Coexistence Of Hypertension Research Articles

The spectrum and burden of Vitreo-retinal diseases among ophthalmic out-patients in a tertiary care hospital: A retrospective study

Objective: To evaluate the spectrum and frequency of patients presenting with vitreo-retinal diseases at a tertiary care hospital in Gujarat.Material and Methods: A total of 92922 patients were seen on OPD basis at the Department of Ophthalmology, GMERS Medical College, Gandhi Nagar, from 01 January 2018 to 31 December 2020. Their data was obtained from the OPD register. Demographic details, evaluation of vision with refraction, anterior segment slit lamp examination, dilated posterior segment slit lamp examination with 90 D lens, indirect ophthalmoscopy with 20 D lens were done. When needed ultrasound (B Scan), Fundus Fluorescein angiography and OCT examination were also done. Data was analysed for simple frequency and inter group differences were performed using the Chi-Square test.Results: Out of the total OPD patients, 4952 patients had vitreo-retinal diseases. Diabetic retinopathy was the most common vitreo-retinal disease. Vision threatening DR was found in 884 patients having DR. Age related macular degeneration (ARMD) and Retinal Vascular occlusive diseases were the next common vitreo retinal diseases causing vision impairment. Co-existent DM and Hypertension were the most common associated systemic diseases. Hematological tests, OCT were the most commonly done investigations.Conclusion: Diabetes is major factor contributing to blindness due to vitreo retinal diseases in the form of Diabetic Retinopathy and its association with retinal vessel occlusive disease. With the changing demographic in the coming years, this problem is going to increase. The time has now come to rise up to the situation and plan the establishment of human resources, early screening, timely management and awareness of the disease and to make it affordable and easily accessible to the community.

Cannabis Use and Electrocardiographic Myocardial Injury

Multiple observational studies have demonstrated an association with cannabis use and acute myocardial infarction, especially among young adults. However, little is known about the connection with subclinical or electrocardiographic myocardial injury. We hypothesized that cannabis use would be associated with an increased risk of myocardial injury as defined by the cardiac infarction and/or injury score (CIIS). This analysis included 3,634 (age 48.0 ± 5.9 years, 47.1% male, 68.7% Caucasians) participants from the Third National Health and Examination Survey. Cannabis use was defined by self-report. Those with history of cardiovascular disease were excluded. Myocardial injury was defined as electrocardiographic CIIS ≥ 10. Multivariable logistic regression was used to examine the association between cannabis use and myocardial injury. The consistency of this association was tested among subgroups stratified by race, gender, tobacco smoking status, and comorbidities. About 26.0% (n = 900) of participants were ever-cannabis users and 15.5% (n = 538) had myocardial injury. In a model adjusted for potential confounders, ever-cannabis users had 43% increased odds of myocardial injury compared to never users (Odds ratio (95% confidence interval): 1.43 (1.14, 1.80); p = 0.002). This association was stronger among participants with a history of hypertension versus those without (Odds ratio (95% confidence interval): 1.83 (1.36, 2.47) vs 1.17 (0.83, 1.64), respectively; interaction p value 0.04). Cannabis use is associated with an increased risk of myocardial injury among those without cardiovascular disease with effect modification by co-existent hypertension. These novel findings underscore the harmful effects of cannabis use on cardiovascular health and also merit a personalized risk assessment when counseling patients with hypertension on its use.

A Genome-Wide Association Study for Hypertensive Kidney Disease in Korean Men.

Hypertension is one of the major risk factors for chronic kidney disease (CKD), and the coexistence of hypertension and CKD increases morbidity and mortality. Although many genetic factors have been identified separately for hypertension and kidney disease, studies specifically focused on hypertensive kidney disease (HKD) have been rare. Therefore, this study aimed to identify loci or genes associated with HKD. A genome-wide association study (GWAS) was conducted using two Korean cohorts, the Health Examinee (HEXA) and Korean Association REsource (KARE). Consequently, 19 single nucleotide polymorphisms (SNPs) were found to be significantly associated with HKD in the discovery and replication phases (p < 5 × 10−8, p < 0.05, respectively). We further analyzed HKD-related traits such as the estimated glomerular filtration rate (eGFR), creatinine, blood urea nitrogen (BUN), systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the 14q21.2 locus, which showed a strong linkage disequilibrium (LD). Expression quantitative trait loci (eQTL) analysis was also performed to determine whether HKD-related SNPs affect gene expression changes in glomerular and arterial tissues. The results suggested that the FANCM gene may affect the development of HKD through an integrated analysis of eQTL and GWAS and was the most significantly associated candidate gene. Taken together, this study indicated that the FANCM gene is involved in the pathogenesis of HKD. Additionally, our results will be useful in prioritizing other genes for further experiments.

