Diabetic Hypertensive Subjects Research Articles

Comparison of Urinary Ace 2 Levels in Individuals with Hypertension and Type 2 Diabetes with Individuals who have Hypertension but not Diabetes

Background: In this investigation, the levels of urine Angiotensin Converting Enzyme(ACE2)in patients with Type 2 diabetes and high blood pressure were evaluated and their results compared in individuals having raised blood pressure but they had normal blood sugar control. Given the growing body of evidence linking ACE 2 insufficiency to the etiology of hypertension in diabetic patients, we hoped to find higher Angiotensin Converting Enzyme2 levels in the urine of hypertensive diabetic patients than in those without diabetes. Aim: As a result, new pathways for the development of antihypertensive medicines aimed at protecting Angiotensin Converting Enzyme2, particularly in diabetic patients, may open up. Methods: Two groups, each with 49 subjects, were created from a population of chosen subjects.Patients with diabetes and hypertension were chosen from the Services Institute of Medical Sciences diabetic clinic and medical wards in Lahore. In the clinics, anthropometric characteristics and blood sugar levels were recorded. In the Physiology Laboratory at University of Health Sciences, blood samples were obtained and maintained in order to evaluate biochemical characteristics. Results: We calculated the median value in each group because the data for urine Angiotensin Converting Enzyme 2 readings was not dispersedevenly. Non-diabetic hypertension participants had a median of 26.47mg/dl, while hypertensivediabetic subjects had a median of 22.86mg/dl. This difference in ACE 2 levels in the urine was statistically significant (p0.05). Non-diabetic, hypertension patients had greater urinary Angiotensin Converting Enzyme 2 levels than diabetic, hypertensive patients. Conclusion: Contrary to our expectations, we were unable to confirm that urine Angiotensin Converting Enzyme 2 readingsare higher in people with high arterial pressure and type 2 diabetes mellitus. This is despite the fact that the current study confirmed that both type 2 diabetes mellitus and hypertension are risk factors for chronic kidney disease. Key words: Renin Aldosterone-Angiotensin System, urinary Angiotensin Converting Enzyme 2 levels, Chronic Kidney Disease

DIABETES MELLITUS AND ASSOCIATED HYPERTENSION, A TOXIC COMBINATION FOR CARDIOVASCULAR RISK

Objective: The coexistence of hypertension in diabetic patients greatly enhances their likelihood of developing CVD. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, inflammation, retinopathy, and “diabetic cardiomyopathy”. We aimed to assess the impact of type 2 diabetes mellitus associated with high blood pressure over these cardiovascular risk factors. Design and method: We performed a transversal study, lasting 12 months, in which 100 patients with essential hypertension, and type 2 diabetes, with medium age 60.7 ± 9.3 years were evaluated in comparison with 100 patients with only hypertension. We evaluate these patients for: BMI; waist circumference; IMT by carotid ultrasonography; microalbuminuria in a spot morning urine; fundus oculi, LVMI for left ventricular hypertrophy by echocardiography. Serum PCR and lipid concentrations were measured. Results: The diabetic hypertensive subjects significantly had higher BMI (p = 0.01) and waist circumference statistically significant (p = 0.005). Patients with hypertension and diabetes had a greater left ventricular mass index (66% vs 51%, P = 0.04). Mean value for IMT was 1.1 ± 0,3 mm for diabetic patients and 0.93 ± 0,2 mm for the other group (P < 0.001) and its prevalence was high in diabetics (75% vs 64%, P = 0.1). Prevalence of microalbuminuria was significantly high in diabetics (44% vs 14%, P < 0.001). PCR as marker of inflammation was prevalently high in people with diabetes and hypertension (32% vs 16%, P = 0.013) Also, prevalence of retinopathy was significantly high in people with diabetes and hypertension compare to other group (27% vs 12%, P = 0.012). There was strong relation between LVMI, microalbuminuria, IMT and PCR. Waist circumference had correlation with IMT and microalbuminuria. Conclusions: DM is an independent risk factor for the increased LV mass and impaired diastolic function regardless of association with hypertension or not. Central obesity is associated with an increased risk for cardio metabolic diseases such as atherosclerosis and diabetic nephropathy. Atherosclerosis is characterized by chronic inflammation affecting the arterial intimae. Thus, individuals with type 2 diabetes and hypertension had increased risk for CVD.

