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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although an elevated blood pressure has been proposed as one of the major risk factors for the development and acceleration of diabetic retinopathy, demonstration of an unequivocal association between high blood pressure and retinopathy is lacking. Recent epidemiologic, cross-sectional studies indicated a close relationship between elevated systolic blood pressure and diabetic retinopathy, particularly in NIDDM subjects. In IDDM patients, the association with diastolic blood pressure was more pronounced. In the few prospective studies with sufficient number of individuals and acceptable documentation of retinal changes, in addition to poor metabolic control elevated blood pressure emerged as one of the best predictors of the development of severe deterioration of diabetic eye disease. In the Joslin study the risk of progression to severe forms of diabetic retinopathy increased exponentially with hemoglobin A1c and was dramatically different in patients with diastolic blood pressure below versus above 70 mmHg. It was hypothesized that a very low diastolic blood pressure is associated with some mechanisms which are protective against progression of eye lesions. Treatment and adequate control of hypertension is strongly recommended in all diabetic patients, the optimal level of blood pressure reduction, however, is yet to be determined.
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PMID:Impact of blood pressure on diabetic retinopathy. 269 52

VLCD is an effective and safe measure to reduce overweight in NIDDM. It substantially improves glucose control and corrects associated coronary risk factors, in particular dyslipoproteinaemia and hypertension. Both insulin secretion and insulin resistance were ameliorated by perfect glucose control with VLCD. Reliable data on long term efficacy and factors determining weight loss and success in permanent glucose control are urgently needed.
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PMID:Very low calorie diet therapy in obese non-insulin dependent diabetes patients. 269 83

The awareness of hypertension as one of the major risk factors for mortality and morbidity in NIDDM has increased greatly in the past few years. It is now accepted practice to measure BP at least yearly in all such patients. Unfortunately, one cannot yet be sure to what extent diabetics benefit from anti-hypertensive therapy, and the simple assumption that treatment of the increased risk reduces that risk must be constantly questioned. No specific data are yet available for NIDDM, though it would be remarkable if the benefits of decreased cerebrovascular mortality and probable reduced total mortality (Sleight, 1987) did not apply to the higher-risk diabetic subject, at least at the higher levels of diastolic pressure (greater than 105 mm Hg). There is, though, no evidence that mortality or morbidity of coronary artery disease, the major killer in NIDDM, is reduced even in non-diabetics and the present author does not consider there to be any evidence suggesting that thresholds for treatment of hypertension in uncomplicated patients with NIDDM should be lower than those for non-diabetics, unless progressive nephropathy is present. Current advice in the non-diabetic is that levels of blood pressure in adults consistently above 95 mm Hg warrant therapy, aiming to reduce it below 90 mm Hg (World Health Organization, 1986). While the importance of hypertension should not be underestimated, it should not deflect attention from the other risk factors. Cessation of smoking, and by implication its reduction, will, for all smoking patients but the most hypertensive, produce a greater reduction in cardiovascular and total mortality risk than will anti-hypertensive therapy. There are also early signs that effective dietary and/or drug treatment of significant hyperlipidaemia lowers cardiovascular mortality. Choice of anti-hypertensive therapy is especially important, not only for efficacy but also for quality of life, in patients who already suffer major restrictions on diet, freedom and life expectancy. While controlled trials in the subject are of immense importance in determining optimum therapy, there is currently no evidence to favour any particular group of drugs, and an individual patient's therapy should be decided on the basis of their own circumstances.
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PMID:Hypertension. 307 98

The standard treatment of NIDDM consists of diet, oral hypoglycaemic agents and, mostly as a last resort, insulin. Indications for insulin therapy cannot be generalized for the whole population of NIDDM patients. The defined objectives of therapy for the individual patient will determine the choice and intensity of therapy. These will usually be either a relief of hyperglycaemic symptoms in the elderly patient or normoglycaemia, as in the insulin-dependent diabetic patients, in order to prevent acute and chronic complications. Primary insulin treatment is advisable in patients with hyperglycaemic symptoms and fasting blood glucose levels above 15 mmol/l, as in these patients the major defect will be insulin deficiency rather than insulin resistance. The correction of long lasting hyperglycaemia partly restores insulin sensitivity and B cell function, thereby allowing sequential reduction of insulin dosage. When metabolic control can be sustained with low insulin dosages some of these patients may later respond well to oral hypoglycaemic agents or to diet alone. In the management of non-insulin-dependent diabetic patients it is of great importance to recognize in time when treatment with oral hypoglycaemic agents fails. Insulin therapy should not be withheld on the presumption that it will cause weight gain and will promote development of macrovascular disease. Weight gain can be reduced by adequate dietary counselling and the level of macrovascular risk factors reduces with improved metabolic control. In this context also it should be realized that the correction of hypertension, hyperlipidaemia and the cessation of cigarette smoking is probably of equal importance. Insulin therapy regimens which have been used in non-insulin-dependent diabetic patients have been the same as prescribed for insulin dependent patients. When considering the fact that hepatic overproduction of glucose is the major determinant of fasting blood glucose level and that postprandial glycaemic excursions are superimposed on this level it seems reasonable to aim for normalization of the basal hepatic glucose production. A bedtime injection of an intermediate or long acting insulin can be used for this aim. Other therapeutical approaches which have been studied recently are the use of combinations of insulin and oral hypoglycaemic agents and the use of proinsulin as an alternative for intermediate acting insulin. Before these forms of therapy can be advocated long-term clinical studies are necessary to define their therapeutic role.
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PMID:Insulin treatment of non-insulin-dependent diabetes mellitus. 307 3

