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

1. Impaired endothelium-dependent relaxation has been previously demonstrated in blood vessels of hypertensive rats and in humans with essential hypertension. Arteries from spontaneously hypertensive rats have been shown to produce, in response to high concentrations of acetylcholine, a vasoconstrictor substance called endothelium-derived contracting factor, the production of which can be inhibited by indomethacin or other cyclo-oxygenase inhibitors, suggesting that it is a prostanoid. The mechanisms involved in endothelium-dependent relaxation of human arteries are unclear, and the potential generation of endothelium-derived contracting factor by endothelium in human hypertension has not been established. 2. We investigated the effects of acetylcholine on precontracted small arteries dissected from gluteal subcutaneous fat biopsies from normotensive subjects and subjects with borderline and mild essential hypertension. Vessels from normotensive subjects and those from borderline hypertensive patients, precontracted by noradrenaline, were relaxed completely by acetylcholine, whereas those from patients with mild essential hypertension relaxed slightly but significantly less, indicating that generation of endothelium-derived relaxing factor (endothelium-derived nitric oxide) was only minimally reduced or that production of minor amounts of endothelium-derived contracting factor occurred in small arteries from these hypertensive subjects. This impairment of endothelium-dependent relaxation was not corrected by indomethacin, which indicated that the contribution of endothelium-derived contracting factor, if any, was minimal in this subset of essential hypertensive patients. In contrast, mesenteric small arteries of adult spontaneously hypertensive rats presented strong contractions in response to the higher concentrations of acetylcholine, which were abolished by exposure to indomethacin. 3. The relaxation induced by acetylcholine in arteries from both hypertensive and normotensive humans was partially blunted (by 30%) by pretreatment with 0.1 mmol/l NG-nitro-L-arginine methyl ester or NG-nitro-monomethyl-L-arginine (inhibitors of nitric oxide synthase) and by 10 mumol/l Methylene Blue (a blocker of soluble guanylate cyclase), indicating the role of endothelium-derived nitric oxide and the generation of its intracellular second messenger cyclic guanosine monophosphate in acetylcholine-induced relaxation. The remaining relaxation elicited by acetylcholine could be blocked with 30 mmol/l KCl or with 10 mumol/l ouabain (inhibitor of Na+, K(+)-ATPase), and, when combined with NG-nitro-L-arginine methyl ester, these interventions abolished acetylcholine-induced relaxation. Tolbutamide at 2 mmol/l or 10 mumol/l glyburide (blockers of ATP-sensitive potassium channels) partially inhibited NG-nitro-L-arginine methyl ester-resistant endothelium-dependent relaxation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Endothelium-dependent relaxation of small arteries from essential hypertensive patients: mechanisms and comparison with normotensive subjects and with responses of vessels from spontaneously hypertensive rats. 754 95

Little is known of the natural history of blood pressure (BP) levels in diabetic patients from sub-Saharan Africa. BP levels were therefore recorded in such patients in Dar es Salaam, Tanzania, over 2, 5, and 7 years. Hypertension was found in 5% of insulin-treated diabetes mellitus (IDDM) and 29.2% of non-insulin-dependent diabetes mellitus (NIDDM) patients at presentation with diabetes. Hypertension developed in a further 2 IDDM (3.7%) and 27 NIDDM (15.6%) patients at 2 years, and in 3 IDDM (13.0%) and 9 NIDDM (9.8%) patients at 5 years. Seven NIDDM (18.4%) patients had developed hypertension by 7 years. In NIDDM patients with normal BP initially, the mean systolic BP rose from 131 to 141 mmHg (P < 0.001) 2 years later (n = 146); from 131 to 138 mmHg (P < 0.001) for those followed for 5 years (n = 82); and from 131 to 138 mmHg (P < 0.05) for those followed for 7 years (n = 31). The mean diastolic BP was 83 mmHg initially and 84 mmHg (NS) for those followed for 2 years (n = 146). There was no observed rise in mean diastolic BP at 5 or 7 years of follow-up. In IDDM patients without hypertension, only the systolic BP rose significantly by 5 years, from 124 to 132 mmHg (P < 0.001; n = 20). These changes were independent of age, sex, body mass index, and proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)
Acta Diabetol 1995 Mar
PMID:Blood pressure changes in diabetes in urban Tanzania. 761 14