Association of Arterial Hypertension (HTA) and Diabetes: Epidemiological, Clinical and Therapeutic Aspects in the Internal Medicine Unit at the Fousseyni Daou Hospital in Kayes

Introduction: This study aimed to study the epidemiological, clinical and therapeutic aspects of arterial hypertension in diabetic subjects followed at the Internal Medicine Unit at the Fousseyni Daou Hospital in Kayes. Patients and Methods: This was a descriptive retrospective study carried out from January 1, 2019 to December 31, 2019 (12 months) at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. Included were diabetic and hypertensive patients (PAS ≥ 140 mmHg and/or PAD ≥ 90 mmHg) aged 15 years and older followed in an outpatient setting or hospitalized. Results: 406 diabetic subjects were recorded including 157 cases of hypertension associated with diabetes, i.e. an overall prevalence of 38.67%. The age group of 50 -59 was the most affected with 44.58% and the average age was 51 years with extremes of 29 - 82 years. The female sex predominated with 57.96% with a sex ratio of 0.72. According to origin, 64.97% lived in the urban area (city of Kayes) against 35.03% of patients who came from the rural area. Housewives predominated with 40.13%. The functional signs frequently encountered were headaches 66.88% and dizziness 49.04%; polyuria 40.76%; polydipsia 41.40%, weight gain. The majority of patients had type 2 diabetes with 98.73% against 1.27% of type 1 In 24.84% hypertension existed before diabetes and was treated; in 52.87% it was discovered at the same time, in 22.29% it occurred later. Thus, in 122 cases out of 157, i.e. 77.71% of cases, hypertension preceded or was discovered at the same time as diabetes. The hypertension was at grade 2 with 33.75% followed by grade 1 with 32.51%. The associated cardiovascular risk factors found were age > 50 years in men 27.39%, and 60 years in women 35.03%; sedentary lifestyle 63.06%. Peripheral neuropathy 63.06%, hypertensive retinopathy 15.19%, diabetic retinopathy 10.19% were the main complications found. Measurement of fasting blood sugar in our patients showed 24.84% normal blood sugar ........

Multivariate Parametric Study of Nailfold Capillary Images for Disease Detection.

Nailfold capillaroscopy is a tool which is non-invasive in nature and can be useful for diagnosis, research, therapeutic study and prognosis. Research shows that specific capillary morphology patterns are identified for diabetic subjects, hypertensive subjects and normal controls. In this study, we have proposed RATHEW approach of classifying these three classes of subjects. RATHEW approach employs a three step process for classifying nailfold images: one, identify six abnormality parameters from the image dataset; two, score these abnormality parameters based on the defined scoring rules; and three, combine them mathematically to segregate them into three classes. This technique can be further enhanced to grade the severity of disease and organ involvement. This can bring in a paradigm shift to the disease detection and therapeutic study mechanism.

Correlation between Urinary Angiotensin Converting Enzyme-2 & Micro Albuminuria in Non-Diabetic-Hypertensive and Type 2 Diabetic-Hypertensive patients

