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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The basic mechanisms that initiate and sustain hypertension in type 2 diabetics are poorly understood. Contributing factors discussed in this review include obesity, insulin resistance, hyperinsulinemia, genetic factors, and abnormalities of cellular cation homeostasis. Also discussed are the features of hypertension in type 2 diabetic individuals that are reminiscent of the hemodynamic abnormalities characterizing hypertension in the elderly, including increased vascular reactivity and increased atherosclerotic vascular disease. This article reviews mechanisms by which hyperinsulinemia, insulin resistance, or both may lead to hypertension.
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PMID:Diabetes and hypertension: a review. 165 39

The frequency of all forms of atherosclerotic vascular disease is much greater in diabetics than in nondiabetics. Abnormalities in both the quantity and the quality of lipoproteins are among the many factors that can contribute to this. The most frequent quantitative lipoprotein abnormality in diabetics is hypertriglyceridemia. High-density lipoprotein (HDL) levels may be reduced, normal, or increased depending on the type of diabetes, its treatment, and the presence or absence of obesity. Low-density lipoprotein (LDL) levels in diabetics generally are not different from those in nondiabetics. The qualitative changes in lipoprotein composition may include alterations in the C apolipoproteins that could retard very low-density lipoproteins (VLDL) catabolism, enrichment of LDL and HDL with triglyceride, and modifications of LDL (e.g., glycosylation or oxidation) that makes it more atherogenic. The present rationale for the treatment of LDL abnormalities in diabetics is based on extrapolation from intervention trials in nondiabetics. These trials have suggested targets for plasma and LDL cholesterol levels. To date, no similar trials have been conducted in diabetics. Hence, it is not known whether the same or even lower LDL targets should apply to diabetics. Primary intervention trials have also shown the benefits, at least in nondiabetics, of increasing HDL levels. There is increasing evidence to support a cardiovascular risk effect of hypertriglyceridemia and one secondary intervention trial has demonstrated benefit associated with the correction of this. An added benefit of triglyceride reduction, at least in the milder diabetics, appears to be an improvement in insulin sensitivity. Fibrates are the drugs of choice for the correction of hypertriglyceridemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of various lipid-lowering treatments in diabetics. 171 Jul 44

Although the pathogenesis of obesity in OZR is unknown, the association among hyperinsulinemia, insulin resistance, and hyperlipidemia suggests that investigations using OZR may help define how a number of vascular disease risk factors interact to cause end-organ damage. Like other rat strains, OZR do not develop atherosclerosis spontaneously. Nevertheless, in an endothelial injury model, atherosclerosis was worse in OZR than in LZR. Perhaps more intriguing is the fact that OZR develop spontaneous glomerular injury. Although the mechanisms important in the development and progression of glomerular injury in OZR remain to be clarified, both lipid abnormalities and glomerular hemodynamic alterations could play a role.
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PMID:The Zucker rat model of obesity, insulin resistance, hyperlipidemia, and renal injury. 173 Apr 47

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.
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PMID:The vascular history and physical examination. 173 54

Three prospective population studies on non-diabetic subjects--the Helsinki Policemen Study, the Busselton Study, and the Paris Prospective Study--have shown that high plasma insulin levels, fasting or after oral glucose load, are associated with an increased risk of coronary heart disease (CHD). The excess of CHD events accumulating in the highest quintiles or deciles for plasma insulin and multivariate analyses suggests that the predictive value of plasma insulin with regard to CHD risk would be independent of blood glucose levels and other major CHD risk factors. Interpretation of the results of multivariate analyses including plasma insulin is, however, complex owing to relatively strong correlations between plasma insulin and several other risk factors. Interaction of the predictive value of plasma insulin with other risk factors, such as obesity, plasma lipids and lipoproteins, and blood pressure also deserves consideration. Analyses of the follow-up data from the Paris Prospective Study have in fact shown that such interaction exists with regard to obesity, high plasma insulin levels being predictive of increased risk of CHD in obese subjects but not in lean subjects. No information is available about the possible relationship between plasma free-insulin levels and atherosclerotic vascular disease (ASVD) in patients with insulin-dependent type diabetes receiving insulin treatment. Information concerning the relationship of plasma insulin to ASVD in subjects with impaired glucose tolerance (IGT) or non-insulin-dependent diabetes (NIDD) is so far fragmentary but suggests that elevated plasma insulin levels would be predictive of increased risk of ASVD in NIDD and its precursor stage, IGT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyperinsulinaemia as predictor of atherosclerotic vascular disease: epidemiological evidence. 183 87