Intraplatelet serotonin (5-HT) content was determined in 23 patients with type I (insulin-dependent) diabetes mellitus (IDDM), 23 patients with type II (non-insulin-dependent) diabetes mellitus (NIDDM), 29 patients with peripheral vascular disease (PVD) and 34 age-matched normal subjects. Intraplatelet 5-HT content in normal subjects showed an age-related decline (r = -0.45; P less than 0.008), as has been previously demonstrated. The median 5-HT content in platelets of the young normal subjects was 4.36 (range: 3.62-6.79) nmol 10(-9) platelets, while that in the elderly normal subjects was 3.87 (range: 2.8-6.0) nmol 10(-9) platelets and that in young + elderly subjects was 4.05 (range: 2.8-6.8) nmol 10(-9) platelets. The median intraplatelet 5-HT content was significantly lower (P less than 0.002) in IDDM patients: 3.0 (range 1.3-6.3), NIDDM patients: 2.5 (range 1.7-5.8), PVD patients: 2.42 (range 0.94-4.98) nmol 10(-9) platelets than that in all young + elderly healthy subjects. The presence of hypertension in DM patients caused a small but significant (P less than 0.05) decrease in intraplatelet 5-HT content, whilst its presence had no effect in PVD patients. In a smaller study, it was established that NIDDM and PVD patients have significantly (P less than 0.002) greater plasma 5-HT concentrations than controls. Insulin-dependent diabetes mellitus patients had greater plasma 5-HT concentrations but this did not achieve statistical significance despite a 66% increment in its value.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intraplatelet serotonin in patients with diabetes mellitus and peripheral vascular disease. 313 26

The major obstacle to a recommendation for screening adults for NIDDM is the conflicting evidence that early detection and treatment reduce future complications. Because obesity is a risk factor for NIDDM, and hypertension in conjunction with NIDDM leads to early atherosclerosis, treatment is indicated for both hypertension and obesity whether or not NIDDM is present concurrently. It is clear that there are those who accept and those that reject the use of oral hypoglycemic agents. Accordingly, there are those who believe that the goal of NIDDM treatment is zealous glycemic control and those who are not so inclined. Whether or not to screen for NIDDM ultimately depends upon which view is adopted. While it may seem prudent to screen for and insist upon "tight" control of NIDDM, we should consider the effect of labeling asymptomatic persons from a positive test result. What are the repercussions regarding status of employment and insurance eligibility as compared to benefits of treatment? What is the psychosocial impact? Although no studies on the effect of labeling patients non-insulin-dependent diabetics could be located, a study of hypertension in an industrial setting demonstrated that patients labeled hypertensive had an increased absenteeism from work. Interestingly, the main factors associated with increased absenteeism were awareness of the condition and low compliance with treatment. Although the parallel to NIDDM is evident, additional studies are needed.
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PMID:Screening for non-insulin-dependent diabetes mellitus. 329 Sep 20

Diabetes is a dangerous, expensive disease with a major economic impact. The cost to the nation in 1984 was estimated to be $14 billion. We now believe the total costs approach $20 billion. Of this, $10.5 billion is guesstimated to be direct cost due to the diagnosis and treatment of the disease, while indirect costs (due to complications, work days lost, decreased productivity, and premature death) are about $9.5 billion. A typical patient with NIDDM and hypertension spends about $1000 per year for doctor visits, lab tests, oral diabetes tablets, blood pressure medications, lancets and blood test strips (4 per week), and miscellaneous expenses. NIDDM is clearly the major diabetes cost to the nation because it represents 85 to 90 per cent of all diabetes and because half the patients are undiagnosed and untreated. We believe the morbidity, mortality, and economic burden of NIDDM can be favorably affected by a concerted national effort as defined by the National Diabetes Advisory Board in its 1987 National Long Range Plan to Combat Diabetes. Finally, one must not forget the "other costs" of NIDDM, which are statistically unmeasurable: emotional costs, loss of freedom, inconvenient life style changes, and the permanent dependence on "others" (family, professionals, and so on) for help.
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PMID:Economic impact of type II diabetes mellitus. 329 Sep 28

