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

The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187-13.659), hypertension (OR=5.564; 95% CI, 1.446-21.400) and retinopathy (OR=3.766; 95% CI, 1.096-12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.
Acta Diabetol 2003 Dec
PMID:Silent coronary artery disease in patients with type 2 diabetes mellitus. 1474 Feb 77

The objective of this study was to investigate the association of insulin resistance and the cluster of insulin resistance syndrome (IRS) factors with hypertension in a native urban population from southern India. The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in southern India. Of the total of 1399 eligible subjects (age >or=20 years), 1262 (90.2%) participated in the study. Subjects were classified as hypertensives if they had systolic blood pressure (SBP) >or=140 mmHg or diastolic blood pressure (DBP) >or=0 mmHg, if they were known hypertensives, or if they were receiving treatment with antihypertensive drugs. Insulin resistance was computed using the homeostasis model assessment (HOMA IR). The overall prevalence of hypertension in the population was 22.1%. Prevalence of hypertension increased with an increase in quartiles of fasting insulin levels ( p=0.035) and HOMA IR ( p=0.03). Logistic regression analysis revealed that HOMA IR was significantly associated with hypertension, which was not altered even after addition of risk factors like age, smoking habit and alcohol consumption into the model. However, inclusion of variables associated with IRS abolished the association of insulin resistance with hypertension. Factor analysis identified four factors: factor 1 had positive loading of body mass index, age, systolic and diastolic blood pressures; factor 2 had positive loading of HOMA IR, fasting plasma glucose, triglycerides and body mass index; factor 3 had positive loading of waist-hip ratio, triglycerides and smoking habit and negative loading of alcohol consumption; factor 4 was loaded with age and serum cholesterol. Factor 1, the hypertension factor loaded with systolic and diastolic blood pressures, shared a correlation with the insulin resistance cluster through body mass index. Our results suggest that the "insulin resistance cluster" is associated with hypertension in this urban population of southern India.
Acta Diabetol 2004 Jun
PMID:Association of hypertension with cluster of insulin resistance syndrome factors: the Chennai Urban Population Study (CUPS-12). 1522 5

We investigated the age-, gender- and race-specific 1-year case fatality rates of diabetic and non-diabetic individuals with a myocardial infarction. Data were obtained from the Atherosclerosis Risk in Communities (ARIC) Surveillance Study, which monitors both hospitalized myocardial infarction and coronary heart disease (CHD) deaths in residents aged 35-74 years in four communities in the USA. The study population comprised 3242 hospitalized myocardial infarctions (HMIs) in diabetic subjects and 9826 HMIs in non-diabetic individuals between 1987 and 1997. Age-adjusted and gender- and race-specific odds ratios (OR) for 1-year case fatality comparing diabetic to non-diabetic patients were 2.0 (95% CI, 1.6-2.4) for white men and 1.4 (95% CI, 1.1-1.8) for white women. Further adjustment for severity of HMI, history of previous MI, stroke and hypertension, and therapy variables showed significantly higher case fatality in white diabetic men than in non-diabetic white men (OR=1.5; 95% CI, 1.2-1.9), but no significant association in the other race-gender groups. The age-adjusted odds of out of hospital death was significantly higher among white diabetic men (OR=1.7; 95% CI, 1.2-2.3), white women (OR=2.3; 95% CI, 1.4-3.8), and African-American women (OR=2.9; 95% CI, 1.5-5.9) as compared to their non-diabetic counterparts. In conclusion, diabetes is an independent factor for mortality within one year following a myocardial infarction among white men, and following out-of hospital coronary death in white men and women and in African-American women. It is possible that these differences could be explained, at least in part, by a less than optimal medical management of the high cardiovascular risk profile of these patients after hospital discharge.
Acta Diabetol 2004 Jun
PMID:Is diabetes an independent risk factor for mortality after myocardial infarction? The ARIC (Atherosclerosis Risk in Communities) Surveillance Study. 1522 9

Obesity, now an epidemic in the USA, northern Europe, and Italy, is associated with several co-morbidities that shorten life expectancy, in particular type 2 diabetes mellitus (T2DM), arterial hypertension, and hyperlipidemia. The impact of obesity on mortality is evident in all ages, and is especially strong in young persons. Obesity, especially visceral obesity, associated with a sedentary lifestyle, is among the strongest risk factors for T2DM, and a diagnosis of T2DM seems to increase linearly as a function of duration of obesity. The pathogenesis of T2DM is based on a dual defect, i.e. increased insulin resistance coupled with defective insulin release. The main abnormality in obesity is increased insulin resistance, while insulin release, even though defective compared with body needs, is usually abundant. The incidence of obesity among children aged 6-16 years is now even greater than that among adults: in Italy, figures up to 30% have been reported. As in adults, obesity is a cause, among children, of arterial hypertension, left ventricular hypertrophy, hyperlipidemia, non-alcoholic-steato hepatitis, sleep apnea syndrome (SAS), and orthopedic, psychological, and social problems. Together with an increase in body weight, there is an increase of visceral fat. Obesity in children has also led to a tremendous increase in the prevalence of impaired glucose tolerance (IGT); the percentages span from 25% in a multiethnic cohort in the USA, to 4% in Italian Caucasians. Management of obesity and of T2DM in children has to face the issue of poor compliance; there is consensus that dietary treatment of obese T2DM children is a failure, so that drugs are required; the only drug evaluated in a formal trial is metformin, that behaves in terms of efficacy and of minor side effects as in adults. In conclusion, obesity in children is not pure obesity, but is accompanied by co-morbidities that cluster to form the "metabolic syndrome" just like in the adults. If this epidemics continues and is not properly challenged, in the next decades we will face an epidemic of early cardiovascular morbidity and mortality.
Acta Diabetol 2004 Sep
PMID:Type 2 diabetes mellitus is becoming the most common type of diabetes in school children. 1566 74