Two diabetic women with pelvic malignancies developed necrotizing fasciitis within the irradiation fields. Despite aggressive surgical and medical therapy, both died when their health became too unstable for them to tolerate further surgery to resect the residual infection. We attribute their poor outcome to several factors. First, postradiation tissue changes obscured the early clinical findings necessary for a prompt diagnosis and made the identification of adequate surgical margins difficult. Second, diabetic patients have increased susceptibility to this infection. Third, the cumulative effects of radiation, diabetes mellitus and other factors that are common in patients with gynecologic malignancy (advanced age, vascular disease, obesity) favor the development, progression and persistence of necrotizing fasciitis. Radiographic studies were helpful in defining the extent of the infection in one patient.
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PMID:Necrotizing fasciitis in irradiated tissue from diabetic women. A report of two cases. 186 3

The risk factors vascular disease, smoking, alcohol, a diet high in saturated fat and cholesterol, sedentary life style, obesity, glucose intolerance and diabetes, high salt intake, oral contraceptives, left ventricular disease, hyperlipidemia, hyperfibrinogenemia, and uricemia are discussed in terms of evidence for added risk to hypertensive patients. Most of these risk factors have been extensively studied as contributors to the vascular diseases of the heart, brain and peripheral circulation, but not specifically in hypertensive people. For example, there is definite evidence that women with high blood pressure are at risk for coronary heart disease, and that oral contraceptives may raise blood pressure, but there are not large studies examining the level of risk for vascular disease for hypertensive women who take the pill. Similarly, the vascular risks to women who smoke and use orals are known to be multiplied, but one can only assume that hypertensive women smokers who contemplate using the pill would be at even higher risk. An exception is exercise, which has been shown to be as effective as drug therapy in lowering blood pressure and other cardiac risk factors. Generally many of these risk factors interact in a logarithmic, rather than additive manner. Furthermore, these risk factors tend to occur together more frequently in the same patient with high blood pressure more than they do in the normotensive population. High blood pressure is itself an independent risk factor for vascular disease, in proportion to its height, for all ages and sexes, whether systolic or diastolic, labile or fixed, and the threat is further aggravated by surges in blood pressure throughout the person's daily activities. In pharmacologic management of hypertension, it is important to ensure that the drug chosen does not aggravate other risk factors, such as hyperglycemia, cardiac arrhythmias or mobilization of uric acid.
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PMID:Management of vascular risk factors in the hypertensive patient. 214 91

It is now well recognized that insulin resistance and/or hyperinsulinemia are characteristic of a number of common human disease states including obesity, non-insulin dependent diabetes mellitus (NIDDM), essential hypertension, and atherosclerotic cardiovascular disease. More recent evidence suggests that impaired insulin action and elevated levels of circulating insulin may also be present in a substantial proportion of apparently healthy nonobese individuals. Considerable attention is now being focused on the potential long term adverse consequences of elevated circulating insulin levels. In particular, the frequent concurrence of these clinical disorders of carbohydrate metabolism, lipid metabolism, and vascular disease has led to the hypothesis that insulin resistance and the ensuing hyperinsulinemia may be a common pathophysiologic factor in the etiology of these disease states. In this review, we will examine the evidence for this hypothesis with particular attention to the adverse effects of chronic hyperinsulinemia.
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PMID:Hyperinsulinemia and its sequelae. 220 24

Duplex Doppler ultrasound has come to play a central role in the diagnosis of a broad spectrum of vascular diseases such as carotid artery occlusive disease and deep vein thrombosis. The role of duplex Doppler in the evaluation of intra-abdominal vascular disease remains unclear. This article summarizes the current status of duplex scanning in the investigation of the mesenteric arteries, the renal arteries, and the portal venous system. The examination is technically demanding, operator-dependent, time-consuming, and frequently unsatisfactory due to bowel gas, obesity, complex anatomy, or postoperative alterations in the normal anatomic patterns. Its advantages reside primarily in the absence of toxicity and in the generation of physiologic as well as anatomic information. In centers with the proper instrumentation and a skilled technician, duplex examination can be useful in the diagnosis and management of abdominal vascular disease and avoids the inherent dangers of contrast angiography.
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PMID:Current status of duplex Doppler ultrasound in the examination of the abdominal vasculature. 225 21

The association of hypertension, diabetes mellitus and abnormal lipoprotein patterns suggests that this combination has a lethal effect with regard to vascular disease. It is therefore necessary to do something about the known lifestyle factors such as cigarette smoking, obesity and possibly a low fibre diet. The high incidence of ischaemic heart disease among emigrant Indians in South Africa and Trinidad, and the low incidence in blacks of South Africa and the West Indies, suggests that there may be different thresholds for susceptibility to disease in various ethnic groups, beyond which the risk factors begin to operate.
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PMID:Hypertension and vascular disease in India and migrant Indian populations in the world. 225 88


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