Hypertensive Diabetic Patients Research Articles

Socio-economic profile and prevalence of hypertension among type 2 newly diagnosed diabetes mellitus patients attending a tertiary hospital in Dhaka

Introduction: Untreated coexistence of hypertension and diabetes mellitus (DM) may result in more severe complications. The implementation of earlier intervention to prevent these complications can be facilitated by earlier identification of the conditions and their associated factors. Methods: This cross-sectional research was conducted at Sir Salimullah Medical College, Dhaka, between June 2020 and July 2021. Following the diagnosis of DM in the symptomatic patients, SPSS V 25 was utilized to collect socioeconomic history and blood pressure data for further analysis. Results : 271 (40 %) of the 542 diabetic patients were between 33 to 47 years of age. Most (332, 60.9%) were females. A majority of the patients (302.55.7%) belonged to lower socioeconomic classes, with incomes ranging from 1 thousand to 14 thousand taka. 253 patients (46.7%) had a familial predisposition to diabetes. Concurrent hypertension was observed in 193 (35.6%) diabetic patients; this was substantially correlated with advancing age, lower socioeconomic status, and higher body mass index (p< 0.05). Result: Diabetic hypertensive patients were more prevalent among those with lower socioeconomic status, a demographic that is least likely to pursue and adhere to treatment. Therefore, it is necessary to develop and execute policies that guarantee their appropriate treatment and avert subsequent complications. Conclusion A significant percentage of the participants simultaneously presented with diabetes mellitus and hypertension, both of which are life-threatening conditions if left untreated. The majority of patients belonged to the lower socioeconomic class, which increases the likelihood of inadequate diagnosis and treatment. It is imperative to develop policies that facilitate their convenient access to healthcare services, thereby enabling them to obtain appropriate treatment and prevent any subsequent complications. J Shaheed Suhrawardy Med Coll 2023; 15(1): 55-58

Formulation and development of bilayer tablet containing irbesartan and metformin hydrochloride for diabetic hypertensive patients

Background: Hypertension is a common complication of type II diabetes. The present research work aimed to develop bilayer tablets that would manage type II diabetes patients with hypertension. The prepared bilayer tablet has an immediate-release layer of anti-hypertensive irbesartan and a sustained-release (SR) layer of anti-diabetic metformin hydrochloride. The purpose of these bilayer tablets was to increase patient compliance by converting two separate monotherapy to single combination therapy. Methodology: Several ratios of polymers, including HPMC K100M, EC, Eudragit, and Guar gum, were employed to prolong the drug release for twelve hours. An immediate-release layer of irbesartan was prepared by spherical agglomeration. The physical properties, drug content, solubility profiles, release kinetics, and stability of prepared bilayer tablets were assessed. Results and Discussion: The examination of SR granules and bilayer tablets revealed outstanding packing qualities and excellent flow properties, with bulk and tapped densities ranging from 0.39-0.46 g/cm³ and 0.42-0.55 g/cm³, respectively. In vitro dissolution tests revealed that the immediate-release layer gave an initial burst of Irbesartan. Still, the sustained-release layer of metformin showed controlled drug release over 12 hours at greater polymer concentrations. According to stability testing, the bilayer tablets' physical properties, drug content, and dissolving profiles did not change significantly. Conclusion: The bilayer tablet combination of Irbesartan and Metformin exhibited desired physical features, controlled drug release, and stability. This formulation represents a viable treatment option for diabetic hypertensive patients, offering effective and consistent management of both disorders while improving patient compliance.

Crucial Interactions between Altered Plasma Trace Elements and Fatty Acids Unbalance Ratio to Management of Systemic Arterial Hypertension in Diabetic Patients: Focus on Endothelial Dysfunction.

