Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is associated with increased risk for cardiovascular health problems including diabetes, hypertension, and stroke. These cardiovascular afflictions increase risk for cognitive decline and dementia, but it is unknown whether these factors, specifically obesity and Type II diabetes, are associated with specific patterns of brain atrophy. We used tensor-based morphometry (TBM) to examine gray matter (GM) and white matter (WM) volume differences in 94 elderly subjects who remained cognitively normal for at least 5 years after their scan. Bivariate analyses with corrections for multiple comparisons strongly linked body mass index (BMI), fasting plasma insulin (FPI) levels, and Type II Diabetes Mellitus (DM2) with atrophy in frontal, temporal, and subcortical brain regions. A multiple regression model, also correcting for multiple comparisons, revealed that BMI was still negatively correlated with brain atrophy (FDR <5%), while DM2 and FPI were no longer associated with any volume differences. In an Analysis of Covariance (ANCOVA) model controlling for age, gender, and race, obese subjects with a high BMI (BMI > 30) showed atrophy in the frontal lobes, anterior cingulate gyrus, hippocampus, and thalamus compared with individuals with a normal BMI (18.5-25). Overweight subjects (BMI: 25-30) had atrophy in the basal ganglia and corona radiata of the WM. Overall brain volume did not differ between overweight and obese persons. Higher BMI was associated with lower brain volumes in overweight and obese elderly subjects. Obesity is therefore associated with detectable brain volume deficits in cognitively normal elderly subjects.
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PMID:Brain structure and obesity. 1966 57

The aim of the study was to assess effect of 12-week long combined therapy with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR on arterial pressure (AP), carbohydrate and lipid metabolism, and safety of the treatment in patients having arterial hypertension (AH) with and without DM2. Sixty outpatients with grade II-III AH (mean age 55.3 +/- 9.6 yr) were divided into 2 groups: group 1 (n = 30) comprised patients with AH and DM2, group 2 (n = 30) included patients with AH alone. Combined therapy with daily doses of 23.3 +/- 9.8 g accupro and 1.5 mg indapamide reduced systolic and diastolic AP by 30.2 and 27.3% respectively in group 1 and by 27.6 and 27.1% in group 2. In patients with AH and DM2, fasting and postprandial blood glucose levels decreased by 7.3 and 5.2% and HbA1c by 8.9% (p < 0.05). Total cholesterol, triglycerides, and LDL cholesterol tended to decrease in both groups. HDL cholesterol significantly (p < 0.05) increased by 11.1% in group 1 and 10% in group 2 Side effects were documented only in 8.3% of the patients and did not require withdrawal of therapy. It is concluded that antihypertensive treatment with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR may be recommended for long-term therapy of AH concomitant with DM2.
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PMID:[Combined antihypertensive therapy in patients with arterial hypertension and type 2 diabetes]. 1982 27

Little information is available on the management of patients with type 2 diabetes mellitus (DM2) in regular clinical practice, prior to and at the point of initiating treatment with insulin. The INSTIGATE study provides a description of the clinical profile of the patient with DM2 who begins treatment with insulin in both primary and secondary care. A total of 224 patients who had been diagnosed with DM2, were not responding to oral treatment, and began receiving insulin were included in the INSTIGATE study in Spain. Demographic data were collected, as well as data on macro- and microvascular complications of diabetes and comorbidities, past medical history of diabetes and oral treatment administered, the clinical severity of diabetes (HbA1c concentration) and insulin treatment initiated. Mean age of the sample was 65.4 years and 56.7% were men. There were 87% of patients who had a diagnosis of at least one significant comorbidity, notably hypertension and hyperlipidemia. The patient profile for metabolic syndrome was met by 75.1% of the patients. There was a higher incidence of macrovascular complications (38.4%) than microvascular complications (16.1%). Prior to insulin initiation, the most recent mean HbA1c was 9.2%. The majority of patients had been treated in the last 12 months with sulfonylureas and/or metformin (69.6 and 57.6%). The most common treatment prior to insulinization was the co-administration of two oral antidiabetics (OADs) (37.5%). Patients with DM2 observed in the study presented with elevated mean HbA1c and body mass index levels, comorbidities and complications related to diabetes at the time of insulin initiation. Changes and adjustments in treatment from diagnosis of diabetes occur when HbA1c levels are far above those recommended by the IDF (International Diabetes Federation), a factor which could be contributing to the development of both macrovascular and microvascular complications in the patient profile described in the study.
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PMID:Clinical characteristics of patients with type 2 diabetes mellitus at the time of insulin initiation: INSTIGATE observational study in Spain. 1985 19