Background: The Renin Angiotensin System (RAS) is one of the main contributors to insulin resistance which leads to T2DM and its complications. The ACE2/Angiotensin-(1-7)/Mas axis has lately been anticipated to function as a negative regulator of the RAS, consequently, rendering a shielding task against progress of type 2 diabetes, as well as, lowering blood pressure. Aim: To correlate urinary angiotensin 2 levels and microalbuminuria in Type 2 Diabetic and non-Diabetic-hypertensive patients. Methods: A particular population of selected subjects was categorized into 2 groups, with 49 subjects in each group. Diabetic and hypertensive patients were selected from the SIMS diabetic Clinic and medical wards, Lahore. Anthrometric parameters, as well as, BSR were recorded in the clinics. Blood and urine samples were collected and stored for evaluating the biochemical parameters in the Physiology Laboratory, UHS. Results: Microalbuminuria, as well as urinary ACE2 levels in group A (non-diabetic-hypertensive subjects), were greater than in group B (diabetic-hypertensive subjects). There was a significant positive correlation between uACE2 levels and microalbuminuria in group A patients. Conclusion: Although the current study reinforced the fact that both T2DM and hypertension are risk factors for CKD, contrary to our prediction based on evidence gained from various research studies, we were unable to prove that urinary ACE 2 levels are higher in patients with hypertension compounded with diabetes mellitus. Keywords: The Renin Angiotensin System (RAS), angiotensin converting enzyme 2, microalbuminuria levels.

Urinary Oxidative Damage Markers and Their Association with Obesity-Related Metabolic Risk Factors.

Oxidative damage and inflammation are possible mechanisms linking obesity to diabetes and related complications. This study investigates the levels of oxidative damage markers in the urine of community free-living subjects with increased prevalence of obesity. Methods: Participants were assessed regarding clinical, anthropometric, and physical activity data at baseline and at 6 months. Blood and urine samples were taken for the measurements of oxidative markers in urine ((glutathione (GSH), thiobarbituric acid reactive substances (TBARS), pteridine, 8-isoprostane and 8-hydroxy-2′-deoxyguanosine (8-OH-dG)), metabolic and inflammatory markers, and related biochemical variables in the blood. Univariate and multiple regression analyses were used to assess the association between oxidative markers and other clinical prognostic indicators. Results: Overall, 168 participants with a complete 6-month follow-up with a mean (±SD) age of 41 ± 12 (119 (71%) females) were included in the study. In multiple regression analysis, log-transformed urinary pteridine levels were significantly correlated with log-transformed urinary GSH, 8-isoprostane, and TBARS after adjusting for urinary creatinine at both baseline and follow-up. Significant correlations were also found between oxidative damage markers and cardiovascular disease risk factors, including systolic blood pressure, HbA1c, plasma glucose, us-C-reactive proteins, total cholesterol, and HDL. Higher TBARS levels were found in males and diabetic subjects, with lower GSH in diabetic hypertensive and obese subjects, but the latter result did not reach statistical significance. We found nonsignificantly higher TBARS, 8-isoprostane, and pteridine levels in smokers compared to those in nonsmokers. All measured urinary oxidative damage markers levels were higher in obese subjects compared with normal-weight subjects, but results did not reach statistical significance. Conclusion: we found significant associations between urinary oxidative damage and metabolic risk factors, and higher levels of urinary oxidative damage markers in diabetic, hypertensive, smoker, and male subjects.

Hypertension Coincident with Type 2 Diabetes Worsen Cognitive Function and Arterial Stiffness

Background: The prevalence of concomitant of hypertension (HT) and type 2 diabetes (T2DM) mellitus have increased. However, the additional contribution of high blood pressure to T2DM on cognitive and vascular functions has not been published. Objective: To compare the vascular functions and cognitive function among hypertensive with type 2 diabetic patients, hypertensive patients, and age-match healthy participants. Materials and Methods: Twenty-three hypertensive-diabetic, 25 HT, and 23 sedentary individuals were included in this study. Using the crosssectional design, the vascular functions were assessed with pulse wave velocity (PWV) and flow-mediated dilation (FMD) among the three groups. Global cognitive function tests were performed using Montreal Cognitive Assessment (MOCA). Results: The hypertensive-diabetic group had higher brachial systolic blood pressure (SBP) (p<0.05), mean arterial pressure (MAP) (p<0.05), and pulse pressure (PP) (p<0.05) than the sedentary group. In addition, the hypertensive-diabetic patients had significantly higher PWV and worse cognitive performance than hypertensive and healthy participants (p<0.05) but did not significantly differ in FMD. Arterial stiffness, blood pressure, and fasting blood glucose were associated with level of cognitive performance (p<0.05). Conclusion: Arterial stiffness and blood pressure are a determinant of cognitive functions in hypertensive diabetic subjects but not in individuals with hypertension without diabetes. These results suggested the additional effects of hyperglycemia on high blood pressure might worsen the cognitive functions through higher level of arterial stiffness and blood pressure. Keywords: Cognitive function; Arterial stiffness; Type 2 diabetes; Hypertension