The coexistence of SAH with T2DM is a common comorbidity. In this study, we investigated the link between altered plasma antioxidant trace elements (ATE: manganese, selenium, zinc, and copper) and fatty acids ratio (FAR: polyunsaturated/saturated) imbalance as transition biomarkers between vascular pathology (SAH) to metabolic pathology (T2DM). Our data revealed strong correlation between plasma ATE and FAR profile, which is modified during SAH-T2DM association compared to the healthy group. This relationship is mediated by lipotoxicity (simultaneously prominent visceral adipose tissue lipolysis, significant flow of non-esterified free fatty acids release, TG-Chol-dyslipidemia, high association of total SFA, palmitic acid, arachidonic acid, and PUFA ω6/PUFA ω3; drop in tandem of PUFA/SFA and EPA + DHA); oxidative stress (lipid peroxidation confirmed by TAS depletion and MDA rise, concurrent drop of Zn/Cu-SOD, GPx, GSH, Se, Zn, Se/Mn, Zn/Cu; concomitant enhancement of Cu, Mn, and Fe); endothelial dysfunction (endotheline-1 increase); athero-thrombogenesis risk (concomitant rise of ApoB100/ApoA1, Ox-LDL, tHcy, and Lp(a)), and inflammation (higher of Hs-CRP, fibrinogen and ferritin). Our study opens to new therapeutic targets and to better dietary management, such as to establishing dietary ATE and PUFA ω6/PUFA ω3 or PUFA/SFA reference values for atherosclerotic risk prevention in hypertensive/diabetic patients.

Sympathetic Hyperactivity and Its Relationship with Obesity in Diabetic Hypertensive Patients: A Study of 122 Cases

Sympathetic Hyperactivity and Its Relationship with Obesity in Diabetic Hypertensive Patients: A Study of 122 Cases

Predictive risk factors associated with non-dipper profile in diabetic hypertensive patients

Predictive risk factors associated with non-dipper profile in diabetic hypertensive patients

The significance of echo Doppler in treatment and prevention of brain danage in hypertensive diabetic and non diabetic patients

The significance of echo Doppler in treatment and prevention of brain danage in hypertensive diabetic and non diabetic patients

The Association of Dietary Indices, Antioxidant Intake and Bioactive Foods with Hypertension in Diabetic Patients: A Cross-Sectional Analysis regarding Fasa PERSIAN Cohort Study

Background: More than half of diabetic patients finally develop hypertension which remarkably increases the risk of multiple complications. This study aims to assess the association between dietary indices, antioxidant intake and bioactive foods, and hypertension in diabetic patients. Methods: This was a cross-sectional population-based study on baseline data of Fasa PERSIAN cohort study which was conducted on adults in Sheshdeh town and its 24 villages, in Iran from 2014 to 2016. This research included 1229 patients with diabetes. A food frequency questionnaire was used to assess three dietary indices (phytochemical index, dietary inflammatory index, and alternative healthy eating index-2010), antioxidant intake, and consumption of bioactive foods. Other lifestyle and demographic factors were also assessed. Multivariable binary logistic regression was performed to assess the associations between independent variables and hypertension. Results: Higher intake of garlic was significantly associated with lower odds of having hypertension after adjusting for potential confounders [adjusted odds ratio (AOR):0.84, 95% confidence interval (CI):0.73-0.97]. Furthermore, female gender [AOR:1.77, 95% CI:1.26-2.49], being older [AOR:1.09, 95% CI:1.08-1.11], having a family history of hypertension [AOR:2.42, 95% CI:1.86-3.16] and higher body mass index (BMI) [AOR:1.1, 95% CI:1.07-1.13] were predictors of having hypertension. Neither dietary indices nor antioxidant intakes were associated with having hypertension in the crude or adjusted models. Conclusion: Garlic consumption is negatively associated with hypertension in diabetic patients. However, female gender, old age, family history of hypertension and higher BMI are positively associated with this condition. Therefore, modifying diet and weight management are recommended for controlling hypertension in this group of patients

Cost-effectiveness Analysis of Lercanidipine Compared to Amlodipine as an Addition to Renin-angiotensin System Blockers in Diabetic Hypertensive Patients with Albuminuria in Thailand

