Hypertensive Diabetic Patients Research Articles

Assessment of plasma insulin, c-peptide, and blood pressure parameters of type 1 and type 2 diabetes mellitus and diabetic complications

Background: Regardless of the type of diabetes mellitus, there is always a Beta-cell dysfunction leading to absolute insulin deficiency in type 1 diabetes mellitus or associated with insulin resistance in case of type 2 diabetes mellitus.
 Materials and Methods: A total of 267 subjects consisting of 164 diabetic patients and 103 non-diabetic apparently healthy individuals were analysed. The plasma insulin and c-peptides levels were determined using enzyme link immunosorbent assay, while plasma glucose level was determined using standard spectrophotometric method.
 Results: The biochemical results showed that the mean plasma glucose of Type 1 diabetes (213.65±20.35) and Type 2 diabetes (218.78+7.85) were significantly (P<0.05) higher than that of non-diabetic control (81.88±17.22) mg/dl; the mean plasma glucose and the systolic reading of the Diabetes Mellitus with Nephropathy, hypertension, coronary artery disease, neuropathy, and retinopathy patients were significantly (p<0.05) higher than the control subjects. Among diabetic hypertensive patients mean insulin and c-peptide levels were significantly (p<0.05) lower, while the mean insulin level was insignificantly (p>0.05) lower in diabetic patients with neuropathy or coronary artery disease. No significant (p>0.05) differences was observed in the mean plasma c-peptide level, and diastolic reading of diabetic patient with neuropathy. There were no significant (p>0.05) differences in the mean plasma c-peptide level, systolic and diastolic readings of Diabetic patients with coronary heart disease or retinopathy.
 Conclusion: There were significant differences in the blood pressure parameters in both the diabetes mellitus and diabetic complications in this study.

SAT-LB127 Regulation of ENaC by Exosomal Lipids in the Diabetic Kidney

Effective treatment of hypertension (HTN) in patients with diabetes may help to significantly reduce the risk of those patients developing additional complications including vascular disease and diabetic nephropathy. Blockers of the renin-angiotensin system including angiotensin converting enzyme inhibitors and angiotensin receptor blockers are not always effective in treating HTN in diabetic patients. Therefore, the aim of this study was to use an animal model of type 2 diabetes to investigate a novel mechanism of diabetes associated HTN involving exosomal lipids in the upregulation of epithelial sodium channel (ENaC) activity in the kidney. We performed metabolic cages studies using male and female hypertensive (salt-loaded induced) diabetic db/db mice and healthy age-matched wild-type control mice in order to isolate and characterize urinary exosomes from each group by nanoparticle tracking analysis, Western blotting, and transmission electron microscopy. Our mass spectrometry based lipidomic studies identified key lipids that were differentially expressed in the kidney derived exosomes from the hypertensive diabetic mice compared to control mice. Sphingomyelin quantification assays showed total sphingomyelin content was elevated in the exosomes from the hypertensive diabetic mice compared to the control group. Single channel patch clamp studies showed urinary exosomes enriched in sphingomyelins from hypertensive diabetic mice compared to controls increase ENaC activity (at the level of channel density and open probability) in cultured distal tubule renal epithelial cells. Moreover, exogenous application of sphinomyelin-6 to cultured mouse cortical collecting duct (mpkCCD) cells resulted in an increase in amiloride-sensitive transepithelial current. Taken together, our data show various lipids are enriched in exosomes from hypertensive diabetic mice compared to controls and these exosomes positively regulate ENaC activity in distal tubule and collecting duct cells.