Joint effect of diabetes mellitus (DM) and extreme natural conditions of the Far North on the clinical course of coronary heart disease (CHD) remains poorly known. Specific features of DM2 concomitant with CHD were studied in 243 of the 8573 subjects living in Far North areas of the Tyumen region and examined by coronarography (mean age 53.4 +/- 0.4 years). The control group comprised 139 patients (56.9 +/- 0.58 years) with CHD and DM2 living in the south of Tyumen region. Clinical and ECG observations were supplemented by measurement of total cholesterol and selective coronarography. Patients of the study group were younger (p < 0.001), more frequently consumed tobacco (p < 0.001) and alcohol (p = 0.001) and had obesity (p = 0.008). Most patients in both groups had a history of myocardial infarction, suffered functional class II or higher angina and circulatory insufficiency (according to NYHA), high cholesterolemia, and arterial hypertension further deteriorating effects of CHD and DM2. However, the two groups were not significantly different in terms of these characteristics. It is concluded that combination of CDH and DM2 has unfavourable effect in patients living in the Far North although severity of clinical and functional manifestations of CDH in DM2 patients is not significantly different between residents of northern and southern areas of Tyumen region.
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PMID:[Clinical features of coronary heart disease with concomitant diabetes mellitus at high latitudes]. 1988 76

The study was designed to evaluate effect of enalapril and telmisartan on hemodynamic characteristics and diastolic function (DF) of left ventricle (LV) in patients with type 2 diabetes and arterial hypertension (AH). It included 64 patients aged 54.3 +/- 5.2 years. Those in group 1 (n = 31) were given enalapril (enap), patients of group 2 (n = 33) were treated with telmisartan (micardis). Examination included 24 hour AP monitoring, Holter ECG monitoring, and echocardiography. Compensation of metabolic disorders was evaluated from fasting and postprandial blood glucose and HbAc1 levels. Impaired LV DF was the main feature of affected myocardium in patients with DM2 and elevated AP in the absence of contractility disturbance. Enalapril therapy ensured the desired level of systolic and diastolic AP in 77 and 64.5% of the patients respectively in association with a decreased number of non-dippers and night-peakers in 45.4% of the observations in the absence of changes in HbAc1 level and LV DF. Treatment with telmisartan ensured within 24 weeks efficacious control of systolic AP and normalization of its daily profile in 87.5% patients with pathological circadian rhythm, besides improvement of carbohydrate metabolism and LV DF.
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PMID:[Arterial hypertension and type 2 diabetes mellitus: clinical evaluation of hemodynamic characteristics, possibility of correction]. 2001 45

A 62-year old woman with obesity, high blood pressure and type 2 diabetes mellitus (DM2) was referred to a Vascular Risk Unit of the Internal Medicine Department due to elevated HbA1C (8.1%) in spite of having taken metformin (850 mg/12h) and glipizide (10 mg/12 h) regularly. She tries to exercise daily (walking 30 min) and has lost weight (from 5 to 12 kg) several times, but always regains what she has lost. Furthermore, she monitors her glucose levels in fasting every two weeks and generally has between 120 and 160 mg/dL. Her high blood pressure is being treated with enalapril/HCTZ and she also takes aspirin 100mg/day and simvastatin 20 mg/day. It is seen in her family background that one brother died suddenly at 50 years of age. Her physical examination shows a BMI of 32.4 Kg/m(2), and she has no edemas in the lower limbs. Her BP is 154/82 mmHg and creatinine 0.9 mg/dL. She has no microalbuminuria and her liver function is normal. What treatment do you think would be the more appropriate? 1 - Add glitazones. 2 - Add incretin mimetics (GLP 1/ DPP-4). 3 - Slow acting insulin.
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PMID:[Therapeutic behavior to follow in the following clinical case: treatment of type 2 diabetes]. 2014 94

The aim of the study was to assess specific cardiovascular lesions in patients with type 2 diabetes mellitus and diabetic nephropathy (DN) and search for the methods of their correction. It included 182 overweight or obese (abdominal type) women above 55 yr with arterial hypertension (AH) divided into groups with normal or low (less than 30 ml/day) albuminuria (n = 87), albuminuria (30-300 mg/day, n = 59), proteinuria (above 30 mg/day, n = 21), and stage I-IIa chronic renal insufficiency (CRI, n = 15). It was shown that structural geometric changes in the left ventricle (LV) with the prevalence of myocardial concentric hypertrophy and diastolic dysfunction (DD), enhanced myocardial hardness, and preserved systolic function undergo progression with increasing severity of DN and decreasing glomerular filtration rate combined with poorly controlled DM2, abnormal lipid profile, long history of AH in the absence of adequate AP control, signs of vascular atherosclerosis (thickening of intima and media in carotid arteries), and large number of macrovascular complications. DN-related insulin resistance (IR) was a factor influencing LV remodeling and DD. Long-term combined therapy affecting IR and markers of cardiovascular disorders (AH, chronic hyperglycemia, dyslipidemia) promoted improvement of LV diastolic function, reverse remodeling of LV myocardium, decrease of atherosclerotic lesions and albuminurea in patients presenting with both low albuminuria and DN; in addition, it improved prognosis of the disease.
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PMID:[Cardiovascular disorders and possibilities of their therapy in patients with type 2 diabetes mellitus and diabetic nephropathy]. 2036 9