Objective: Dihydropyridine calcium channel blocker (DHP-CCBs) is an appropriate add-on antihypertensive option for uncontrolled blood pressure diabetic hypertensive patients with albuminuria who are already taking renin-angiotensin system blockers (RASBs). Among DHP-CCBs, amlodipine is the first-line medication in combination with RASBs. However, new-generation DHP-CCBs like lercanidipine has demonstrated superior effectiveness and fewer side effects, although at a higher cost than amlodipine. This study aims to assess the cost-effectiveness of lercanidipine versus amlodipine when added to RASBs in diabetic hypertensive patients with albuminuria. The objective is to provide robust evidence guiding the selection of the most suitable and worthwhile treatment option in Thailand. Materials and Methods: This study analyses the cost-effectiveness of lercanidipine versus amlodipine as an addition to RASBs in diabetic hypertensive patients with albuminuria. The analysis was conducted from a societal perspective using a Markov model. Results: The total costs of lercanidipine and amlodipine treatments were 370,392.83 baht and 384,221.85 baht, respectively. The life years gained for lercanidipine and amlodipine treatments were 11.33 years and 10.96 years respectively. Additionally, the quality-adjusted life years (QALYs) of lercanidipine and amlodipine treatments were 8.06 years and 7.51 years respectively. Conclusion: Due to lercanidipine's noticeable cost-effectiveness, lower costs, and longer QALYs. Adding lercanidipine has proven to be more cost-effective than amlodipine for diabetic hypertensive patients with albuminuria who have been unable to achieve their blood pressure goals with RASBs alone. Therefore, lercanidipine should be the preferred choice as an add-on to RASBs in Thailand. These results could significantly aid policymakers in making informed decisions.

Effect of Verapamil on Glycemic Control in Type 2 Diabetic Hypertensive Patients in Saudi Arabia: A Quasi Experimental Study.

Type 2 diabetes is a common chronic disease that continues to increase in prevalence globally and is a major healthcare burden. Diabetes and hypertension frequently occur concurrently, and the use of antihypertensive agents is common in diabetic patients. One antihypertensive agent, verapamil, has tentatively shown potentially positive effects on glycemic control in assorted pre-clinical models. To evaluate the effect of verapamil on glycemic control in hypertensive type 2 diabetic patients. Type 2 diabetic hypertensive patients were recruited from King Fahad Medical City, Riyadh, KSA, to receive oral verapamil therapy. Blood pressure and glycometabolic parameters, including fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), C-peptide, and homeostatic model assessment insulin resistance (HOMA-IR), were monitored at baseline and after 6 months of verapamil therapy. Thirty-five patients (16 male, 19 female) with a mean age of 57.2 years were recruited. The use of verapamil was associated with non-significant decreases in HbA1c, FPG, C-peptide, and HOMA-IR. However, a sub-group of 17 participants showed a decrease in HbA1c that was ≥0.5%. Univariate logistic regression showed that baseline BMI, HOMA-IR, and C-peptide were significantly (P < 0.05) associated with HbA1c reductions of ≥0.5%. Verapamil is metabolically neutral and allows the stabilization of glycometabolic parameters in type 2 diabetic individuals. Additional research exploring the mechanism behind the variable response to verapamil therapy is warranted.

Management of Hypertension in Patients with Type 2 Diabetes Mellitus: Indian Guideline 2024 by Association of Physicians of India and Indian College of Physicians.