Mendelian randomization analysis of vitamin D in the secondary prevention of hypertensive-diabetic subjects: role of facilitating blood pressure control

BackgroundVitamin D (Vit-D) promotes vascular repair and its deficiency is closely linked to the development of type 2 diabetes mellitus (T2DM) and hypertension. Whether genetially predicted vitamin D status (serological 25-hydroxyvitamin D [25(OH)D]) confers secondary protection against cardiovascular diseases (CVD) among high-risk hypertensive-diabetic subjects was unknown.MethodsThis is a prospective, individual-data, two-sample Mendelian randomization study. We interrogated 12 prior GWAS-detected SNPs of comprehensive Vit-D mechanistic pathways using high-throughput exome chip analyses in a derivation subcohort (n = 1460) and constructed a genetic risk score (GRS) (rs2060793, rs4588, rs7041; F-statistic = 32, P < 0.001) for causal inference of comprehensive CVD hard clinical endpoints in an independent sample of hypertensive subjects (n = 3746) with prevailing co-morbid T2DM (79%) and serological 25(OH)D deficiency [< 20 ng/mL] 45%.ResultsAfter 55.6 ± 28.9 months, 561 (15%) combined CVD events including myocardial infarction, unstable angina, ischemic stroke, congestive heart failure, peripheral vascular disease, and cardiovascular death had occurred. Kaplan-Meier analysis showed that genetically predicted reduced vitamin D status was associated with reduced event-free survival from combined CVD events (log-rank = 13.5, P = 0.001). Multivariate-adjusted per-allele increase in GRS predicted reduced combined CVD events (HR = 0.90 [0.84 to 0.96], P = 0.002). Mendelian randomization indicates that increased Vit-D exposure, leveraged through each 1 ng/mL genetically instrumented rise of serum Vit-D, protects against combined CVD events (Wald’s estimate: OR = 0.86 [95%CI 0.75 to 0.95]), and myocardial infarction (OR = 0.76 [95%CI 0.60 to 0.90]). Furthermore, genetically predicted increase in Vit-D status ameliorates risk of deviation from achieving guideline-directed hypertension control (JNC-8: systolic target < 150 mmHg) (OR = 0.89 [95%CI 0.80 to 0.96]).ConclusionsGenetically predicted increase in Vit-D status [25(OH)D] may confer secondary protection against incident combined CVD events and myocardial infarction in a hypertensive-diabetic population where serological 25(OH)D deficiency is common, through facilitating blood pressure control.

Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study

ObjectiveTo know the vascular age (VA) of a sample of general population included in the RICARTO study. Patients and methodEpidemiological study of the general population aged ≥ 18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type 2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. Results1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5 CVR factors vs none (P < .001 in all). Higher differences (Cohen’s D > 0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). ConclusionsVA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO

ObjectiveTo know the vascular age (VA) of a sample of general population included in the RICARTO study. Patients and methodEpidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. Results1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). ConclusionsVA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

Predictors of mortality, strategies to reduce readmission, and economic impact of acute decompensated heart failure: Results of the Vellore Heart Failure Registry

