Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

Serum levels of angiotensin-converting enzyme (ACE) were measured in 53 patients with type II (non-insulin-dependent) diabetes (25 without ophthalmologic complications, 20 with background retinopathy, and eight with proliferative retinopathy) and in 33 healthy nondiabetic subjects. Diabetic subjects were excluded if they had hypertension, ischemic heart disease, peripheral vascular disease, or an elevated urine albumin level. After an overnight fast, blood was taken for determination of ACE, blood glucose, glycosylated hemoglobin (HbA1), and C peptide levels. Data were analyzed according to the nonpaired Student's t test and linear regression analysis. Levels of ACE were significantly elevated in the whole diabetic group as compared with control subjects (334.0 U/L +/- 97.0 vs 250.5 U/L +/- 85.5, P less than .001). This elevation was more marked in those diabetics with background retinopathy (344.6 U/L +/- 96.8, P less than .001) and proliferative retinopathy (357.3 U/L +/- 93.2, P less than .01); no significant difference was found between ACE levels of diabetics without complications and those of control subjects. No correlation was found between ACE levels and HbA1, blood glucose, or C peptide values. We conclude that ACE levels are elevated in type II diabetes, chiefly in patients with retinopathy. This finding may reflect microvascular damage caused by secretion of ACE by the vascular endothelial cells.
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PMID:Elevated serum levels of angiotensin-converting enzyme in patients with diabetic retinopathy. 215 94

Increased glycosylation of various proteins in diabetic patients has been reported by many authors. In the present study, the extent of non-enzymatic glycosylation in diabetic patients with or without chronic complications was investigated. Eighty-five diabetic patients were studied, 20 were without any clinical evidence of chronic complications while the remainder were suffering from cataract (n = 18), retinopathy (n = 16), peripheral neuropathy (n = 16) and cardiovascular complications like angina pectoris, myocardial infarction and hypertension (n = 15). All patients were selected on clinical grounds. Fifteen apparently healthy subjects of similar age and weight were studied as control subjects. Fasting plasma glucose was increased in all diabetic patients and correlated significantly with glycosylated hemoglobin, glycosylated plasma protein and serum fructosamine concentrations. There was no significant difference between diabetic patients with or without chronic complications in the levels of fasting plasma glucose, glycosylated plasma proteins, glycosylated hemoglobin, serum fructosamine, mucoprotein, hexosamine, sialic acid and fucose. Alpha-2 globulin fraction was increased in both uncomplicated and complicated diabetic patients and albumin was found to be decreased in patients with cataract, peripheral neuropathy and cardiovascular diseases. Alpha-1 and beta globulins were significantly decreased in patients with cardiovascular diseases and retinopathy respectively while gamma globulin was increased in retinopathy patients. In uncomplicated diabetic patients alpha-1 glycoprotein was decreased and gamma glycoprotein was increased. In diabetic patients with retinopathy, alpha-1 glycoprotein was elevated significantly while beta glycoprotein was decreased.
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PMID:Changes in glycosylated proteins in long-term complications of diabetes mellitus. 216 68

Anemia of malignancy is a complication of neoplastic disease which causes impairing symptoms and often requires blood transfusions. In this clinical trial, we have treated 13 patients suffering from chronic anemia of malignancy and multiple myeloma with recombinant human erythropoietin (rHuEPO) three times a week. Eleven patients responded to the treatment by appropriate increases of their hemoglobin levels and the eventual correction of the anemic state, one non-responding patient had to terminate the treatment early because of transfusion requirements. Under rHuEPO therapy, the evaluated parameters of iron metabolism indicated the enhanced synthesis of hemoglobin. The symptoms of anemia subsided in the responding patients and most of them reported a hightened subjective sense of well-being. No adverse side effects, particularly no episodes of hypertension, were observed in any patient.
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PMID:[Erythropoietin treatment of tumor-associated anemia in patients with multiple myeloma]. 218 25