In India and the Southeast Asian population, hypertension and type 2 diabetes mellitus (T2DM) are the leading lifestyle-related diseases, responsible for a majority burden of morbidity and mortality. Multiple population-spanning studies have revealed the staggering prevalence of both diseases in India, and the prevalence of both will only increase further due to factors such as an aging population, rapid urbanization, increased obesity, and sedentary lifestyles. More than 50 percent of hypertensive patients in India are also diagnosed with T2DM, and a detailed management protocol for the same is required, especially when a major portion of the disease is managed at the primary care level. The Association of Physicians of India (API) guidelines for the management of hypertension in patients with T2DM have been formulated based on consultation with leading physicians, cardiologists, diabetologists, and endocrinologists of India and Southeast Asia, keeping in mind the challenges faced by the patients in these countries and the appropriate management protocols that will be beneficial. While standard office-based blood pressure (BP) measurement forms the cornerstone of hypertension diagnosis and demands a uniform methodology to be followed, home blood pressure monitoring (HBPM) is recommended for long-term follow-up with validated devices. Ambulatory blood pressure monitoring (ABPM) offers comprehensive insights crucial for cardiovascular (CV) risk stratification. The complications of diabetic hypertension can span from increased CV risk, heart failure (HF), and renal dysfunction, and nonpharmacological and pharmacological management should be aimed toward not only control of the BP values but also protecting the end organs. While nonpharmacological measures include a focus on nutrition and diet, they also focus on approaches to weight loss, including a novel section covering the benefits of yoga. The guideline also focuses on a novel section of factors influencing CV risk, especially in the Indian population. For the pharmacological management, the guidelines address each of the categories of antihypertensive drugs, emphasizing the significance of combination therapies in the management of diabetic hypertension. In line with leading global guidelines for the management of hypertension in T2DM, for diabetic patients who often struggle with BP management and carry a high CV risk, the recommended dual combination antihypertensive therapy is particularly crucial and should be considered as first-line management therapy. While angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) play a highly beneficial role in the management of diabetic hypertension, a combination of ACEi or ARB with dihydropyridine calcium channel blockers (DHP-CCBs) is recommended to reduce the risk of complications and enhance patient adherence. To achieve the target of effective BP control and end-organ protection, it is beneficial and recommended to include newer CCBs (e.g., cilnidipine) in the management protocol in combination with ACEi/ARBs. Combination therapy including ARBs and DHP-CCBs should be preferred over β-blockers and thiazides. Among the CCBs, cilnidipine, a novel molecule, is a more effective and safer option for diabetic hypertensive patients in India. β-blockers should be used if there is a history of myocardial infarction (MI), HF, coronary artery disease (CAD), or stable angina along with the initial hypertensive regimen. The guideline also focuses on the novel reno- and cardioprotective molecules such as finerenone and sodium-glucose cotransporter 2 inhibitors (SGLT2i) and their benefits in the management of diabetic hypertension.

Blood Pressure Control Among Diabetic Patients in the Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

The control of blood pressure (BP) is a challenge in diabetic patients and is associated with adverse outcomes of diabetes. In this systematic review and metaanalysis, we investigated the BP control rate among hypertensive diabetic patients in the Eastern Mediterranean Region (EMR) countries. We systematically searched PubMed, Scopus, Embase, Cochrane, and Web of Science databases up to January 2023 for observational studies on BP control among hypertensive diabetic patients in all EMR countries. We included studies reporting the proportion of hypertensive, type 2 diabetic patients with controlled BP, defined as systolic/diastolic BP < 140/90 or <130/80 mmHg. Study quality was assessed using modified STROBE guidelines, and a random-effect meta-analysis was conducted to pool prevalence data and calculate overall rates. Subgroup analysis was performed by gender, study design, country, and BP control cut-offs (140/90 and 130/80). Among the 1949 retrieved studies, 20 studies assessing 27956 individuals were included. The proportion of BP control regardless of cut-off points was 36.8% (95% CI=29.1%45.3%) based on the studies reported for both genders.The prevalence was 53.2% (95% CI=36.1%- 69.6%) and 43.5% (95% CI=20.0%-70.3%) based on the studies reported just for women or men, respectively. Our findings indicate that BP control targets are not successfully achieved in hypertensive diabetic patients in the Eastern Mediterranean region. It is recommended to place greater emphasis on the quality of hypertension care in the management of type 2 diabetes.