Roughly 40% of all patients with insulin-dependent diabetes mellitus (IDDM) develop diabetic nephropathy with proteinuria, hypertension and a decrease in glomerular filtration rate 10 to 20 years after the onset of the disease, and 5 years later most patients suffer from end-stage renal disease. Microalbuminuria, defined as an urinary albumin excretion rate (UAER) between 30 and 300 mg/day, strongly predicts the development of nephropathy in IDDM. Nearly all patients with IDDM, a decreasing glomerular filtration rate and a UAER > 300 mg/day have coexisting hypertensive disease additionally worsening renal function. We review the results of recent long-term studies of the current therapeutic management in diabetic patients by means of better blood pressure control, low-protein diet and near-normal blood glucose control in the early microalbuminuric phase as well as in the later phases of the disease characterized by diabetic nephropathy with a UAER > 300 mg/day. Since the large majority of studies have been performed on IDDM, our conclusions with regard to therapy are only valid in this subgroup of diabetic patients.
Acta Diabetol 1994 Sep
PMID:Current therapeutic management of diabetic nephropathy. 782 47

The risk factors for asymptomatic coronary artery disease (CAD) were examined in 138 diabetic patients. Following non-invasive screening examinations (exercise electrocardiography, dynamic thallium scintigraphy, 24-h electrocardiographic recording), CAD was confirmed angiographically in 21 symptom-free diabetic subjects with an ischaemic finding in at least one of the non-invasive tests. The prevalence of asymptomatic CAD in this cohort of diabetic patients was 21/132 (16%), which may be an underestimation because 6 patients refused angiography. Risk factors (age, diabetes, smoking, hypertension, serum lipoproteins, apoproteins and apo E phenotypes) were analysed according to the presence or absence of CAD. Multivariate logistic stepwise analysis did not show any definite changes of serum lipids, lipoproteins and apoproteins in type 1 (n = 72) and type 2 (n = 66) diabetic patients with or without asymptomatic CAD. The only factors associated with asymptomatic CAD were the duration of diabetes (P < 0.005) and the age of the patient (P < 0.05). These results suggest that in diabetic patients the major risk factor for premature coronary atherosclerosis is diabetes itself. Assessment of other risk factors does not seem to define any subgroup with asymptomatic CAD.
Acta Diabetol 1994 Dec
PMID:Asymptomatic coronary artery disease in diabetes: relation to common risk factors, lipoproteins, apoproteins and apo E polymorphism. 788 91

The efficacy of care in the centralized diabetes care system in the former German Democratic Republic was evaluated on the basis of the recommendations of the St. Vincent Declaration. Eighty-three per cent (n = 190, 46% women) of all insulin-treated diabetic patients aged 16-60 years who were registered in one district diabetes care unit were examined. Of these, 131 patients had type 1 (insulin-dependent) diabetes (69%) and 59 type 2 (non-insulin-dependent) diabetes (31%). All patients were on animal insulin and 96% (n = 187) had conventional therapy consisting of fixed insulin dose and a fixed diet. Levels of glycosylated haemoglobin (normal 4.15%, SD 0.54) were 6.3 +/- 1.3% in type 1 and 7.4 +/- 1.7% in type 2 diabetics. Retinopathy was found in 35% of type 1 (proliferative 3.8%) and 23% of type 2 patients (proliferative 3.4%). No patient was blind. Screening for nephropathy identified 29% of type 1 and 47% of type 2 diabetics as having albuminuria > 20 mg/l in early-morning urine. The prevalence of hypertension was 31% and 69% for type 1 and type 2 patients respectively. Foot ulcers were found in 2.1% and lower limb amputations in 2.1%. The incidence of severe hypoglycaemia (except in pregnancy) was 0.07 per patient per year. This study shows that the diabetes care system was effective and the winding up of this system with the reunification of Germany was not a medical necessity. However, the system failed to establish an integrated regime with regional general practitioners for the effective treatment of hypertension.
Acta Diabetol 1993
PMID:Quality of centralized diabetes care: a population-based study in the German Democratic Republic 1989-1990. 811 Oct 78