Diabetes mellitus (DM) is closely associated with cardiovascular (CV) diseases. These are the main cause of death in patients not only with type 2 but also type 1 diabetes. Apart from the traditional risk factors such as arterial hypertension, dyslipidemia and obesity, hyperglycaemia is an independent risk factor for the development of ischemic heart disease (IHD). Long-term hyperglycaemia leads to vascular damage through several mechanisms. These include oxidative stress, formation of advanced glycation end products, activation of the nuclear factor kappa B and decreased production of nitrogen monoxide (NO). Insulin resistance is believed to have an important bearing on pathogenesis of IHD in type 2 diabetes (DM2) patients. The course of IHD in diabetic patients is usually more complicated. Direct percutaneous coronary intervention (PCI) is the gold standard in the treatment of myocardial infarction (MI) in diabetic as well as non-diabetic patients. Drug-eluting stents, associated with fewer reocclusions, have also proved useful. In addition to drug-eluting stent implantation, surgical revascularization, preferably utilizing internal thoracic artery, is a suitable technique in patients without acute coronary syndrome indicated for an intervention. Conservative approach should be applied in less severely affected patients. IHD prevention should include appropriate control of arterial hypertension, dyslipidemia and weigh reduction. Diabetes treatment should be managed individually and with respect to the potential risk of hypoglycaemia in high-risk patients with longer duration of diabetes and known CV disease. Newly diagnosed type 2 diabetes patients should from the onset be treated with metformin and tight compensation should be aimed for with target value for glycated haemoglobin of less than 4.5% (IFCC methodology). Evidence exists that this approach may significantly reduce the CV risk. Intensified insulin regimen is the most suitable treatment approach for the type 1 diabetes patients also with respect to microvascular and macrovascular complication prevention. Treatment of hyperglycaemia is one of the set of measures that may contribute to CV risk reduction in diabetic patients.
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PMID:[Diabetes mellitus and ischemic heart disease]. 2046

Disturbances of coagulation and fibrinolysis in type 2 diabetes mellitus (DM2) contribute to increased rates of macrovascular complications such as myocardial infarction and ischemic stroke. The aim of the study was to investigate the relationship among plasminogen activator inhibitor 1 (PAI-1), thrombin-activable fibrinolysis inhibitor (TAFI), tissue plasminogen activator (t-PA), prothrombin fragments 1+2 (F1+2), glycemic control, hypertension, sex and body mass index (BMI) in DM2 patients with normoalbuminuria and microalbuminuria. Forty-two normoalbuminuric (NAU), 42 microalbuminuric (MAU) patients with DM2 and 42 blood donors as control group were enrolled. TAFI, PAI-1, t-PA and F1+2 were assessed by enzyme-linked immunosorbent assay (ELISA) in all patients. TAFI was significantly increased in the MAU group, PAI-1 and F1+2 were increased in both groups and t-PA was not elevated in either group compared to controls. We found positive correlations in the NAU: TAFI and fibrinogen (r=0.65, P=0.02), PAI-1 and triglycerides (r=0.67, P=0.01), in the MAU: TAFI and F1+2 (r=0.48, P=0.02), TAFI and systolic blood pressure (r=0.53, P=0.01), PAI-1 and BMI (r=0.43, P<0.05). We found decreased fibrinolysis in DM2 patients presented with increased PAI-1 in both NAU and MAU. Hypofibrinolysis in MAU is further accented by the elevation of TAFI. TAFI-mediated inhibition of fibrinolysis in DM2 is regulated independently from PAI-1. Patient[Combining Acute Accent]s sex does not affect diabetes-related changes in hemostasis and fibrinolysis.
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PMID:The relationship among TAFI, t-PA, PAI-1 and F1 + 2 in type 2 diabetic patients with normoalbuminuria and microalbuminuria. 2151 32

Diabetes mellitus types 1 and 2 (DM1 and DM2) and/or hypertension (HTN) can contribute to cognitive decline, cerebral atrophy and white matter abnormalities in humans. Adult rat models of streptozotocin-induced DM1 and genetic strains of DM2 and HTN were used to investigate relative contributions of DM and HTN for alterations in cerebral structure and function as well as insulin receptor biology using cognitive testing, magnetic resonance imaging (MRI), and histological and molecular methods. The effects of DM1 or DM2 were generally similar. DM was associated with earlier onset of cognitive impairment than with HTN alone. DM was independently correlated with brain atrophy, whereas HTN had minimal effects on brain volume. The combination of DM and HTN led to identifiable mild hippocampal neuronal loss while either DM or HTN led to synaptic loss. Only DM led to downregulation of the insulin receptor pathways' activation. In contrast, only HTN was associated with vascular luminal reduction and restricted cerebral perfusion on MRI. The impacts of DM and HTN in the brain differ, while their separate contributions can lead to some additive adverse effects within rodent brain grey matter.
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PMID:Differential impact of diabetes and hypertension in the brain: adverse effects in grey matter. 2507 53


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