Association between Systolic Blood Pressure and Diabetic Retinopathy in Both Hypertensive and Normotensive Patients with Type 2 Diabetes: Risk Factors and Healthcare Implications.

A common diabetes-related microvascular complication is diabetic retinopathy (DR), yet associations between blood pressure (BP) and risks for DR in diabetic patients with normal BP received inadequate attention. This may lead to ‘clinical inertia’ in early DR prevention. We aimed to assess whether the extent to which systolic BP levels were associated with DR in patients with type 2 diabetes (T2DM) and normal BP were similar to that in those with concurrent hypertension. Data were collected from patients with T2DM attending ophthalmic check-up with primary care referral (n = 2510). BP measurements, clinical laboratory tests, and dilated fundus examination were conducted according to gold standard of diagnosis and routine clinical procedure. Of all subjects, over 40% were normotensive and one fifth were clinically diagnosed with DR. Systolic BP levels increased across DR categories of escalated severity irrespective of the coexistence of hypertension. Ordinal logistic regression analysis showed that an increased systolic BP was independently and significantly associated with DR (adjusted odds ratio [aOR] = 1.020, p < 0.001 for hypertensives; aOR = 1.019, p = 0.018 for normotensives), after adjusting for diabetes duration, sex, lifestyles, and haemoglobin A1c levels. Regular monitoring of systolic BP should not be neglected in routine diabetes management even when BP falls within the normal range. (200 words)

Subclinical impact of diabetes and hypertention on left ventricular function

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Assessment of longitudinal left ventricular (LV) function has a major clinical significance for the early detection of contractile LV dysfonction. The measurement of the MAPSE (Mitral annular plane systolic excursion) and the systolic peak velocity of the edge of the mitral ring (Sm) allow an accurate assessment of longitudinal systolic performance Objective The aim of this study was to compare the impact of isolated type 2 diabetes and the coexistence of hypertension and diabetes on LV longitudinal systolic performance. Patients and Methods The study included 170 diabetic patients, of whom 85 had both hypertension and diabetes, and 50 controls. The systolic mitral annulus (Sm) velocity by tissue Doppler and the Mitral annular plane systolic excursion (MAPSE) by M mode were measured in all subjects. Results The mean age was 52.8 ± 15 years with a sex ratio M / F 0.23 in diabetic patients, and a mean age 60.8 ± 8 years with a sex ratio M / F 0.45 in control subjects. The mean MAPSE value was reduced in diabetics (11.5 ± 2.6 mm) and even more in hypertensive diabetics (10.5 ± 3.0 mm) compared to controls (16.1 ± 2.4 mm ) (p = 0.02). Similar results were found for Sm (controls, 12.4 ± 2.5 cm / s; diabetics, 9.0 ± "3.3 cm / s; diabetic hypertensive, 7.3 ± 2.0 cm) (p = 0.04). Conclusions diabetics present a depression of the LV longitudinal systolic indices compared to healthy controls; the coexistence of diabetes and hypertension results in further impairment of LV longitudinal systolic function in an additive manner.

The Significance of Vascular Pathogenesis in the Examination of Corticobasal Syndrome

Corticobasal syndrome (CBS) is a clinical entity, classified as an atypical Parkinsonism, characterized by both motor and higher cortical dysfunctions. The clinical manifestation of CBS is associated with several pathologies, among which corticobasal degeneration (CBD) is the most common. The aim of our study was to elaborate on the possible vascular pathogenesis of CBS and consider types of vascular lesions in these cases. Several cases of vascular CBS are described in the literature. The majority of presented patients were affected by internal carotid artery (ICA) stenosis and ischemic strokes; few cases were associated with vascular malformations or autoimmune diseases. Vascular CBS is preceded by an abrupt onset. The clinical manifestation does not significantly differ with non-vascular CBS. Patients with vascular CBS are usually elderly; often with coexistent hypertension, dyslipidemia and diabetes mellitus. Inferring from our observations, cerebral hypoperfusion can play a significant role in neuropathological changes in neurodegenerative diseases. To the best of our knowledge paper is the first comprehensive review of vascular CBS and we are positive that our observations show that further research concerning the vascular pathogenesis of tauopathy atypical Parkinsonism is required.