AimHeart failure is a global problem that is increasing in prevalence. We undertook the initiative to compile the Vellore Heart Failure Registry (VHFR) to assess the clinical profile, mortality, risk factors and economic burden of heart failure by conducting a prospective, observational, hospital-based cohort study in Vellore, Tamil Nadu. Methods and resultsThis study was a prospective observational cohort study conducted at the Christian Medical College and Hospital, Vellore, between January 2014 and December 2016. A total of 572 patients who satisfied the Boston criteria for “definite heart failure” were included and the primary outcome was all-cause mortality. The median duration of hospital stay was eight days and the in-hospital, one, three and six month mortalities were 13.25%, 27.3%, 32.53% and 38.15%, respectively. The median duration of survival was 921 days. Readmission for heart failure constituted 42%, and the most common cause of decompensation was an infection(31.5%). The presence of cyanosis at admission, history of previous stroke or transient ischemic attack, and American College of Cardiology (ACC)/American Heart Association (AHA) stage D at the time of discharge were independently associated with mortality at six months. The median total direct cost of admission was INR 84,881.00 ($ 1232.34) ConclusionThe VHFR cohort had younger, more diabetic, and fewer hypertensive subjects than most cohorts. Admission for heart failure is a catastrophic health expenditure. Attempts should be made to ensure a reduction in readmission rates by targeting goal-directed therapy. As the most common cause of acute decompensation is pneumonia, vaccinating all patients before discharge may also help in this regard.

P5731Optimal blood pressure in diabetic hypertensive patients with overt proteinuria

Abstract Background Evidence for the benefit of intensive blood pressure lowering in diabetic nephropathy is not clear at this time. The objective of this study was to demonstrate whether lower mean blood pressure (BP) in treated hypertensive patients with diabetic nephropathy is associated with better prognosis. Methods From the National Health Insurance Service (NHIS) Health Examination Database, diabetic hypertensive subjects with proteinuria between 2009 and 2010 were selected and followed-up until 2015 (N=8,663). Mean of the recorded systolic and diastolic BP during follow-up health examinations were stratified into five categories (SBP: &lt;120, 120 to &lt;130, 130 to &lt;140, 140 to &lt;150, and ≥150 mmHg; DBP: &lt;70, 70 to &lt;80, 80 to &lt;90, 90 to &lt;100, and ≥100 mmHg). All-cause death, myocardial infarction (MI), stroke, and renal outcome (progression to end stage renal disease or doubling of serum creatinine) were examined by Cox proportional hazard models with the propensity scores adjusted method. Results Compared to SBP of 130 to &lt;140 mmHg, SBP of 120 to &lt;130 mmHg was associated with lower risk of all-cause death (HR=0.78; 95% CI, 0.64–0.95), stroke (HR: 0.65; 95% CI, 0.45–0.94), and renal outcome (HR: 0.81; 95% CI, 0.68–0.97). SBP of &lt;120 mmHg was associated with benefit for renal outcomes (HR: 0.69; 95% CI 0.55–0.88) but not with elevated risk of other outcomes. Compared to DBP of 80 to &lt;90 mmHg, DBP of 70 to &lt;80 mmHg were associated with lower risk of all-cause death (HR: 0.75; 95% CI, 0.64–0.88) but with higher risk of MI (HR: 1.52; 95% CI, 1.05–2.21). DBP of &lt;70 mmHg was associated with reduced risk of all-cause death (HR: 0.79; 95% CI, 0.64–0.98). Conclusion In diabetic hypertensive subjects with overt proteinuria, deterioration of renal function decreased with decreasing SBP and the lowest risk of all-cause death and stroke were observed in SBP &lt;130 mmHg. Low DBP was associated with low risk of all-cause death but there was a J curve phenomenon for MI in DBP of 70 to &lt;80 mmHg.