Abdominal obesity is a known risk factor for diabetes-related diseases. This study aimed to establish a formula to predict visceral abdominal fat area on the basis of simple clinical and anthropomorphic parameters easily measured in the clinic. We determined visceral fat (V) and subcutaneous fat (S) areas in 115 Japanese women using the standard procedure based on computed tomography (CT) at umbilical level. Furthermore, we measured clinical and anthropometric parameters including height, weight, waist circumference, hip circumference, skin fold thickness and body fat percentage. In 115 subjects, V area was 87.8+/-52.5 cm2 and S area was 221.1+/-99.7cm2. Abdominal obesity is diagnosed in Japan as a V area > or =100 cm2; on this basis 42 women (37%) had abdominal obesity. The prevalences of diabetes and related diseases were significantly higher among women with abdominal obesity. By simple regression analysis, V and S areas significantly correlated with anthropometric parameters: in particular, V area correlated with waist circumference (r=0.745, p<0.01) and S area with body mass index (r=0.793, p<0.01). However, these parameters were not sufficient to predict V area. By multiple regression analysis using simple parameters, we established the following formula to predict visceal fat: V area = 159.475 + 1.023(age) - 2.119(height) + 1.454(body weight) + 2.841(waist circumference) - 1.208(hip circumference) (r=0.812, p<0.01). The V area calculated by formula correlated (r=0.761) with that determined by CT in a second age-matched group of 31 Japanese women. The present study confirms that visceral adipose tissue is closely associated with type 2 diabetes mellitus, dyslipidemia and hypertension, and generated a formula to predict visceral adipose tissue accumulation.
Acta Diabetol 2004 Sep
PMID:Evaluation of visceral adipose accumulation in Japanese women and establishment of a predictive formula. 1566 78

Both diabetes mellitus and hypertension are major risk factors for cardiovascular, renal and atherosclerotic vascular disease. Hypertension is known to be more common in patients with diabetes than in the general population. Patients with diabetes mellitus are at high risk for renal injury, which may be exacerbated by abnormalities in circadian blood pressure pattern. Ambulatory blood pressure monitoring (ABPM) permits the observation of blood pressure throughout day and night in a non-medical environment, and to quantify the circadian blood pressure variability. Recent studies with the use of ambulatory blood pressure monitoring have shown that the physiological nocturnal fall in blood pressure is blunted or absent in some individuals with type 1 diabetes who are completely normotensive by conventional criteria. Patients with type 1 diabetes and microalbuminuria have higher nocturnal blood pressure than either patients with type 1 diabetes and normal albumin excretion or age-matched controls. Moreover, changes in the circadian pattern of blood pressure in patients with type 1 diabetes may predict the development of albuminuria.
Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2005
PMID:[Changes in blood pressure and methods of blood pressure monitoring in patients with type-1 diabetes]. 1585 May 36

Diabetes and hypertension frequently coexist, and their combination provides additive increases in the risk of life-threatening cardiovascular events. Recent guidelines agree on the need for early, aggressive reduction of blood pressure, with a goal of <130/80 mmHg, in patients with diabetes. The mechanism that underpins the increased sensitivity of diabetic subjects to hypertension is not known, but may involve impaired autoregulation or attenuated nocturnal decrease of blood pressure. All classes of antihypertensive agents are effective in reducing blood pressure in diabetic subjects, and all show evidence of a concomitant reduction in cardiovascular risk. Although there is some evidence that agents that interrupt the renin-angiotensin system (RAS) provide greater protective effects, the data are not conclusive. However, most diabetic subjects will require combination therapy to reach goal blood pressure. Antihypertensive drugs can also significantly influence the probability that otherwise healthy individuals will develop metabolic syndrome or type 2 diabetes. While diuretics and betablockers have a prodiabetic effect, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers may prevent diabetes more effectively than the metabolically neutral calcium channel blockers. Given that diabetes is an important cardiovascular risk factor, there is the potential for reductions in risk due to reduced blood pressure to be offset by an increased risk due to the development of diabetes. Such concerns should be considered in the selection of antihypertensive therapy.
Acta Diabetol 2005 Apr
PMID:The association of hypertension and diabetes: prevalence, cardiovascular risk and protection by blood pressure reduction. 1586 15