Hospital Outcome of Hypertensive Non-ST elevation Myocardial Infarction Patients in Diabetic and Non-Diabetic Groups

Objective: Acute myocardial infarction is one of the leading causes of all acute emergencies and is becoming an important public health problem in developing countries. Non-ST elevation myocardial infarction (NSTEMI) is more heterogeneous in its presentation and may be poorly characterized in clinical practice, leading to greater variation in diagnosis and treatment. Patients with diabetes and hypertension who develop an NSTEMI are at increased risk for poor hospital outcomes. This study aims to assess the differences between hypertensive diabetic and hypertensive non-diabetic patients with NSTEMI and to evaluate the prognostic impact of selected clinical and laboratory parameters on the occurrence of hospital complications. Methods: This was a cross-sectional analytical study. All the adult hypertensive patients of newly diagnosed NSTEMI with or without diabetes mellitus admitted to Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka who fulfilled the inclusion and exclusion criteria were enrolled. The study population comprised 100 hypertensive patients with their first NSTEMI and were divided into two groups according to the presence of type 2 diabetes mellitus. Group I (n = 40) patients were diabetic and Group II (n = 60) were non-diabetic. The hospital outcome of the study population was recorded. The incidence of in-hospital adverse clinical events in the two groups was compared by using the odds ratio of the two binomial proportion analyses. Results: Among 100 hypertensive NSTEMI patients, 40% were diabetic (Group I) and 60% were non-diabetic (Group II). The mean age was 58.1±10.2 years in the case of the diabetic group (Group I) and 56.3±10.5 years in the non-diabetic group (Group II) ranging from 30-70 years. Male patients (66%) were predominant in the study. The most common clinical presentation was chest pain which was 77.5% in Group I and 83.3 % in Group II followed by sweating (12.5% and 16.7%), dyspnea (10.0% and 11.7%), syncope (5.0% and 6.7%) and atypical chest pain (2.5% and 3.3%) respectively. Smoking was the commonest risk factor which was 62.5% in Group I and 75% in Group II followed by dyslipidemia (32.5% and 36.7%), family history of IHD (30% and 23.3%) and obesity (22.5% and 13.3%) respectively. Diabetic hypertensive patients had significantly higher heart rates, hypertensive peaks, and more episodes of asymptomatic ST segment depression. The most common in-hospital complications were heart failure (30% and 16.7%), arrhythmias (22.5% and 6.7%), renal failure (10% and 5.0%), cerebral ischemia (7.5% and 1.7%), death (7.5% and 3.3%) and cardiogenic shock (5.0% and 3.3%) in Group I and Group II respectively. Conclusion: In-hospital adverse clinical events were more frequent in diabetic hypertensive individuals compared to non-diabetics.

Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure

Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and ‘others’ ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.

ACHIEVED SYSTOLIC BLOOD PRESSURE BELOW 130 MMHG PRESERVES KIDNEY FUNCTION IN DIABETIC AND NON-DIABETIC HYPERTENSIVE PATIENTS WITHOUT CARDIAC HYPERTROPHY