Arterial hypertension and diabetes association in the elderly

High blood pressure is common in the elderly diabetic, responsible for an increase in cardiovascular risk and an acceleration of the degenerative complications of diabetes. The aim of this study was to determine the characteristics of hypertension in elderly diabetic subjects and to study its repercussions. Our descriptive study was performed in 60 hypertensive diabetic patients over than 65 years of age, followed in our department. Hypertension was defined as arterial pressure ≥ 140/90 mmHg. A complete clinical examination and a standard biological assessment were performed for each patient. The mean age of the patients was 68.72 years; 61.2% of patients were between 60 and 65 years of age. The mean duration of diabetes progression was 14.2 years and 72% of patients received insulin therapy. The majority (91%) of these patients had uncontrolled diabetes; the average HbA1c was 10.2%. The diagnosis of diabetes preceded that of hypertension in 73.6% of cases. Thirty-three percent of our population had an uncontrolled hypertension. Patients had on a salt-free diet in 18.1% of cases and a dietary salt restriction in 21.2% of cases. Among our hypertensive patients, 29.9 received a monotherapy and 44.2% a dual therapy. Dyslipidemia was found in 51.6% of our patients. A microalbuminuria was noted in 32.3% of patients. Retinopathy was found in 48% of patients, neuropathy in 34.6%. There is a history of stroke in 3.8% of cases and a history of myocardial infarction in 2.2% of cases. Coronary insufficiency was confirmed in 5.8% of cases, unexplored chest pain was found in 26.6% of cases. Intermittent claudication was noted in 24.2% of cases. This claudication was explored and confirmed in 2% of cases. Vascular metabolic complications are serious in hypertensive elderly diabetic subjects; thus, multidisciplinary care and regular monitoring is required to detect these complications early and improve life expectancy.

Omental Arteries from Diabetic Hypertensive Subjects are Larger and Stiffer than those from Non‐Diabetic Normotensives

Diabetes and hypertension are associated with structural and mechanical changes of the resistance vasculature that contribute to cardiovascular disease development and progression. We have previously reported that in mouse isolated resistance arteries prolonged vasoconstriction leads to vascular inward remodeling and stiffening, through a process that requires smooth muscle actin polymerization. We hypothesized that human arteries from diabetic hypertensive subjects would be inwardly remodeled and stiffer than those from non‐diabetic normotensives. We also hypothesized that actin stress fiber disruption would dilate and soften the arteries from diabetic hypertensives. To test these hypotheses, omental samples were obtained from patients undergoing abdominal surgery at The University of Missouri Hospital. Small arteries were isolated, cannulated and analyzed using pressure myography. Vascular luminal diameters and wall‐thicknesses were monitored by videomicroscopy at different levels of intraluminal pressure (5–120mmHg) under passive conditions (calcium‐free buffer with 100μM adenosine and 2mM EGTA) in the absence or presence of Mycalolide‐B (2uM) to disrupt the actin cytoskeleton. Investigators were blinded to the subject condition throughout the experimental procedures. Data were used for assessment of vascular remodeling and characterization of vascular wall mechanical properties. Subsequently, the arterial parameters obtained were compared across groups according to diabetic and hypertensive status retrieved from medical records. Results indicate that small omental arteries from diabetic hypertensive (N=10) subjects have larger diameters and are stiffer than those from non‐diabetic normotensives (N=22, P&lt;0.05). Data also show that disruption of the actin cytoskeleton had no significant effects on their mechanical properties. We conclude that small omental arteries from diabetic and hypertensive subjects undergo a process of outward remodeling that results in them becoming larger and stiffer and that, at the single time point of our sampling, this is not dependent on vascular cell actin stress fibers.Support or Funding InformationNational Institutes of Health grants: R01 HL137769 (JP), R01 HL088105 (LM‐L).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Relationships of Anthropometric Indices of Centripetal Adiposity With Essential Hypertension and Type - 2 Diabetes Mellitus in Kano Metropolis

The use of centripetal indices of adiposity for cardiovascular risk prediction is gaining popularity over body mass index (BMI). The objectives of the study were to investigate the relationships of centripetal adiposity indices with essential hypertension and type 2 diabetes mellitus and find sexual dimorphism in such relationship in Kano. Also to determine the correlation between centripetal adiposity indices and BMI. The study included 405 registered hypertensive, diabetic or hypertensive – diabetic subjects (215 females and 190 males) with mean age of 53.4±0.36. The adiposity indices [BMI, waist circumference (WC) hip circumferences (HC) and waist to hip ratio (WHR)] were obtained using standard protocol. Chi-square and Pearson correlation were used to test for relationship. The results showed that WC was not significantly associated with essential hypertension and type 2 diabetes mellitus in females, but was significant in males (P = 0.04). In both sexes, WHR was significantly associated with essential hypertension and type 2 diabetes mellitus, however, relationship was stronger in the males (P < 0.0001 for males, P = 0.023 for females) In males where both WC and WHR had significant relationship with essential hypertension and type 2 diabetes mellitus, the relationship was stronger for WHR (P < 0.0001 for WHR, P = 0.04 for WC). In conclusion, WC in males and WHR in both sexes had significant association with essential hypertension and type 2 diabetes mellitus and compared to WHR, WC correlated better with BMI.