Possibilities of using fosinopril in treatment of patients with chronic kidney disease in combination with cardiovascular diseases and diabetes mellitus

Chronic kidney disease is one of the most common diseases in general medical practice, due to their secondary damage to the kidneys in arterial hypertension, chronic heart failure, and diabetes mellitus. The coexistence of hypertension and diabetes increases the likelihood of developing chronic kidney failure tenfold. In turn, chronic kidney disease is an important independent risk factor for the development of cardiovascular complications, including fatal ones, due to the direct relationship of the pathogenetic mechanisms of cardiorenal relationships. Approaches to the treatment of chronic kidney disease should be aimed both at preventing the risks of developing renal dysfunction, and at treating existing pathology. The multifactorial nature of the disease and the complex etiopathogenetic relationships determine the need to optimize existing approaches to the treatment of chronic kidney disease in multimorbidity patients with concomitance cardiovascular diseases and diabetes mellitus. This is also due to the fact that, unlike other target organs, compensation for background disease does not always prevent further deterioration of kidney function. According to the recommendations of the main scientific communities, in such cases, it is advisable to start therapy with the most effective angiotensin-converting enzyme inhibitors that combine nephro-and cardioprotective effects and have a dual route of elimination from the body, which is especially important in multimorbidity, the aim to prevent polypharmacy, reduce the risk of drug interactions and, consequently, side effects. This article reviews the literature data indicating the high efficacy and safety of the angiotensin converting enzyme inhibitor fosinopril in patients with chronic kidney disease in combination with cardiovascular diseases and diabetes mellitus.

Zaburzenia erekcji – punkt widzenia diabetologa

The prevalence of erectile dysfunction among diabetic patients is not exactly known. There is no doubt, however, that due to the complex nature of complications of poorly controlled diabetes, related to both blood vessel and nervous system damage, the frequency of these disorders increases with the duration of the disease. The coexistence of hypertension and obesity is also important, especially in the case of patients with type 2 diabetes. Our sexuality is slowly ceasing to be a taboo subject, so we are talking more and more often about the treatment of erectile dysfunction. In this article we present this problem from the diabetic point of view.

Clinical and Laboratory Factors Associated with Severe Disease Course in Turkish Patients with SARS-COV-2 Infection

Background: Coronavirus disease 2019 (COVID-19) can demonstrate different clinical spectra. Objectives: The current study aimed to analyze the clinical and laboratory risk factors of the severe course of disease in patients with COVID-19. Materials and Methods: Consecutive patients with a diagnosis of COVID-19 pneumonia were included in the present study. The demographic characteristics, comorbid diseases, symptoms, chest computed tomography (CT) findings, laboratory data, oxygen saturation (SpO2), and body temperature of the patients were recorded. The coexistence of pulmonary infiltration in CT and SpO2 of ≤ %93 on fingertip pulse oximeter was defined as the severe course of the disease. Results: A total of 475 patients were included in the current study. The mean age of the patients was 52.02±15.9 years, and 259 (54.5%) participants were male. The disease was mild and severe in 80% (n=380) and 20% (n=95) of the patients. The age of &gt; 50 years, coexistence of hypertension (HT) and diabetes mellitus (DM), neutrophil/lymphocyte ratio (NLR) of &gt; 4, high lactate dehydrogenase (LDH) of &gt; 240 U/L, C-reactive protein (CRP) of &gt; 8 mg/dL, and D-dimer of ≥ 1000 ng/mL were determined to be the risk factors for the severe course of the disease. Conclusion: Age, NLR, CRP, LDH, D-dimer, comorbidity, and coexistence of DM and HT were the independent risk factors for the severe course of the disease. The aforementioned factors should be taken into account during risk stratification and management of patients with COVID-19.