Correlação entre obesidade geral e abdominal em mulheres ativas diabéticas e/ou hipertensas

Este estudo teve por objetivo investigar a correlação entre o índice de massa corporal e os indicadores antropométricos de obesidade abdominal em pacientes diabéticos e/ou hipertensos ativos assistidos pelo Núcleo de Apoio à Saúde da Família de Canindé, Ceará. Trata-se de uma pesquisa correlacional, transversal e de análise quantitativa. A amostra foi composta por 25 mulheres diabéticas e/ou hipertensas, ativas, com idade média de 63,64±10,25 anos. Foram coletadas as medidas de peso, altura e circunferências da cintura (CC). O índice de massa corporal (IMC) foi calculado para identificar obesidade geral e a obesidade abdominal foi identificada com base nos indicadores CC, Relação Cintura/Estatura (RCE) e Índice de Conicidade (IC). Os resultados apontaram pacientes com sobrepeso (IMC=28,3±4,0) e elevados índices antropométricos de obesidade abdominal (CC=100,1±8,7; RCE=66,4±5,1; IC=139,4±8,3). A CC (p<0,01; r=0,826) e a RCE (p<0,01; r=0,730) se mostraram correlacionadas com o IMC nas pacientes hipertensas. Não foram identificadas correlações significativas entre os indicadores antropométricos de obesidade geral e abdominal na amostra de pacientes diabéticos e hipertensos-diabéticos. Em conclusão, identificou-se uma amostra de mulheres diabéticas e/ou hipertensas com sobrepeso e com risco elevado de desenvolver doenças associadas à obesidade. O IMC das pacientes hipertensas apresentou positiva correlação com a CC e com a RCE, mas não com o IC. Não houve correlações significativas nas pacientes diabéticas.

Incidence and Risk Assessment for Atrial Fibrillation at 5 Years: Hypertensive Diabetic Retrospective Cohort.

(1) Background: The link between diabetes and hypertension is mutual and reciprocal, increasing the risks for the development of atrial fibrillation (AF). The main objective was to develop a prediction model for AF in a population with both diabetes and hypertension at five years of follow-up. (2) Methods: A multicenter and community-based cohort study was undertaken of 8237 hypertensive diabetic patients without AF between 1 January 2103 and 31 December 2017. Multivariate Cox proportional-hazards regression models were used to identify predictors AF and to stratify risk scores by quartiles. (3) Results: AF incidence was 10.5/1000 people/years (95% confidence interval (CI) 9.5–11.5), higher in men. The independent prognostic factors identified: age (hazard ratio (HR) 1.07 95% CI 1.05–1.09, p < 0.001), weight (HR 1.03 95% CI 1.02–1.04, p < 0.001), CHA2DS2VASc score (HR 1.57 95% CI 1.16–2.13, p = 0.003) and female gender (HR 0.55 95% CI 0.37–0.82, p = 0.004). Q4 (highest-risk group for AF) had the highest AF incidence, stroke and mortality, and the smallest number needed to screen to detect one case of AF. (4) Conclusions: Risk-based screening for AF should be used in high cardiovascular risk patients as the hypertensive diabetics, for treatment of modifiable cardiovascular risk, and monitoring AF detection.

Renin-angiotensin-aldosterone system blockade is associated with higher risk of contrast-induced acute kidney injury in patients with diabetes.

As the incidence of diabetes and cardiovascular comorbidities continues to rise, driven by increased prevalence of obesity and an aging population, so does the demand for percutaneous coronary intervention (PCI) to restore cardiac blood flow. Renin-angiotensin-aldosterone system (RAAS) inhibitors are commonly prescribed to hypertensive diabetic patients to prevent diabetic nephropathy. However, evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the risk of contrast-induced acute kidney injury (CIAKI) following coronary angiography (CAG) and PCI. We therefore conducted a retrospective, multicenter study applying the propensity score matching method to evaluate the impact of RAAS inhibition on CIAKI in diabetic patients undergoing CAG/PCI. Among 2240 subjects that met the inclusion criteria, 704 patients in the ACEIs/ARBs group were successfully matched to eligible control patients. The incidence of CIAKI (serum creatinine increase ≥0.5 mg/dl or ≥25% from baseline within 72 h post-CAG/PCI) was significantly higher in the ACEIs/ARBs group than in the control group (26.6% vs. 16.2%, P<0.001). However, control patients showed increased risk of overall adverse cardiovascular events (4.1% vs. 1.8% for ACEIs/ARBs; P=0.016). These data indicate that RAAS inhibition increases the risk of CIAKI in diabetic patients, but confers protection against early cardiovascular events.