This perspective deals with prediction of overt diabetic nephropathy in patients with insulin-dependent diabetes mellitus (IDDM). The role of elevated urinary albumin excretion rate (microalbuminuria) in predicting diabetic nephropathy has been emphasized by new follow-up studies. Development of severe kidney impairment was seen in a large percentage of patients with microalbuminuria, but with more intensive care for diabetic patients, this percentage may be falling. Herein, I analyzed alternatives to microalbuminuria in predicting kidney disease in diabetes. 1) Parental predisposition to hypertension is not seen in all studies and therefore may not be a decisive factor, and it cannot be used in prediction of nephropathy. 2) Prediabetic blood pressure may predict nephropathy in certain non-insulin-dependent diabetic patients, but elevated blood pressure seems to develop after early microalbuminuria and is likely to be an aggravating factor in established microalbuminuria in IDDM patients. 3) At the clinical diagnosis of IDDM, diabetic nephropathy cannot be predicted. 4) Glycemic control is poor in normoalbuminuric patients with later development of microalbuminuria, and multiple glycosylated hemoglobin measurements are therefore important. 5) In diabetes, glomerular hyperfiltration is associated with late nephropathy, but it alone cannot be the decisive factor, because hyperfiltration in nondiabetic individuals does not produce kidney disease, according to new long-term follow-up studies. 6) Studies of glomerular structure and ultrastructure have not yet documented predictive values for overt nephropathy, but further studies are in progress. 7) Isolated blood pressure elevation without microabuminuria (probably representing essential hypertension in diabetes) has not been predictive. 8) It is clear that elevation of serum creatinine is a very late and insensitive parameter, occurring only with pronounced proteinuria.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prediction of clinical diabetic nephropathy in IDDM patients. Alternatives to microalbuminuria? 219 82

High blood pressure, but also diabetes mellitus and even glucose intolerance are well known risk factors for premature cardiovascular morbidity and mortality. To counteract these sequelae, it is obvious that drug treatment of hypertension should not adversely affect the glucose homeostasis in nondiabetic as well as in diabetic patients. Therefore, the findings that calcium antagonists could dose-dependently throttle the insulin output after addition of glucose in pancreas perfusion experiments in vitro were of considerable concern. Within the last years, most of more than 100 short-term and long-term trials in diabetic and non-diabetic patients were able to show that different calcium antagonists at their "usual" antihypertensive dosages did not impair the glucose metabolism, whereas results of acute studies, especially with higher doses and after a glucose challenge, were more controversial. However, in all of the 13 long-term follow-up trials (up to 5 years) with determinations of the glycated hemoglobin published to date, this most relevant parameter remained unchanged. Thus, currently available data indicate that calcium antagonists do not alter glucose handling at a clinically relevant degree, both in non-diabetic or diabetic patients, so that it is not justified to withhold the benefits of these medications from hypertensives out of fear to introduce a deterioration in their carbohydrate homeostasis.
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PMID:Glucose metabolism and calcium antagonists. 220 27

A population-based prospective study of insulin-dependent diabetics between the ages of 14-30 southern Wisconsin examined the relationship between oral contraceptive use and presence and severity of diabetic retinopathy, hypertension and glycosylated hemoglobin (HbA1). HbA1 is a measure of overall control of hyperglycemia. Out of 10,135 diabetic patients of 452 physicians in an 11-county area of Wisconsin, 432 were women between 14-30, and were followed from 1980-1986. The exit interview and exam consisted of pupil dilatation, stereoscopic fundus photographs, blood glucose by Chemstrip, blood pressure and determination of HbA1 with a resin microcolumn. 384 of these women provided oral contraceptive use history at follow-up. 170 ever used pills, 62 for 1yr, 59 for 2-4 yr, and 49 for 5 or more years. There was a trend toward current pill use with less severe diabetic retinopathy. There was no evidence of an association between ever using pills and the severity of diabetic retinopathy, controlling for age, duration of diabetes, systolic or diastolic blood pressure, HbA1, proteinuria or body mass index. Duration of diabetes, diastolic blood pressure, proteinuria and HbA1 were significantly associated with severity of retinopathy, while age, systolic blood pressure and body mass were not. Current, prior or duration of use of pills did not show significant effects on severity of retinopathy. Number of daily doses of insulin were inversely significantly related to HbA1.
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PMID:Oral contraceptives in women with diabetes. 220 28

