Body Weight Blood Pressure Research Articles

Early-Onset Type 2 Diabetes and Tirzepatide Treatment: A Post Hoc Analysis From the SURPASS Clinical Trial Program.

We evaluated baseline characteristics of participants with early-onset type 2 diabetes (T2D) from the SURPASS program and tirzepatide's effects on glycemic control, body weight (BW), and cardiometabolic markers. This post hoc analysis compared baseline characteristics and changes in mean HbA1c, BW, waist circumference (WC), lipids, and blood pressure (BP) in 3,792 participants with early-onset versus later-onset T2D at week 40 (A Study of Tirzepatide [LY3298176] in Participants With Type 2 Diabetes Not Controlled With Diet and Exercise Alone [SURPASS-1] and A Study of Tirzepatide [LY3298176] Versus Semaglutide Once Weekly as Add-on Therapy to Metformin in Participants With Type 2 Diabetes [SURPASS-2]) or week 52 (A Study of Tirzepatide [LY3298176] Versus Insulin Degludec in Participants With Type 2 Diabetes [SURPASS-3]). Analyses were performed by study on data from participants while on assigned treatment without rescue medication in case of persistent hyperglycemia. At baseline in SURPASS-2, participants with early-onset versus later-onset T2D were younger with longer diabetes duration (9 vs. 7 years, P < 0.001) higher glycemic levels (8.5% vs. 8.2%, P < 0.001), higher BW (97 vs. 93 kg, P < 0.001) and BMI (35 vs. 34 kg/m2, P < 0.001), and a similarly abnormal lipid profile (e.g., triglycerides 167 vs. 156 mg/dL). At week 40, similar improvements in HbA1c (-2.6% vs. -2.4%), BW (-14 vs. -13 kg), WC (-10 vs. -10 cm), triglycerides (-26% vs. -24%), HDL (7% vs. 7%), and systolic BP (-6 vs. -7 mmHg) were observed in both subgroups with tirzepatide. Despite younger age, participants with early-onset T2D from the SURPASS program had higher glycemic levels and worse overall metabolic health at baseline versus those with later-onset T2D. In this post hoc analysis, similar improvements in HbA1c, BW, and cardiometabolic markers were observed with tirzepatide, irrespective of age at T2D diagnosis. Future studies are needed to determine long-term outcomes of tirzepatide in early-onset T2D.

Is there any difference in the therapeutic effects of Levosimendan on advanced HFrEF patients with sinus rhythm or atrial fibrillation?

Patients with advanced heart failure have a high incidence of atrial fibrillation (AF) and develop into heart failure with reduced ejection fraction (HFrEF), and require higher doses of inotropes. However, it is uncertain about the differences in the effects of levosimendan in HFrEF patients with sinus rhythm or AF. A total of 63 advanced HFrEF subjects (ejection fraction < 40%) were divided into sinus rhythm (SR, n = 34) and atrial fibrillation (AF, n = 29) cohorts. All patients received six cycles of intermittent repeated levosimendan infusion. After 3 months of treatment, B-type natriuretic peptide (BNP), estimated glomerular filtration rate, resting heart rate (rHR), creatinine, left ventricle ejection fraction (LVEF), left ventricular end diastolic diameter and blood pressure body weight, NYHA classification were measured. After completing the course of treatment, LVEF, BNP, and rHR were significantly decreased (p < 0.0.5), and no significant differences between the two groups were observed (p > 0.05). The NYHA classification improved in the SR group but not in the AF group. There was no significant difference between patients with different rHRs (≤70 bpm vs. >70 bpm) in the SR group (p > 0.05) or in the AF group (rHR ≤ 90 bpm vs. rHR >90 bpm) (p > 0.05). This study showed no difference in the therapeutic effect of intermittent repeated levosimendan infusion on advanced HFrEF with different heart rhythms (SR or AF); Advanced HFrEF patients receive levosimendan treatment without taking the inference of heart rhythm.