Adu, K.K. and Adjei, E. (2018). The phenomenon of data loss and cyber security issues in Ghana. Foresight, 20(2), 150–61. Ahmed, M.T.U., Bhuiya, N.I. and Rahman, M.M. (2017). A secure enterprise architecture focused on security and technology-transformation (SEAST), The 12th International Conference for Internet Technology and Secured Transactions, (ICITST-2017), Cambridge, UK, 11–4/12/2017. Alanazi, S.T., Anbar, M., Ebad, S.A., Karuppayah, S.

Few epidemiological studies have discussed the gender-specific prevalence of ischemic heart disease (IHD). We aimed to investigate the gender-specific prevalence of IHD among Saudi patients visiting the emergency department and if it is affected by diabetes mellitus and/or hypertension. Three hundred patients were recruited from Prince Sultan Cardiac Center in Al Ahsa, KSA. Hypertension was identified as systolic pressure equal to or more than 140 mmHg and/or diastolic pressure equal to or more than 90 mmHg or by the patient currently being on antihypertensive medication, and coronary artery disease (CAD) was diagnosed by electrocardiogram, cardiac markers, cardiac exercise testing or coronary angiography. Hypertension was found in 80% of males and 72% of females. A significantly higher rate of diabetes was noted in females (62%) compared to males (48%) (p&lt;0.012). Co-existing diabetes and hypertension was found in 70% of females as compared to 38% of males. The occurrence of IHD in males was significantly higher than that in females (p&lt;0.001). However, the incidence of myocardial infarction was greater in females (52%) compared to males (38%) (p&lt;0.035). Co-existing hypertension and diabetes may affect the gender prevalence of myocardial infarction among emergency department patients, with more infarctions being noted among females. This finding helps to guide the treatment strategy for both genders.

Macrotyloma uniflorum a plant food alleviates the metabolic syndrome through modulation of adipokines and PPARs.

A sedentary lifestyle combined with the intake of high-calorie diet has been the paramount cause of metabolic syndrome (MS) which is now a serious concern of public health worldwide as it involves the coexistence of hypertension, hyperlipidemia, glucose intolerance, and obesity. Hence, identifying a suitable strategy to overcome the worldwide menace of MS is imperative. Macrotyloma uniflorum a lesser known legume is highly nutritious and notable for its ethano-medicinal potential. Herein, the influence of M. uniflorum in high-fat dietinduced metabolic changes in a rodent model of metabolic syndrome was evaluated. Serum levels of glucose, total cholesterol, triglycerides, VLDL-c, and bodyweight were decreased, whereas HDL-c was increased in M. uniflorum-treated MS rats. The protein expression (AMPK-α, PPAR-α, and PPAR-γ) and gene expression (leptin, adiponectin, resistin, UCP2, NF-κB, and IL-6) results are impressive to highlight that M. uniflorum modulates the pathological conditions of MS and proves to be cardioprotective. Furthermore, the histopathological analysis confirmed the pathological changes and substantiates the influence of M. uniflorum to overcome MS. The HPLC and GC (MS) profiling reveals the presence of an array of polyphenols such as rutin (694.61μg/g), catechin (500.12μg/g), epicatechin (158.10μg/g), gallic acid (17.98μg/g), ferulic acid (10.911μg/g), daidzein (6.51μg/g), and PUFA, respectively, which probably exhibits the therapeutic effect on MS and associated complications by modulating lipid metabolism and adipogenesis. PRACTICAL APPLICATIONS: Metabolic disorders like CVD and diabetes are leading cause of mortality and morbidity worldwide. With emerging issues on adverse effects of modern drugs, the emphasis on "Food is Medicine and Medicine as Food" has taken dramatic dimensions in the healthcare sector. Therefore, nutraceuticals are in great demand in the developed world off late. Legumes, are potent elements in a balanced diet next to cereals. Exploring the medicinal properties of legumes could bring a revolution in public health and nutraceutical industries. This study scientifically validated the phytochemicals in M. uniflorum for its functional potential in the management of Metabolic Syndrome (MS). This study would help the nutraceutical industries to develop functional foods using M. uniflorum seeds to make porridges and soups or nutraceutical supplements with the bioflavonoids isolated from M. uniflorum for the management of metabolic disorders by mitigating hyperlipidemia, oxidative stress, and inflammation.

Usefulness of Exercise for Home Blood Pressure Control in People with Diabetes: A Study Protocol for a Crossover Randomized Controlled Trial.