Ten children with renal failure (age range 2 years 6 months to 18 years 9 months; median 11 years 10 months), maintained by long-term hemodialysis, had successful correction of their anemia after intravenous administration of recombinant human erythropoietin in a dosage escalating every 2 weeks (75 to 150 to 300 to 450 IU/kg/wk). Mean hemoglobin concentration increased from 6.4 +/- 0.9 to 11.5 +/- 1.0 gm/dl. Blood cell counts used to evaluate the correction of anemia were done after dialysis; this was especially important for children less compliant with water restriction. The higher hemoglobin concentration resulted in improvement of the quality of life, a greater tolerance for physical effort (exercise tolerance doubled and the ventilatory anaerobic threshold increased significantly), correction of some subclinical central nervous system abnormalities detected by evoked potentials testing, and reduction of bleeding time. Few side effects were noted; severe hypertension developed in one patient when postdialysis hematocrit was only 28%, and there were two episodes of hypertransaminasemia with no other evidence of liver dysfunction. We conclude that in children with renal failure the use of recombinant human erythropoietin to correct anemia is safe and strongly advisable, because of the resolution of many of the symptoms correlated with anemia.
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PMID:Benefits and risks of anemia correction with recombinant human erythropoietin in children maintained by hemodialysis. 221 78

We evaluated the need for erythropoietin (EPO) treatment in 134 end-stage renal disease patients assuming a level of hemoglobin below 6 mmol/l (9.6 g/dl) as indication for treatment. 91 patients (68%) fulfilled this criterion. Absolute contraindications in 2 patients were previous thrombotic encephalopathy and refusal of treatment. Relative contraindications due to cardiac disease were found in 3 patients. In 15 patients additional treatment was required because of hypertension (5) or deficiency states (10). The implications of elevated serum PTH and aluminum overload are discussed.
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PMID:On the need for erythropoietin treatment in dialysis patients. A Copenhagen City Dialysis Unit study. 222 88

Data on 100 consecutive non-emergency coronary artery bypass (CABG) patients were analyzed retrospectively. Sixty-nine patients received no homologous blood (Group I). Thirty-one patients received a total of 118 units of blood products averaging 2.23 units of red cells (Group II). The average red cell transfusion rate for all patients was 0.7 units per patient. The median age for Group I was 61 and Group II was 68 years (p less than 0.05). The average number of grafts was the same for both (3 per patient) with 75% of Group I and 58% of Group II receiving internal mammary artery (IMA) grafts (p less than 0.05). Twelve of the Group II patients who received intraoperative transfusions on cardiopulmonary bypass to maintain adequate hemoglobin levels were older and had lower admission hematocrits: 36 +/- 0.8% compared to 41 +/- 0.5% for all other patients (p less than 0.05). Average postoperative blood loss was 889 +/- 38 ml for Group I and 1077 +/- 104 ml for Group II (p less than 0.05). Increased hemorrhage was correlated with bypass time and IMA use but not with preoperative heparin administration, pre-existing risk factors (diabetes, hypertension, etc.), bleeding time, post-bypass clotting time, age or number of grafts. Two patients in Group II and none in Group I required exploration for excessive postoperative hemorrhage. Mortality rate was 2% (both in Group II, neither transfusion related). Discharge hematocrits were the same for all at 29.4 +/- 0.4%. Among anemia-related postoperative symptoms, only sinus tachycardia was significantly higher in Group I (20%) compared to Group II (6.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aggressive blood conservation in coronary artery surgery: impact on patient care. 222 48

Recombinant human erythropoietin is effective therapy for the anemia of chronic renal failure. Hypertension, seizures, dialysis access thromboses, and clotted dialyzers have been reported as problems associated with the use of this drug. To test the hypothesis that low-dose erythropoietin is effective and safe, we gave 37 chronic hemodialysis patients this compound (3,000 units, i.v.) three times each week for 3 months. Before and for 3 months during therapy, we measured hemoglobin, hematocrit, blood transfusions, blood pressure, access thromboses, seizures, and clotted dialyzers. After 2 months of treatment, mean hemoglobin concentration and mean hematocrit increased significantly. Five patients had no increase in either value. In 4 of these 5 nonresponders, blood loss accounted for treatment failure. Neither blood pressure nor the incidence of access thromboses, seizures, and clotted dialyzers changed during the 3 months of therapy. We conclude that recombinant human erythropoietin is effective as treatment for the anemia of chronic renal failure at much lower doses than have been reported previously. The low incidence of adverse events may be related to the low dose used.
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PMID:The treatment of anemia with low-dose recombinant human erythropoietin. 226 Jun 17


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