BLOOD PRESSURE CHANGES OVER 18 MONTHS AFTER INITIATION OF ANTIRETROVIRAL THERAPY IN HIV INFECTED PATIENTS IN LILONGWE, MALAWI

Objective: The improved survival of people living with HIV (PLHIV) and the economic and demographic changes in sub-Saharan Africa are accompanied by a rising number of patients suffering from cardiovascular disease. According to a recent meta-analysis hypertension prevalence is higher in PLHIV on antiretroviral therapy (ART) compared to ART-naïve patients. As part of the ongoing prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we examined blood pressure (BP) changes in ambulatory PLHIV who initiated ART in urban Lilongwe, Malawi. Design and method: Anthropometric measurements of adult study participants at baseline and during study visits after 1, 3, 6 and every 6 months thereafter were recorded in an electronic patient registry. For the present analysis we surveyed systolic and diastolic BP values (oscillometric measurements) and body weight (BW) from this data base for patients who were still alive and active study participants at month 18. Student's t-test was used to compare systolic and diastolic BP, BW and their changes between baseline and month 18. Pearson's r was calculated to test for correlations between changes in BW and BP. Results: Data from 995 (577 females, mean age 36.7 ± 9.2 years) of the originally included 1436 PLHIV were analyzed. BW (p &lt; 0.001) and systolic BP (p &lt; 0.01) differed significantly between baseline and month 18. The change in systolic and diastolic BP correlated with the change in BW (r = 0.312 and r = 0.220, respectively; p &lt; 0.01). There were significant differences (p &lt; 0.001) in the mean change of systolic/diastolic BP between the lowest (-9.6 ± 18.8/-3.8 ± 12.9 mmHg) and highest (6.8 ± 19.2/4.3 ± 13.9 mmHg) quartile of the distribution of BW changes (decrease &gt;1.39 kg vs. increase &gt;6.09 kg). Also, the mean change in BW for normotensive patients at baseline who still had a BP &lt; 140/90 at month 18 (n = 722, 89.6%) compared to those whose BP values had increased to 140/90 mmHg or higher (n = 84, 10.4%) was significantly lower (2.3 ± 6.2 kg vs. 5.6 ± 7.6 kg, p &lt; 0.001). Conclusions: Increasing body weight due to the improved health status after ART initiation was associated with hypertensive BP values. Counselling of PLHIV regarding measures to control body weight should be embedded into patient education programs at HIV centers in countries like Malawi.

Achieving the composite endpoint of HbA1c, body weight, and systolic blood pressure reduction with canagliflozin in patients with type 2 diabetes

Objective: In addition to achieving glycemic control, weight loss and blood pressure (BP) reduction are important components of type 2 diabetes mellitus (T2DM) management, as many patients with T2DM are overweight/obese and/or have hypertension. Canagliflozin, an SGLT2 inhibitor, has demonstrated improvements in HbA1c, body weight (BW), and systolic BP across a broad range of patients with T2DM. This analysis evaluated achievement of composite endpoints of HbA1c, BW, and systolic BP targets with canagliflozin versus placebo.Methods: This post hoc analysis evaluated the proportion of T2DM patients achieving the composite endpoint of HbA1c reduction ≥0.5%, BW reduction ≥3%, and systolic BP reduction ≥4mmHg with canagliflozin 100 and 300mg compared with placebo using pooled data from four 26-week, phase 3 studies (N = 2313; NCT01081834, NCT01106677, NCT01106625, NCT01106690). The proportion of patients achieving the composite endpoint of HbA1c <7.0%, BW reduction ≥3%, and BP <130/80 mmHg was also evaluated.Results: At week 26, greater proportions of patients met individual HbA1c, BW, and systolic BP targets with canagliflozin versus placebo. A greater proportion of patients treated with canagliflozin 100 or 300 mg versus placebo also achieved the composite endpoint of HbA1c reduction ≥0.5%, BW reduction ≥3%, and systolic BP reduction ≥4 mmHg at week 26 (21.1%, 25.3%, and 5.7%, respectively; odds ratios [95% CI] of 4.5 [3.1, 6.5] and 5.6 [3.8, 8.2]). A greater proportion of patients also achieved the composite endpoint of HbA1c <7.0%, BW reduction ≥3%, and BP <130/80 mmHg with canagliflozin 100 and 300 mg versus placebo (14.7%, 20.9%, and 3.3%, respectively; odds ratios [95% CI] of 5.2 [3.2, 8.4] and 8.4 [5.2, 13.5]). Canagliflozin was generally well tolerated, with a safety profile similar to that seen in other phase 3 studies.Conclusions: Patients with T2DM were more likely to achieve clinically important reductions in HbA1c, BW, and systolic BP with canagliflozin versus placebo.