BackgroundThe coexistence of hypertension and diabetes mellitus significantly increases the risk of macrovascular complications in patients with diabetes. Home blood pressure is important because it is more strongly associated with target organ damage and total mortality than clinic blood pressure measurements. Regular moderate aerobic exercise has antihypertensive effects. This study aims to examine the effect of aerobic exercise therapy on blood pressure at home in patients with diabetes.Patients and MethodsIn this crossover randomized controlled trial, 110 patients with type 2 diabetes will be randomly assigned to two groups: an exercise preceding group and an exercise lagging group. During the exercise period, patients will be instructed to walk either 30 minutes twice each day or 60 minutes once each day for at least 3 days per week. During the non-exercise period, patients will be permitted to perform physical activity associated with activities of daily life. Patients will be followed up for 56 days. The primary outcome will be the mean nocturnal blood pressure from day 24 to 28 during the exercise period compared to that during the non-exercise period. The secondary outcome will include variation in nocturnal blood pressure, mean blood pressure values and variation of morning and evening blood pressure from day 24 to 28 in the exercise period compared to the non-exercise period, body weight, body mass index and bioelectrical impedance analysis. Biochemical tests such as hemoglobin A1c level, blood glucose level, serum lipid profile, renal function, uric acid levels and liver function tests will also be measured.DiscussionThis randomized controlled trial will provide critical information regarding the effectiveness of moderate exercise on nocturnal blood pressure reduction. If successful, the results of this randomized controlled trial may increase exercise motivation in people with diabetes and may lead to improvement or prevention of target organ damage and overall mortality.Trial RegistrationTrial registration: University Hospital Medical Information Network, UMIN 000035973. Protocol version number: R000040969. Registration date: February 22, 2019. Recruitment began: June 19, 2019. The date of completion of recruitment: July 3, 2020. URL: http://www.umin.ac.jp.

Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study)

BackgroundThe present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey. MethodsPatients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg. ResultsA total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04–1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05–1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01–1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15–1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively. ConclusionOur findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.

Contemporary Strategies to Manage High Blood Pressure in Patients with Coexistent Resistant Hypertension and Heart Failure With Reduced Ejection Fraction.

Resistant hypertension (RH) represents an advanced subtype of hypertension that is complex to diagnose and treat. Compared with general hypertension, RH increases the risk patients will develop more advanced cardiovascular complications, including heart failure with reduced ejection fraction (HFrEF). As expected, the prevalence of RH has increased since the introduction of lower blood pressure targets included in the recent 2017 American blood pressure guidelines. The array of pharmacotherapies available to treat both hypertension and HFrEF has also expanded within the past decade. However, the efficacy of these cutting-edge pharmacotherapies has not come without a more advanced understanding of the important adjunct role non-pharmacological therapies play in helping with the management of both hypertension and HFrEF. In this review, we provide a summary of the latest pharmacological and non-pharmacological strategies that can be used to initiate treatment and optimize long-term blood pressure control in patients with coexistent RH and HFrEF.

Cardiovascular Risk Factors, Cognitive Dysfunction, and Mild Cognitive Impairment

Objectives: The present study sought to evaluate the contribution of cardiovascular risk factors to cognitive functioning in a sample of Mexican Americans diagnosed with mild cognitive impairment (MCI). Methods: Hypertension, diabetes, dyslipidemia, and obesity were diagnosed based on self-report and/or standardized procedures. Cognitive function was measured with MMSE, Logical Memory I and II, Trail A & B, FAS, animal naming, and digit span tests. Independent samples t tests and two-way ANOVAs were conducted for analyses, adjusting for relevant covariates. We studied 100 Mexican Americans (65 female) with MCI, ages 50–86, from a longitudinal study of cognitive aging conducted at the University of North Texas Health Science Center. Results: A difference between subjects with and without obesity and memory scores was shown by t tests. Two-way ANOVAs detected an association between the coexistence of hypertension and diabetes with language measures, diabetes and dyslipidemia with executive function, and diabetes and obesity with memory and language measures. Conclusions: This study provides additional evidence about the link between cardiovascular risk factors and cognitive dysfunction in MCI subjects, and also demonstrated that comorbid risk factors increased the degree of cognitive deficit in many areas, which may indicate a higher risk of developing dementia.