Coronary heart disease (CHD) is the leading cause of death among individuals with diabetes. However, information on CHD and its association with known risk factors in populations with high rates of diabetes is limited. The purpose of the Strong Heart Study is to quantify CHD and its risk factors among three geographically diverse groups of American Indians who have a high prevalence of diabetes. The study group consisted of 4549 adults between 45 and 74 years of age in 13 Indian communities in Arizona, Oklahoma, and South and North Dakota. Rates of diabetes ranged from 33% to 72% in men and women in the three centers. The prevalence rates of definite myocardial infarction (MI) and definite CHD were higher in men than in women in all three centers (P < 0.0001) and higher in those with diabetes (P = 0.002 and P = 0.0003 in women and men, respectively). Diabetes was associated with a relatively greater increase in prevalence of MI (PR = 3.8 vs 1.9) and CHD (PR = 4.6 vs 1.8) in women than in men. Logistic regression analysis indicated that prevalent CHD was significantly related to age, diabetes, hypertension, albuminuria, percent body fat, smoking, high concentrations of plasma insulin, and low concentrations of high-density lipoprotein (HDL)-cholesterol. These findings from the baseline Strong Heart Study examination emphasize the relative importance of diabetes-associated variables as risk factors for CHD among populations with high rates of diabetes.
Acta Diabetol 1996 Sep
PMID:Risk factors for cardiovascular disease in individuals with diabetes. The Strong Heart Study. 890 22

The purpose of the study was to examine the prevalence and interrelationships of micro- and macrovascular complications and their risk factors in insulin-dependent (type 1) diabetic patients. The prevalence of nephropathy, retinopathy and cardiovascular disease was examined and their associations to risk factors (glycemic control, blood pressure, blood lipid concentrations) and neuropathy were estimated in a cross-sectional study. A total of 140 type 1 diabetic patients were examined. They were grouped by gender, age, and duration of diabetes into 14 subgroups of 10 patients each. Nephropathy was observed in 40%, retinopathy in 55%, and signs of cardiovascular disease in less than 5% of patients. Microvascular complications were associated with the duration of diabetes, systolic blood pressure, and serum triglyceride concentration. The glycosylated hemoglobin (HbA1c) level was significantly associated with the presence of nephropathy, whereas the association with retinopathy was of borderline significance. Statistically speaking, the duration of diabetes, mean systolic blood pressure, HbA1c and triglyceride level explained 31% of the variation in log albumin excretion rate (P < 0.001). Duration, age, and triglyceride level explained 46% of the variation in the severity of retinopathy (P < 0.001) and 31% of the variation in the vibration perception threshold in the ankle (P < 0.001). While the well-established risk factors (duration of diabetes, hyperglycemia, and hypertension) are associated with microvascular complications, more than half of the variation in their severity cannot be explained. An additional risk factor may involve triglycerides even at a normal serum concentration. The mechanism could be the incorporation of triglycerides in the cell membrane, leading to variations in membrane fluidity.
Acta Diabetol 1997 Mar
PMID:Occurrence and interrelationships of complications in insulin-dependent diabetes in Finland. 913 55

A significantly different prevalence in the Gly40Ser variant of the glucagon receptor gene in a small group of essential hypertensive patients compared with normotensive probands was described in a Caucasian population. It has been postulated that this variant may exacerbate the antinatriuretic effect of high plasma insulin levels commonly seen in hypertensive subjects, leading to volume expansion and rise in blood pressure level. The aim of this study was to evaluate the prevalence of the Gly40Ser variant in a population of 404 non-insulin-dependent diabetic patients of Sardinian origin. No association of the Gly40Ser variant with hypertension was seen in this large population.
Acta Diabetol 1997 Aug
PMID:Glucagon receptor Gly40Ser amino acid variant in Sardinian hypertensive non-insulin-dependent diabetic patients. Sardinian Diabetic Genetic Study Group (SDGSG). 932 68