HIGH INTENSITY EXERCISE;

Objectives: To clarify the interrelationship of high intensity exercise and durationof time on lipid profile, blood pressure and, body weight in young hyperlipidemic adults andto evaluate the beneficial effects on health in possible shorter duration of time. Study Design:Case control study. Setting: Department of Physiology, BMSI, JPMC, Karachi. Period: January2012 to April 2012. Methods: Total numbers of 60 volunteers moderately active, younghyperlipidemic adults, aged 30 to 50 years, thirty for each A (control), and B (high intensityexercise) group respectively were assigned to participate for 12 weeks exercise programwithout restricted caloric diet at pre–identified track of specific time. Lipids profile and age, sex,weight, BMI, blood pressure, and lab investigations like serum Total cholesterol, Triglycerides,LDL, and HDL, of each participant were recorded at baseline (0 day) and similarly on day30, 60 and 90 respectively. Results: At the end of the 12 weeks program in high intensityexercise group significant effects have been observed by lowering the level of total cholesterol,triglyceride (p &lt;0.05) and lipoproteins variables, with increasing the level of HDL-c. While nosignificant change in blood pressure and weight reduction was observed between indicialand final measurement in control and high intensity exercise groups (p&lt;o.o5). Conclusion:Finding of this study suggest that, high intensity exercise has positive effects on lipid profileby lowering the level of total cholesterol(TC), triglycerides(TGs) low density lipoprotein (LDL-c)and increasing the level of high density lipoprotein (HDL-c) in hyperlipidemic adults rapidlyin short duration of time, thus have beneficial effects by reducing the cardiac risk factors,chronic metabolic disorders and improving the cardio respiratory fitness but reduction in bloodpressure body weight can be achieved in short time by combination of high intensity exerciseand nutritional guidance of caloric restriction.

Cardiac Fibrosis in Tg (mREN2)Rats (TGR) Involves Both At-1 and Endothelin Receptors

P60 Ang II plays a role in cardiac hypertrophy (CH) and was associated to cardiac fibrosis (CF). However, data are conflicting on the occurrence of CF and little is known on the mechanisms leading to collagen deposition and CF in TGR, a model of CH with an activated tissue renin-angiotensin system (RAS). Thus, we investigated if: 1) CH is associated with excess collagen deposition; 2) the RAS, and/or the endothelin (ET) system contribute to the development of CF. Four-wk old TGR were body weight (BW)- and blood pressure (BP)-matched randomly allocated to receiving the following (oral) treatments for 4 weeks : placebo (P), Bosentan (100 mg/Kg b.w., B) and Irbesartan (50 mg/kg b.w., I). BW and systolic BP were measured weekly. After rats were euthanized, 5 μm thick equatorial sections of the left ventricle (LV) werestained with Sirius Red to visualize fibrillar collagen. A quantitative analysis of percent collagen areas (CA) was performed with a Leica DM photomicroscope coupled to a PC with Qwin Leica Image Software. Development of severe hypertension and CH was prevented in group I (BP: 160±mmHg; normalized LV wt: 2.28±0.06 mg/g bw, p&lt;0.0001 by ANOVA &amp; Bonferroni test), but not inboth groups P (BP:262±; 3.71±.10) and B (275±; 3.38±.11). At variance, collagen deposition was significantly reduced not only in group I (CA % arb. Units: 1.38±.10) , but also in B (1.33±.10), compared to P (2.19±.40, p&lt;0.0001). Thus, hypertension and CH are associated with excess collagen deposition in the LV of TGR rats. Although both hypertension and CH were prevented by selective AT1 but not mixed ETA/ETB receptor blockade, both treatments hindered CF. Thus, our data show a dissociation between the BP changes and the molecular mechanisms underlying fibrosis, which do and do not involve ET-1, respectively.

Cardiac fibrosis in Tg(mREN2)rats (TGR) involves both AT-1 and endothelin receptors.

P60 Ang II plays a role in cardiac hypertrophy (CH) and was associated to cardiac fibrosis (CF). However, data are conflicting on the occurrence of CF and little is known on the mechanisms leading to collagen deposition and CF in TGR, a model of CH with an activated tissue renin-angiotensin system (RAS). Thus, we investigated if: 1) CH is associated with excess collagen deposition; 2) the RAS, and/or the endothelin (ET) system contribute to the development of CF. Four-wk old TGR were body weight (BW)- and blood pressure (BP)-matched randomly allocated to receiving the following (oral) treatments for 4 weeks : placebo (P), Bosentan (100 mg/Kg b.w., B) and Irbesartan (50 mg/kg b.w., I). BW and systolic BP were measured weekly. After rats were euthanized, 5 μm thick equatorial sections of the left ventricle (LV) werestained with Sirius Red to visualize fibrillar collagen. A quantitative analysis of percent collagen areas (CA) was performed with a Leica DM photomicroscope coupled to a PC with Qwin Leica Image Software. Development of severe hypertension and CH was prevented in group I (BP: 160±mmHg; normalized LV wt: 2.28±0.06 mg/g bw, p