Real-world use of ACEI/ARB in diabetic hypertensive patients before the initial diagnosis of obstructive coronary artery disease: patient characteristics and\xa0long-term follow-up outcome

BackgroundCurrent guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) as a first-line therapy in diabetic hypertensive patients and for secondary prevention in patients with obstructive coronary artery disease (OCAD). However, the effects of using ACEI/ARB before the initial diagnosis of OCAD on major adverse cardiac and cerebral event (MACCE) in diabetic hypertensive patients remain unclear. This study investigated whether using ACEI/ARB before the initial diagnosis of OCAD could be associated with improved clinical outcomes in diabetic hypertensive patients.MethodsA total of 2501 patients with hypertension and diabetes, who were first diagnosed with OCAD by coronary angiography, were included in the analysis. Of the 2501 patients, 1300 did not used ACEI/ARB before the initial diagnosis of OCAD [the ACEI/ARB(-) group]; 1201 did [the ACEI/ARB(+) group]. Propensity score matching at 1:1 was performed to select 1050 patients from each group. Incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, heart function, and subsequent MACCE during a median of 25.4-month follow-up were determined and compared between the 2 groups.ResultsCompared with the ACEI/ARB(-) group, the ACEI/ARB(+) group had significantly lower incidence of AMI (22.5% vs. 28.4%, p < 0.05), smaller infarct size in patients with AMI (pTNI: 5.7 vs. 6.8 ng/ml, p < 0.05; pCKMB: 21.7 vs. 28.7 ng/ml, p < 0.05), better heart function (LVEF: 60.0 vs. 58.5%, p < 0.05), and lower incidences of non-fatal stroke (2.4% vs. 4.6%, p < 0.05) and composite MACCE (23.1% vs. 29.7%, p < 0.05). No prior ACEI/ARB therapy was significantly and independently associated with non-fatal stroke and composite MACCE.ConclusionsIn diabetic hypertensive patients, treatment with ACEI/ARB before the initial diagnosis with OCAD was associated with decreased incidence of AMI, smaller infarct size, improved heart function, and lower incidences of non-fatal stroke and composite MACCE.Trial registration Retrospectively registered

The study of Mean Platelet Volume (MPV) as a Potential Risk Factor for Macrovascular Complications (Ischemic Heart Disease and Cerebrovascular Stroke) in Type 2 Diabetes Mellitus