Objective: Kidney function is preserved by achieving systolic blood pressure (SBP) primarily &lt;140mmHg and possibly &lt;130mmHg in hypertensive patients. We aimed to investigate kidney function when achieving SBP 130-139 and &lt;130mmHg in type-2 diabetic and non-diabetic hypertensive patients without cardiac hypertrophy who participated in a major prospective hypertension outcome trial. Design and method: Of the 15,245 study participants, 13,803 patients were without cardiovascular events during the first six months after randomization with roll-over from previous medications to blinded study drugs and had a minimum of 3 subsequent BP visits during 4-6 years. Of these, 2,458 patients with cardiac left ventricular hypertrophy (LVH) by ECG were not included in the present analysis because, as previously reported, they had increased cardiac and all-cause mortality at average achieved SBP &lt;130mmHg. Of the remaining 11,345 patients, 3932 had diabetes. Cox analyzes adjusted for baseline covariates compared the pre-specified kidney endpoints 50% rise of se-creatinine (worsening kidney function, WKF) and end-stage renal disease (ESRD, dialysis and/or transplantation) for patients who achieved average SBP 130-139 and &lt;130mmHg with those who remained with SBP &gt;=140mmHg. Results: Patients with diabetes had less WKF at SBP 130-139mmHg (HR=0.50, 95% CIs 0.34-0.72, n=1605, p&lt;0.001) and at SBP &lt;130mmHg (HR=0.43, CIs 0.23-0.80, n=599, p=0.008). They also had less ESRD at SBP 130-139mmHg (HR=0.32, CIs 0.12-0.88, p=0.03) with similar trend at SBP &lt;130mmHg (HR=0.21, CIs 0.03-1.65) which was significant for the 3rd quartile of SBP (135mmHg) (HR=0.09, CIs 0.01-0.71, p=0.02) and for the 4th quartile of SBP (126mmHg) (HR=0.12, CIs 0.02-0.92, p=0.04). Patients without diabetes (n=7413) also had less WKF at SBP 130-139mmHg (HR=0.58, CIs 0.40-0.83, n=3258, p=0.003) and at SBP &lt;130mmHg (HR=0.38, CIs 0.21-0.68, n=1542, p&lt;0.001). For ESRD the trend was similar as for diabetes at 3rd quartile of SBP (135mmHg) (HR=0.37, CIs 0.14-1.00, p=0.05) and at 4th quartile of SBP (126mmHg) (HR=0.23, CIs 0.07-0.75, p=0.02). Conclusions: In high-risk hypertensive patients above 50 years, with and without type-2 diabetes, but without cardiac hypertrophy, we found stepwise less worsening of kidney function and end-stage renal disease with lower average achieved systolic BP from &gt;=140mmHg to 130-139mmHg to &lt;130mmHg.

Utilization of nutrition information on food labels by diabetic mellitus and hypertensive patients attending clinic at Kakamega County Teaching and Referral Hospital, Kenya

The aim of food labels is to inform consumers on the food content. The information conveyed on food labels has evolved over time thus the objectives of food labelling have become numerous. Despite the recognized association of food labels utilization and disease management, the current global mortality rate from diabetes mellitus and hypertension remains high. In order for the prevalence rate of diabetes mellitus and hypertension to reduce, population-wide interventions including the promotion of healthy diets through the provision of adequate information on food labels should be done. This study aimed at assessing utilization of nutrition information on food labels by diabetic mellitus and hypertensive patients. This was a cross-sectional study conducted in March and April 2022 at Kakamega County Teaching and Referral hospital, Kenya. Data was collected from respondents using a structured questionnaire administered to 125 randomly selected respondents and the response rate was 80%. Socio- demographic characteristics of the study participants were determined using descriptive statistics for distribution. Association between the study variables was determined using Chi-square test. Statistical significance was set at p&lt;0.05. The analyzed data was presented by use of frequency tables, graphs and pie charts. About 46% of the respondents were aged &gt;60years. About 73% were married and about 40% reported to have completed primary education level. About 39 % were self-employed earning less than Ksh. 5,000 (50 USD) per month. Prevalence of diabetes and hypertension in Kakamega were at 4.6% and 29.4% respectively. Age (p= 0.028), Education (p= 0.001), Job/employment (p=0.0010), Monthly income (p=0.001) and Monthly household food expenditure (p=0.007) significantly influenced utilization of food labels. About 64% (n=64) reported to be knowing what food labels are and about 34% (n=34) reported not knowing what they are. About 46.8% (n=30) of those who reported they read the labels participants reported that they read nutrition information every time they purchased the product, 37.5% (n=24) read the information the first time they purchased the product and 15.7% (n=10) read nutrition information on food labels at other different times. Food prices, nutrition information on the food label, health and nutrition status and fat/sodium/sugar content were among the factors that had a high influence on utilization of food labels. This study recommends nutrition education to the general population on benefits of reading nutrition information on food labels in order to make healthful food choices in order to reduce the prevalence of these chronic diseases. Key words: Food labels, Utilization, Nutrition, Diabetes mellitus, Hypertension, Kakamega

No Detectable Differences in microRNA Plasma Levels between Diabetic Hypertensive Patients with and without Incident Subclinical Atrial Fibrillation.