Diabetic patients often develop hypertension, and the presence of both hypertension and diabetes doubles the risk of death from coronary heart disease (CHD). Moreover, the presence and importance of abnormalities such as high low-density lipoprotein (LDL) cholesterol and triglycerides levels as CHD risk factors in insulin-dependent diabetes mellitus type 1 have been downplayed, while increasing evidence suggests that the management of type 1 patients should include control of dyslipidemia and hyperglycemia and an effective antihypertensive treatment able also to reduce risk factors for coronary artery events. In this study we assessed the antihypertensive and metabolic effects of doxazosin in hypertensive patients with type 1 diabetes. We show that the drug normalizes blood pressure, and while no improvement in glucose control was observed, it reduced total cholesterol and increased HDL cholesterol as well as the HDL to total cholesterol ratio. The changes of the various parameters studied, including the calculated CHD risk score based on the Framingham equation, suggest that doxazosine can reduce the CHD risk for hypertensive type 1 patients.
Acta Diabetol 1998 Jul
PMID:Effect of doxazosin in mild to moderate hypertensive patients with insulin-dependent diabetes mellitus. 974 62

Obesity is often accompanied by non-insulin-dependent diabetes mellitus (type 2), arterial hypertension, and hyperlipidaemia. The aim of this study was to evaluate whether duration of obesity is a risk factor for the appearance of type 2 diabetes, hypertension, and hyperlipidaemia. We studied 760 obese subjects, 207 of whom had normal glucose tolerance, 125 impaired glucose tolerance, and 428 type 2 diabetes; in addition, 560 had hypertension and 315 had hyperlipidaemia. At univariate analysis, passing from normal through impaired glucose tolerance to type 2 diabetes there was a progressive increase of age and of duration of obesity, hypertension and hyperlipidaemia. Compared to subjects without hypertension, hypertensive subjects were older, had a longer duration of obesity, a greater body mass index (BMI, kg/m2), and more frequently a family history of hypertension; they also more frequently showed impaired glucose tolerance and type 2 diabetes and hyperlipidaemia. Compared to subjects without hyperlipidaemia, hyperlipidaemic subjects were older, had a longer duration of obesity, and more frequently showed impaired glucose tolerance and type 2 diabetes, and hypertension. Diabetes, hypertension, and hyperlipidaemia were highly associated, as up to 80% of subjects with type 2 diabetes had hypertension, and more than 80% of hyperlipidaemic subjects had hypertension. Type 2 diabetes was less frequent than hypertension and hyperlipidaemia during the first 10 years of obesity, and progressively increased thereafter; in contrast the frequency of hypertension and of hyperlipidaemia increased only after 30 years of obesity. In 359 subjects undergoing an oral glucose tolerance test (168 with simultaneous determination of insulin release), increasing durations of obesity were accompanied by an increasing prevalence of type 2 diabetes, and in deterioration of glucose response, with no decrease in insulin release. At logistic regression analysis, age was a common risk factor for diabetes, hypertension, and hyperlipidaemia; duration of obesity and hyperlipidaemia were additional risk factors for diabetes; family history of hypertension, BMI and hyperlipidaemia were additional risk factors for hypertension, as were impaired glucose tolerance or diabetes, and hypertension for hyperlipidaemia. These data indicate that duration of obesity is a risk factor for type 2 diabetes, and emphasize the importance of preventing obesity in young subjects.
Acta Diabetol 1998 Oct
PMID:Duration of obesity is a risk factor for non-insulin-dependent diabetes mellitus, not for arterial hypertension or for hyperlipidaemia. 984 Apr 48


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