Left atrial structural and functional remodeling study in type 2 diabetic patients in sub-Saharan Africa: Role of left atrial strain by 2D speckle tracking echocardiography.

To evaluate the role of peak atrial longitudinal strain (PALS) through speckle tracking 2D echocardiography for the assessment of structural and functional left atrial (LA) remodeling in a type 2 diabetes mellitus (T2DM) population. We conducted a cross-sectional study during a 9-month period. T2DM adults aged 18 and above were included. The variables assessed during the study include age and gender of participants, diabetes characteristics, cardiovascular risk factors, clinical anthropometric and hemodynamic parameters, standard echocardiographic parameters, volume-derived LA functions, and 2D PALS. We included a total of 102 patients. The mean age was 58 ± 11.7 years, and the M/F sex ratio was 1:1.5. Coexistent arterial hypertension (HTN) was observed in more than half (59.8%) of the population sample. Mean 2D PALS was 29.2 ± 8.9% with 58.8% (95% CI: 50.0-68.6) of subjects having a reduced LA strain (ie,<32%). Reservoir and pump functions were the most altered LA volumetric phasic functions. Mean indexed LA maximal volume was 22.2 ± 6.8 mL/m2 . There was a significant association between abnormal PALS and age, Body mass index (BMI), indexed LA volume, E/E' ratio, LA active ejection fraction (pump function), and LA expansion index (reservoir function). Left atrial remodeling is a recurrent condition in adult T2DM Cameroonians. The reservoir and pump LA functions were the most affected. Assessment of LA global strain allows early detection of LA remodeling with comparison to LA size standard analyses. Age, BMI, indexed LA volume, E/E' ratio, and reservoir and pump LA functions were associated to 2D LA global strain impairment.

To compare the efficacy of Telmisartan and Ramipril in patients of essential hypertension with type 2 diabetes in controlling the blood pressure and improving lipid profile of the patients.

Background: Hypertension is an extremely common comorbid condition in DM, affecting 20-60% patients with DM. As the common denominator of hypertensive diabetic target organ-disease is the vascular tree, the co-existence of hypertension and DM is devastating to cardiovascular and renal system. Lipids stand one of the major contributing factor in cardiovascular morbidity amongst these patients. Many drugs are available in the market to control this, we have studied the efficacy of Telmisartan and Ramipril in improving the lipid profile of these patients. Observation and Results: Group A received Telmisartan while Group B received Ramipril. The baseline lab values of both the groups showed no any statistical difference showing the homogeneity of the groups. Similarly there was no any significant difference between the baseline Lipid profile values of TC, LDL, TG &amp; HDL (All P &gt; 0.05). The reduction in mean SBP &amp; DBP was statistically significant over 12 weeks of therapy in both the groups. But there was no statistical difference inter group wise. It was observed that there was statistically significant difference in mean TC levels, mean LDL levels, when two groups are compared after 12 weeks of therapy. (P value &lt; 0.05). While no significant difference was observed in the values of TG &amp; HDL (P value &gt; 0.05). Conclusion: Our study concludes that there is significant correlation between the use of Telmisartan and Ramipril in lowering the lipids in the patients of Diabetes with Hypertension. Lowering the lipids is very important to prevent any cardiovascular complications, which are one of the major contributing factors to the morbidity and mortality amongst these patients.

Diastolic Blood Pressure Does Not Influence Cardiovascular Outcomes in Type 2 Diabetes; or Does It?

Hypertension and diabetes are prominent cardiovascular (CV) risk factors and major issues of public health (1,2). The common coexistence of hypertension and type 2 diabetes is long-established and represents a “deadly” combination: diabetes increases CV risk threefold at any level of systolic blood pressure (SBP), while the presence of hypertension in patients with diabetes increases CV risk by fourfold (3,4). The optimal level of blood pressure (BP) in patients with diabetes has been a matter of debate for many years (5–7). Following older observational evidence and interventional data from the UK Prospective Diabetes Study (UKPDS) 38 and Hypertension Optimal Treatment (HOT) study, which showed CV benefits with diastolic blood pressure (DBP) of 15% 10-year CV risk) with type 2 diabetes to a target SBP of <120 mmHg or <140 mmHg. After 4.7 years of follow-up, the two groups had no differences in the primary outcome (nonfatal myocardial infarction, nonfatal stroke, death from CV causes) (hazard ratio [HR] 0.88, 95% CI 0.73–1.06; P = 0.20), CV mortality, and all-cause mortality; those in the intensive group had fewer stroke events (HR 0.59, 95% CI 0.39–0.89) but a higher incidence of serious adverse events (3.3% vs. 1.3%, P < 0.001), including hypotension, syncope, arrhythmias, hyperkalemia, angioedema, and renal failure. The ACCORD BP findings were considered by many as conclusive evidence against the <130 mmHg …

Clinical Characteristics and Outcomes of Type 2 Diabetes Patients Infected with COVID-19: A Retrospective Study.