Background: Long-term rhythm monitoring (LTRM) can detect undiagnosed atrial fibrillation (AF) in patients at risk of AF and stroke. Circulating microRNAs (miRNAs), which have been shown to play a role in atrial electrical and structural remodelling, could help to select patients who would benefit most from LTRM. The aim of this study was to investigate whether patients with diabetes mellitus (DM) and hypertension and screen-detected subclinical AF (SCAF) using an insertable cardiac monitor (ICM) have significantly different plasma baseline levels of five selected miRNAs playing a role in the modulation of atrial electrical and structural remodelling (miR-21-5p, miR-29b-3p, miR-150-5p, miR-328-3p, and miR-432-5p) compared to those without SCAF. Methods: This study was performed at the outpatient clinic of a secondary academic teaching hospital between December 2013 and November 2015. Eligible patients were ≥65 years of age with DM and hypertension but without known heart diseases. All patients received an ICM. On the day of ICM implantation, blood samples for the measurement of plasma levels of the five miRNAs were drawn. In this post hoc analysis, we investigated their expression by reverse transcription-quantitative polymerase chain reaction. MiRNA plasma levels in patients with and without newly detected SCAF were compared. Results: We included 82 consecutive patients (median age of 71.3 years (IQR 67.4-75.1)), who were followed for a median of 588 days (IQR: 453-712 days). Seventeen patients (20.7%) had ICM-detected SCAF. Plasma levels of miR-328-3p, miR-29b-3p, miR-21-5p, miR-432-5p, and miR-150-5p were slightly but not significantly different in patients with incident SCAF compared with patients without. Conclusions: In patients with hypertension and DM, newly detected SCAF was not significantly associated with changes in expression levels of miR-21-5p, miR-29b-3p, miR-150-5p, miR-328-3p, and miR-432-5p.

Relationship Between Hyperuricemia and Hypertension in Diabetic Patients Undergoing Hemodialysis

Background: Diabetes is a prevalent chronic disease and is considered a risk factor for other chronic diseases. Various studies have pointed out the relationship between uric acid and type 2 diabetes. Objectives: This study aimed to investigate the relationship between hyperuricemia and hypertension in diabetic patients undergoing hemodialysis. Methods: The descriptive-analytical cross-sectional study was conducted on dialysis patients referred to the Comprehensive Center for the Treatment of Special Diseases in Birjand in 2022. Data were collected through a checklist, which included information such as age, sex, duration of hemodialysis, duration of diabetes, history of underlying diseases, blood pressure, and serum uric acid level. The data were analyzed using SPSS 26 software and chi-square, Fisher's exact, Mann-Whitney tests with a significance level of 0.05. Results: Hypertension was present in 61 (85.9%) of patients. The average uric acid level was 5.9 ± 1.12, and hyperuricemia was observed in 11 (15.5%) of patients. Although the rate of hyperuricemia was higher in patients with high blood pressure [10 (16.4%) vs. 1 (10%)], no significant relationship between hyperuricemia and high blood pressure was observed (P = 0.605). Additionally, no significant relationship was observed between the average uric acid level and demographic factors (age, sex, duration of dialysis, and average blood sugar) (P &gt; 0.05). Conclusions: According to the present study's results, the rate of hyperuricemia in dialysis patients with high blood pressure is higher than in patients without high blood pressure. However, due to the non-significance of this relationship, there is a need to conduct studies with a larger sample size to truly understand its relationship with high blood pressure in diabetic patients undergoing hemodialysis.

The association between serum copper concentration and prevalence of diabetes among US adults with hypertension (NHANES 2011-2016).