Being overweight or obese has become highly prevalent in Western countries and are rapidly reaching epidemic proportions in the developing world. Obesity-related disorders, such as hypertension and diabetes, are also increasing at an alarming rate. The relationship between obesity, hypertension and insulin resistance is well recognised, but the molecular mechanisms involved remain relatively poorly understood. Adipose tissue plays a key role in the pathogenesis of the metabolic syndrome. It serves as an important source of pro-inflammatory molecules, including leptin, tumour necrosis factor alpha, angiotensin II and interleukin-6, as well as anti-inflammatory molecules, such as adiponectin. Knowledge of how these adipose tissue-derived factors influence metabolic and cardiovascular disease has recently expanded. Leptin is now considered to play a key role in the elevation of sympathetic activity commonly found in obese, hypertensive patients, and decreased secretion of adiponectin appears to be an important predictor of diabetes. The ectopic storage of excess fat in skeletal muscle, liver or pancreas, due to the decreased capacity of adipose tissue to scavenge excess calories, may also play a role in the development of insulin resistance and type 2 diabetes. Overall, continuing research into the relationship between adipose-tissue biology and metabolic abnormalities may lead to a better understanding of the molecular mechanisms underlying the relationship between obesity and cardiovascular disease, and ultimately provide alternative treatments for the control of potentially life-threatening conditions.
Acta Diabetol 2005 Apr
PMID:Obesity, hypertension and insulin resistance. 1586 17

Renal function is closely associated with cardiovascular risk, to the extent that even minor renal abnormalities, which are present in 10% of the general population, carry a greatly elevated risk of cardiovascular disease, target-organ damage and death. Reducing blood pressure by 20 mmHg or more in patients with severe hypertension (>160/100 mmHg) and advanced renal disease is sufficient to ensure a considerable reduction in proteinuria. In patients with less severe disease, however, blockade of the renin-angiotensin-aldosterone system (RAAS) is necessary to restore normal renal function. Clinical studies have shown that angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which both overcome the activity of angiotensin II, provide renoprotection in diabetics and non-diabetic populations. Which class of drugs is more effective remains a subject of debate, but the evidence favours ARBs for providing more effective renoprotection in patients at risk of diabetic nephropathy. The ARBs preserve renal haemodynamics and reduce progression to end-stage renal disease by around 25% in patients with overt nephropathy and prevent progression to overt disease by up to 70% in patients with mild renal impairment. The combination of ARBs and ACE inhibitors is even more protective, halving the number of patients with progression of renal impairment compared with either monotherapy. Long-term clinical studies now under way will help to establish the relative efficacies of the ARBs and ACE inhibitors and provide greater insight into the benefits of combination therapy.
Acta Diabetol 2005 Apr
PMID:Renin-angiotensin-aldosterone system blockade and renal protection: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers? 1586 18

Diabetic nephropathy is characterised by hypertension and persistent proteinuria. If ineffectively controlled, a progressive decline in renal function can result in end-stage renal disease. Patients with diabetic nephropathy are also at greatly increased risk of cardiovascular disease. Angiotensin-converting enzyme (ACE) inhibitors display additional renoprotective effects beyond systemic blood pressure lowering, perhaps due to reduction in intraglomerular pressure by inhibition of angiotensin II activity. In type 2 diabetics, ACE inhibitors have variable effects, with some studies showing a reduction in microalbuminuria, prevention of the progression to macroalbuminuria and maintenance of renal function. Randomised studies have demonstrated that angiotensin II receptor blockers (ARBs), as well as controlling systemic blood pressure, delay progression of proteinuria in patients with diabetic nephropathy. Telmisartan has a number of features that may make it particularly suitable for the treatment of diabetic nephropathy. In addition to its long duration of action and almost exclusive faecal excretion, its high lipophilicity should assist in tissue penetration. The Diabetics Exposed to Telmisartan And enalaprIL (DETAIL) study was designed to compare the long-term renal outcome of treatment with telmisartan 40.80 mg versus enalapril 10.20 mg (with titration to the higher dose after 4 weeks) in patients with type 2 diabetes, mild-to-moderate hypertension and albuminuria. The primary endpoint is the change in glomerular filtration rate after 5 years' randomised treatment. Secondary endpoints are annual changes in glomerular filtration rate, serum creatinine and urinary albumin excretion, as well as incidences of end-stage renal disease, cardiovascular events, all-cause mortality and adverse events. The groundbreaking DETAIL study revealed that telmisartan conferred comparable renoprotection to enalapril and was associated with a low incidence of mortality.
Acta Diabetol 2005 Apr
PMID:Preventing renal complications in diabetic patients: the Diabetics Exposed to Telmisartan And enalaprIL (DETAIL) study. 1586 19


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>