SBP and DBP ranged from 72 mm Hg to 160 mm Hg and from 46 mm Hg to 120 mm Hg, respectively. The prevalence of hypertension (systolic, diastolic or both) was 11.9 percent in boys and 11.4 percent in girls, an insignificant difference. Anthropometric variables like height, weight and body mass index showed positive correlation with systolic as well as diastolic blood pressure but the waist-hip ratio showed negative correlation coefficient with blood pressure. Family history of hypertension in one or both the parents was present in 20.4 percent children with high blood pressure compared to 6.8 percent in normotensives. Family history or diabetes was also significantly higher in hypertensive children (5.4%) than in normotensives (3.1%).
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PMID:An epidemiological study of blood pressure in school children (5-14 years) in Delhi. 1040 46

We performed a population survey in the Valle Sabbia mountain community, a highly industrialized area in the province of Brescia, in northern Italy, in order to estimate the prevalence of the main risk factors for coronary heart disease (CHD) among middle-aged men and women. A random sample of 1497 subjects (747 males) aged 40-59 were interviewed and underwent a physical examination. A blood sample was also taken to test total serum cholesterol. Personal histories of hypertension and CHD were given by 20.3 and 4.6% of men, and by 23 and 2.4% of women, respectively. A personal history of diabetes mellitus was reported by 5.2% of men and 4% of women. The mean values of systolic and diastolic blood pressure (SBP and DBP), total cholesterol, number of cigarettes smoked per day and BMI were, respectively: 135.1 and 84.1 mmHg, 219.2 mg/dl, 10.2 cig/day and 26.2 in men, and 136.8 and 83.9 mmHg, 214.3 mg/dl, 2.4 cig/day and 25.1 in women. Among men, 45.0% had SBP > or = 140 or DBP > or = 90, 32.3% had total cholesterol > or = 240 mg/dl, 29.3% were current smokers and 60.7% had a BMI higher than 25. Among women, 48.7% had SBP > or = 140 or DBP > or = 90, 26.0% had total cholesterol > or = 240 mg/dl, 16.8% were current smokers and 44.3% had a BMI higher than 25. When considering the prevalence of high SBP or DBP, high total cholesterol or cigarette smoking, 72.3% of men and 67.7% of women had at least one of the main risk factors for CHD, usually higher values of SBP or DBP, whereas 29.3% of men and 21.2% of women had two or more factors. Overall, prevalences of the most common CHD risk factors in this community were similar to those found in other surveys carried out in Italy in the last decade.
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PMID:Prevalence of risk factors for coronary heart disease in a mountain community in northern Italy. 1048 51

The authors performed the study of the influence of spa treatment in Wysowa Health Resort on heart function in 294 subjects during their 24-day stay in sanatorium within three groups of patients: 28 with diabetes mellitus, 63 with arterial hypertension and a control group. Hemodynamic parameters were recorded by non-invasive impedance cardiography twice: in the first three days of spa treatment and again in the last three days of a 24-day stay. The following hemodynamic parameters were evaluated: SBP, DBP, MAP, CI, SVRI, IC, ACI, LCWI, EF, SI, EDI, TFC, HR. Relation of hemodynamic parameter changes on other measurable features was described in each group by correlation analysis. A small value of Pearson r coefficient proves a small relation among the examined variables. Both in the control group and in diabetic patients and also in patients with arterial hypertension, a spa treatment in Wysowa Health Resort does not show a significant influence to the examined hemodynamic parameters measured by impedance cardiography.
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PMID:[The influence of the Wysowa Spa treatment on heart function]. 1049 25


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