The objective of this study was to examine the association between the serum copper concentration and the prevalence of diabetes among US adults with hypertension using the data from the National Health and Nutrition Examination Survey (NHANES). The study population was selected from adults aged over 20 years old in the three survey cycles of NHANES from 2011 to 2016. Logistic regression model analyses were applied to determine the independent risky effect of copper to the prevalence of diabetes. Also, a restricted cubic spline (RCS) model was performed to explore the potential nonlinear association between serum copper concentration and the prevalence of diabetes. A total of 1786 subjects (742 cases and 1044 controls) were included, and 924 were men (51.7%), and 742 (41.5%) were diabetic. Compared with non-diabetic individuals, the concentration of serum copper in diabetic patients with hypertension was higher. After adjusting for age, sex, race, education, marital status, body mass index (BMI), family poverty income ratio (PIR), smoking, alcohol drinking, physical activity, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hyperlipidemia, the highest quartile of serum copper concentration significantly increased the risk of diabetes as compared with the lowest quartile (OR: 1.38, 95% CI: 1.01-1.92, ptrend = 0.036). The results of RCS analysis showed significant non-linear relationship between serum copper concentration and prevalence of diabetes (p-non-linear = 0.010). This study finds that serum copper concentration are significantly associated with risk of diabetes in hypertensive patients, which suggests copper as an important risk factor of diabetes development.

The connection between hypertension and diabetes and their role in heart and kidney disease development

Abstract Hypertension and diabetes are two common metabolic disorders that often coexist in the same individual. Their concurrence increases the risk of cardiovascular disease, renal dysfunction, and other complications. Cardiovascular disease is the primary cause of morbidity and mortality in individuals with diabetes, and hypertension further aggravates this condition. Interestingly, hypertension and diabetes share several common pathophysiological mechanisms including insulin resistance, vascular inflammation, endothelial dysfunction, obesity, and oxidative stress suggesting a cross-talk between these two conditions that could potentially contribute to the development of other human diseases. Effective management of diabetes should include a multifaceted approach that addresses not only glycemic control but also blood pressure (BP) and lipid control. Treatment plans should be individualized to each patient’s needs and should involve a combination of lifestyle modifications and medications to achieve optimal control. With the availability of newer antidiabetic medications such as SGLT inhibitors and GLP1 receptor agonists, it is crucial to consider their potential to reduce BP, enhance kidney function, and lower the risk of cardiovascular diseases when initiating treatment for glycemic control. A more profound comprehension of the shared underlying mechanisms between these conditions could pave the way for the development of innovative therapeutic approaches to tackle them. Our review offers an in-depth analysis of the literature, providing a holistic view of the mechanisms underlying diabetes-hypertension comorbidity and its implications on heart and kidney diseases. The present article concludes by discussing current approaches for managing hypertensive diabetic patients to create a set of comprehensive individualized recommendations.

Determination of Vitamin K2, Lipoprotein (a) and N-Terminal pro Brain Natriuretic Biomarkers in Diabetic Hypertensive Patients with Acute Myocardial Infarction for Clinical Intervention

Background: Severe Myocardial Infarction is a highly stark manifestation of heart illness, often accompanied with additional complications such as diabetes mellitus (DM) and hypertension (HTN). The hormone within the body enables glucose to enter the cells and burn them up as fuel. HTN is a common vascular disorder that represents a major cardiovascular condition. Methods: The study was conducted at the Biochemistry Department of the College of Medicine from April 2022 to May 2023 and used the Human Vit K2 ELISA Kit, Human Lp(a) ELISA Kit, and Human N-terminal ProBST ELISA Kit to estimate the serum levels of vitamin K2, lipoprotein (a) (Lp(a)), and N-terminal of the Pro brain natriuretic peptide (NT-proBNP). Results: The results showed a important decrease in VK2 levels in AMI patients with DM and HTN than the other two groups (less than AMI patients group with and without HDL-c). On the other hand, Lp(a), and NT-pro BNP levels were significantly increased in AMI patients with DM and HTN than the other two groups (less than AMI patients group with no DM and HTN). As the diagnostic accuracy of tests increased, the area under the ROC curve for NTproBNP for diagnosing AMI achieved the highest 0.988. NTproBNP showed a promising ability to differentiate AMI patients from DM+ HTN group with 0.971 (AUC). Conclusions: In diabetic hypertensive patients with acute myocardial infarction, a low level of vitamin K2 and a high level of lipoprotein(a) might be risk markers for the onset of myocardial infarction.