Diabetes is associated with changes in plasma lipids and lipoproteins into atherogenic direction. In IDDM these changes are small or absent if good metabolic control can be maintained. Diabetic nephropathy is, however, associated with the appearance of dyslipoproteinemia. In NIDDM plasma total and VLDL triglyceride levels are elevated, and HDL-cholesterol level is decreased, and this pattern of dyslipoproteinemia does not always respond to improved control of hyperglycemia. Abnormalities of lipoprotein metabolism, not reflected in conventional plasma lipid and lipoprotein level measurements, and glucosylation of lipoproteins and resulting alterations in lipoprotein catabolism may be of importance in the enhanced atherogenesis in diabetes. Both IDDM and NIDDM are associated with an increased frequency of hypertension, but the underlying mechanisms appear to be different. In IDDM hypertension is usually associated with the development of diabetic nephropathy and thus with a long duration of the disease. In NIDDM hypertension is often present already at the time of diagnosis, and also in IGT, the precursor stage of NIDDM, the prevalence of hypertension is already increased. Obesity explains only in part the high prevalence of hypertension in patients with NIDDM. Diabetes is known to be associated with multiple abnormalities in hemostatic factors and, although these abnormalities may contribute importantly to the increased risk of ASVD in diabetic patients, information about their real role is scanty and conflicting. The impact of general major risk factors for ASVD, elevated plasma cholesterol, elevated blood pressure, and smoking, on the risk of ASVD appears to be similar in diabetics and nondiabetics. Only a relatively small proportion of the excessive occurrence of ASVD in diabetics can, however, be explained by the effects of diabetes on the levels of general risk factors for ASVD. This proportion mediated through the effects of diabetes on risk factors is larger in female diabetics than in male diabetics. The major proportion of the excess of ASVD in diabetics remains, however, unexplained and must be due to effects of diabetes itself through mechanisms that are incompletely understood.
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PMID:Diabetes and atherosclerosis: an epidemiologic view. 355 30

Since February 1, 1980, the identical standardized Greenville Gastric Bypass has been performed in 397 morbidly obese patients with an operative mortality rate of 0.8%. The operation effectively controlled weight and maintained satisfactory weight loss even after 6 years (mean weights and ranges: Preoperative: 290 lbs (196-535); 18 months: 175 lbs (110-300); 72 months: 205 lbs (140-320). The gastric bypass favorably affected non-insulin-dependent diabetes (NIDDM), hypertension, physical and role functioning, and several measures of mental health. Rigorous follow-up (97.5% over 6 years) revealed that health problems were common in postoperative patients; there were nine late deaths. Abnormal glucose metabolism was present in 141 (36%) of 397 patients before surgery: NIDDM was present in 88 patients (22%) and 53 patients (14%) were glucose impaired. Of these, all but two became euglycemic within 4 months after surgery without any diabetic medication or special diets. The most recent 42 morbidly obese patients with NIDDM were studied intensively. In that cohort, fasting blood glucose, fasting insulin, and glycosylated hemoglobin returned to normal after surgery; insulin release, insulin resistance, and utilization of glucose improved sharply. The normalization of glucose metabolism after gastric bypass may not be related solely to weight loss and restriction of caloric intake, but may also be due to the bypass of the antrum and duodenum.
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PMID:The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. 363 94

Serum immunoglobulin (G, A, M) levels were performed on 66 patients with non-insulin-dependent (type II) diabetes mellitus (NIDDM). When compared with 30 age-matched normal controls and 32 hospitalized controls there was no significant difference between the mean IgG and IgM levels. The IgA levels were significantly higher (P less than 0.005) in the diabetic group when compared with both control groups. This is true regardless of age, sex, duration of disease, and type of treatment (insulin/diet or oral hypoglycemic agents and/or diet). Thirty-six percent of the diabetic patients' IgA levels exceeded the mean +/- 2 SD of the normal control group. There were no significant differences in immunoglobulin levels between insulin-treated and non-insulin-treated diabetic groups. Since diabetic patients may have a number of secondary diseases, attempts were made to correlate the most common of these (acute and/or chronic bacterial infections, hypertension, arteriosclerotic heart disease, and diabetic neuropathy) with elevated IgA levels. Only IgA levels of diabetic patients with infections versus diabetic patients without infections were significantly different (P less than 0.05). However, IgA levels of uninfected diabetic patients remained significantly higher than those of normal controls (P less than 0.005), hospitalized controls (P less than 0.01), and hospitalized controls with bacterial infections (P less than 0.005). Possible reasons for the isolated elevations of IgA are discussed.
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PMID:Elevation of IgA levels in the non-insulin-dependent (type II) diabetic patient. 675 40


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