Diabetes and its related metabolic disorders have been reported as the leading comorbidities in patients with coronavirus disease 2019 (COVID-19). This clinical study aims to investigate the clinical features, radiographic and laboratory tests, complications, treatments, and clinical outcomes in COVID-19 patients with or without diabetes. This retrospective study included 208 hospitalized patients (≥ 45 years old) with laboratory-confirmed COVID-19 during the period between 12 January and 25 March 2020. Information from the medical record, including clinical features, radiographic and laboratory tests, complications, treatments, and clinical outcomes, were extracted for the analysis. 96 (46.2%) patients had comorbidity with type 2 diabetes. In COVID-19 patients with type 2 diabetes, the coexistence of hypertension (58.3% vs 31.2%), coronary heart disease (17.1% vs 8.0%), and chronic kidney diseases (6.2% vs 0%) was significantly higher than in COVID-19 patients without type 2 diabetes. The frequency and degree of abnormalities in computed tomography (CT) chest scans in COVID-19 patients with type 2 diabetes were markedly increased, including ground-glass opacity (85.6% vs 64.9%, P < 0.001) and bilateral patchy shadowing (76.7% vs 37.8%, P < 0.001). In addition, the levels of blood glucose (7.23 mmol·L−1 (interquartile range (IQR): 5.80–9.29) vs 5.46 mmol·L−1 (IQR: 5.00–6.46)), blood low-density lipoprotein cholesterol (LDL-C) (2.21 mmol·L−1 (IQR: 1.67–2.76) vs 1.75 mmol·L−1 (IQR: 1.27–2.01)), and systolic pressure (130 mmHg (IQR: 120–142) vs 122 mmHg (IQR: 110–137)) (1 mmHg = 133.3 Pa) in COVID-19 patients with diabetes were significantly higher than in patients without diabetes (P < 0.001). The coexistence of type 2 diabetes and other metabolic disorders is common in patients with COVID-19, which may potentiate the morbidity and aggravate COVID-19 progression. Optimal management of the metabolic hemostasis of glucose and lipids is the key to ensuring better clinical outcomes. Increased clinical vigilance is warranted for COVID-19 patients with diabetes and other metabolic diseases that are fundamental and chronic conditions.

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease.

Early diagnosis of systemic sclerosis-related interstitial lung disease (SSc-ILD) is important to enable treatment to be administered with minimal delay. However, diagnosing SSc-ILD is challenging because key symptoms are non-specific. High-resolution computed tomography (HRCT) of the chest is recognized as a sensitive imaging method for diagnosing and assessing SSc-ILD. Exposure of patients to ionizing radiation may be considered as a limitation, although methodological steps may be taken to moderate this. We present practical recommendations for performing HRCT scans and interpreting the results. Key features of SSc-ILD on HRCT include a non-specific interstitial pneumonia (NSIP) pattern with peripheral ground-glass opacities and extensive traction bronchiectasis. Despite similarities between SSc-ILD and idiopathic pulmonary fibrosis (IPF), HRCT can be used to differentiate between these conditions: in SSc-ILD compared with IPF, there is a greater proportion of ground-glass opacity and fibrosis is less coarse. A dilated, air-filled esophagus with diameter >10 mm, suggestive of esophageal dysmotility is commonly seen in SSc-ILD. Pulmonary artery size greater than the adjacent ascending aorta suggests coexistent pulmonary hypertension. Nodules must be monitored due to the increased risk of lung cancer. A large extent of disease on HRCT (≥20%) or a high fibrosis score suggests an increased risk of mortality. HRCT is central to diagnosing SSc-ILD, and serial assessments can be helpful in monitoring disease progression or treatment response.