Angiopoietin-2 level as a tool for cardiovascular risk stratification in hypertensive type 2 diabetic subjects

ABSTRACT Objectives: This observational cross-sectional study aimed to investigate the relationship between serum Angiopoietin-2 (Ang-2) levels and cardiovascular (CVD) risk factors in drug controlled hypertensive diabetic subjects without cardiovascular complications. Methods: All subjects were evaluated for fasting blood glucose (FBG), HbA1c, liver enzymes, lipid profile and serum Ang-2. Results: Mean serum Ang-2 level was significantly higher in hypertensive diabetic subjects. In bivariate analysis in diabetic subjects with cardiovascular risk factors, Ang-2 positively correlated with waist circumference, body mass index (BMI), systolic blood pressure (SBP), FBG, HbA1c and triglycerides. In multivariate linear regression analysis, this association remained significant with FBG and triglycerides. Ang-2 levels were independently associated with CVD risk factors in drug controlled Type 2 diabetes (T2D) subjects. Conclusions: Further detailed studies in larger population with more attention is needed to consider Ang-2 level as a tool for CVD risk stratification in hypertensive diabetic subjects.

Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects

BackgroundBlood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet.ObjectiveThe aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects.MethodsCross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p < 0.05.ResultsThere was a circadian variation of BP levels in C and DH groups; systolic BP and time-rate were higher in DH subjects in all periods evaluated. In C subjects, high positive correlations were shown between time-rate index (24h-ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p < 0.001). Records obtained from DH showed weak positive correlations.Conclusions Indices obtained from 24h-ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

Serum high-sensitive C-reactive protein is associated with dietary intakes in diabetic patients with and without hypertension: a cross-sectional study.

Background Serum high-sensitive C-reactive protein (hs-CRP) concentrations independently predict the development of diabetes, metabolic syndrome and cardiovascular disease. However, the impact of dietary factors on serum high-sensitive C-reactive protein concentrations in diabetic patients has received limited attention. We aimed to investigate the association between dietary factors and high-sensitive C-reactive protein , among diabetic patients with and without hypertension and healthy subjects. Methods In this cross-sectional study, diabetics with ( n = 325) and without hypertension ( n = 599) and healthy individuals ( n = 1220) were recruited in Mashhad, Iran. Dietary intake was assessed by 24-h recall. Biochemical parameters including serum high-sensitive C-reactive protein were measured using standard protocols. Stepwise multiple regression analysis was used to predict whether serum high-sensitive C-reactive protein concentration was associated with dietary constituents. Results High-sensitive C-reactive protein was significantly higher among hypertensive and non-hypertensive diabetic patients compared with healthy subjects ( P < 0.001). The dietary intake of zinc + 6.4% and calcium -3.4% and body mass index +3.9% explained approximately 13.7% of the variation in serum high-sensitive C-reactive protein among diabetic hypertensive patients. Approximately 9.7% of the variation in serum high-sensitive C-reactive protein in diabetic non-hypertensive patients could be explained by body mass index, and intake of sodium, iron and cholesterol. In the healthy subjects, approximately 4.4% of the total variation in serum high-sensitive C-reactive protein concentration could be explained by cholesterol consumption and waist circumference. Conclusion Serum high-sensitive C-reactive protein concentrations were found to be a significant predictor for hypertensive and non-hypertensive diabetic subjects. There was a significant association between dietary factors include zinc, iron, sodium and cholesterol and serum high-sensitive C-reactive protein, while there was an inverse association between dietary calcium and serum high-sensitive C-reactive protein in diabetic hypertensive individuals.

Association of polyunsaturated/saturated fatty acids to metabolic syndrome cardiovascular risk factors and lipoprotein (a) in hypertensive type 2 diabetic patients.

We investigated whether PUFA/SFA - PUFA-ω6/PUFA-ω3 ratios and EPA + DHA can be associated with predictive atherothrombogenic biomarkers status in type 2 diabetes (T2D) patients with or without hypertension (HT). The study was conducted on 507 adult subjects (men and women) cohort (36-54 years), divided into 3 groups: T2D, diabetic-hypertensive (DH) and healthy group. Patients were phenotyped regarding their CMS profile using the NCEP/ATPIII criteria. Hypertension was defined as systolic (SBP) and diastolic (DBP) blood pressure ≥140/90 mmHg, respectively. Insulin resistance was assessed by Homa-IR model. Metabolic, atherothrombogenic and inflammatory parameters (CRP) were analyzed by various automata; Non-esterified fatty acids (NEFA) by microfluorimetry; PUFA-ω6 and PUFA-ω3 by gas phase chromatography. CMS clusters and IR were found in T2D and DH groups. Dyslipidemia was correlated with accretion NEFA levels. The PUFA/SFA ratio and PUFA-ω3 level are decreased, concomitant with an increase ApoB100/ApoA1 ratio and very high lipoprotein (a) concentrations. Raising the PUFA-ω6/PUFA-ω3 ratio and PUFA-ω6 levels were associated with the drop HDL-c/LDL-c ratio and EPA+DHA drastic depletion. In conclusion, fatty acids nutritional quality may be associated with atherothrombogenic biomarkers, mainly Lp (a), to prevent the thrombosis and an accident vascular risk in diabetic-hypertensive subjects.

Raised Arterial Pressure and Microalbuminuria in Type 2 Diabetic Subjects with Familial Hypertension

Background and Aims : Microalbuminuria is claimed to be an early marker of nephropathy in type 2 diabetes.The raised arterial pressure is an important factor in the progression of diabetic nephropathy. There is a significant correlation between blood pressure and the progression of albuminuria in both type 1 and type 2 diabetes. This study in Bangladeshi type 2 diabetic patients was to evaluate whether microalbuminuria and raised arterial pressure are influenced by familial predisposition to hypertension.Methods : Sixty three newly diagnosed Bangladeshi type 2 diabetic patients were investigated. The diabetic subjects were divided into two groups as diabetes with family history of hypertension (n=37) and diabetes without family history of hypertension (n=26). Diabetic subjects were further divided into normotensive (n= 46) and hypertensive (n= 17); diabetic normoalbuminuric (n 44) and diabetic microalbuminuric (n 19) subgroups. Serum glucose was measured by glucose-oxidase; blood urea, serum creatinine and urinary creatinine by enzymatic-colorimetric method and urinary albumin by immunoturbidimetry method.Results : systolic blood pressure (SBP), diastolic blood pressure (DBP) and microalbuminuria were significantly elevated in diabetic subjects with familial predisposition to hypertension when compared to diabetic subjects without familial predisposition to hypertension [SBP (127±16 vs 110±14) mmHg P= 0.001; DBP (81±9 vs 72±11) mmHg P= 0.001; Microalbuminuria 2.23(0.28-9.43) vs 1.52(.29-3.91) mg/mmol p&lt;0.03]. When diabetic normotensive subjects were compared with diabetic hypertensive subjects for microalbuminuria, no significant difference was found among themselves [median (range) 1.67(0.17-8.62) vs 1.70(.28-9.43) mg/mmol p = NS]. Comparison of blood pressure was found no significant difference between diabetic normoalbuminuric and diabetic microalbuminuric subjects [systolic blood pressure (117±17 vs 125±17) mmHg p= NS ; diastolic blood pressure (76±11 vs 82±10) mmHg p= NS ].Conclusion : Microalbuminuria, a marker of early diabetic nephropathy and raised arterial pressure, a progression factor of nephropathy are more influenced by familial predisposition to hypertension in diabetic population irrespective of presence or absence of microalbuminuria and hypertension.Bangladesh Crit Care J March 2016; 4 (1): 14-18