Abstract Background Type 2 diabetes mellitus (T2DM) has reached global epidemic proportions, with more than 382 million people affected according to 2013 estimate. By 2035, its prevalence is expected to reach 471 million, meaning that 10% of the world’s population will have diabetes. Patients with diabetes often suffer from metabolic abnormalities, poor glycemic control, oxidative stress, insulin resistance, and low-grade inflammation. These conditions trigger vascular dysfunction, which predisposes them to atherothrombosis Objective The present study aimed to study the mean platelet volume (MPV) as a potential risk factor for ischemic heart disease and cerebrovascular stroke in type 2 diabetes. Methods The study was conducted on 150 subjects there ages ranged from 40 to 60 years old. They were divided into 4 groups: Group 1: included30 type 2 diabetic overweight or obese patients without previous history of myocardial infarction or cerebrovascular stroke. Then, they were subdivided into 2 subgroups: 1a) 15 diabetic non hypertensive patients. 1b) 15 diabetic hypertensive patients. Group 2: included A) 30 type 2 diabetic overweight or obese patients with recent cerebrovascular stroke. Then, they were subdivided into 2 subgroups: 2Aa) 15 diabetic non hypertensive patients. 2Ab) 15 diabetic hypertensive patients. B) 30 type 2 diabetic overweight or obese patients with acute myocardial infarction. Then, they were subdivided into 2 subgroups: 2Ba) 15 diabetic non hypertensive patients. 2Bb) 15 diabetic hypertensive patients. Group 3: 30 overweight or obese non-diabetic patients with acute myocardial infarction or recent cerebrovascular stroke. Then, they were subdivided into 3a) 15 patients with acute myocardial infarction. 3b) 15 patients with recent cerebrovascular stroke. Group 4: 30 Healthy control with matching age and sex and were subdivided into 2 subgroups: Control a) 15 lean subjects. Control b) 15 overweight or obese subjects. All subjects in this study were subjected to Full medical history taking. Thorough clinical examination (including weight, height, BMI, blood pressure). The following laboratory investigations were done: Fasting blood glucose, Two hour post prandial, HbA1c, Fasting insulin (for HOMA IR), Lipid profile (Total cholesterol-LDL-HDL-Triglycerides), Mean platelet volume and Liver and kidney function test. The following radiological investigation were done: Carotid ultrasonography for estimation of intima-media thickness and abdominal ultrasonography. Results As regards MPV, there was a high statistical significant difference between the studied groups (p-value&amp;lt;0.01), being the highest in group II (mean 11.93 ± 0.37 fl) followed by group III (10.77±1.69 fl), group I (10.67±1.98 fl) and group IV (8.83±0.98 fl). On comparing between every other groups there was a high statistical significant difference between group (I) &amp; (II) being higher in group II, (I) &amp; (IV) being higher in group I, (II) &amp; (III) being higher in group II, (II) &amp; (IV) being higher in group II and (III) &amp; (IV) being higher in group III (P value&amp;lt;0.01). However, there was a non-statistical significant difference between group (I) &amp; (III) regarding the MPV (P value&amp;gt;0.05). On comparing between hypertensive and non-hypertensive patients in each group as regard MPV, there were non-significant statistical difference. Conclusion MPV was higher in type 2 diabetic patients than healthy control. Moreover, MPV was significantly higher in type 2 diabetic patients with macrovascular complications. There was no significant difference between hypertensive and non hypertensive patients as regard MPV. There was no significant difference between obese and lean subjects as regard MPV. There was a positive significant correlation between MPV and markers of glycemic control in T2DM.

A comparison of macrophage migration inhibitory factor with C reactive protein in diabetic hypertensive patients with myocardial infarction that underwent primary percutaneous coronary intervention

A comparison of macrophage migration inhibitory factor with C reactive protein in diabetic hypertensive patients with myocardial infarction that underwent primary percutaneous coronary intervention

Serum uric acid level among diabetic, hypertensive and diabetic-hypertensive patients attending specialist hospital Sokoto

Elevated serum uric acid is associated with metabolic disorders such as insulin resistance, hypertension, diabetes, dyslipidaemia and also increases the risk of cardiovascular disease. This study evaluated serum uric acid and fasting plasma glucose in diabetic, hypertensive and diabetic-hypertensive patients. This study consist of 120 subjects including 30 diabetics, 30 hypertensives, 30 diabetic-hypertensive patients and 30 age- and sex-matched controls. The mean serum uric acid was significantly (p<0.001) higher in diabetic, hypertensive and diabetic-hypertensive patients when compared with those of controls. While the mean values of fasting plasma glucose were significantly (p<0.001, p=0.007 and p<0.001) higher in diabetic, hypertensive and diabetic-hypertensive patients respectively when compared with those of controls. It was concluded from the finding of this study that, serum uric acid level and fasting plasma glucose increases significantly in diabetic, hypertensive and diabetic-hypertensive patients. It is recommended that serum uric acid and plasma glucose should be included as a routine investigation for the management of these groups of individuals to avoid the risk of cardiovascular diseases.

Serum uric acid level among diabetic, hypertensive and diabetic-hypertensive patients attending specialist hospital Sokoto

Serum uric acid level among diabetic, hypertensive and diabetic-hypertensive patients attending specialist hospital Sokoto

Value of ambulatory blood pressure measurement in diagnosing hypotension in hypertensive diabetic patients with medication-controlled BP.

BackgroundHypotension is a common clinical finding in diabetic patients on anti-hypertensive medications. In the absence of clearly defined and documented hypotensive episodes, clinicians are faced with the challenge of modifying antihypertensive medication in potentially symptomatic diabetic patients.ObjectiveTo determine the value of ambulatory blood pressure monitor (ABPM) in diagnosing hypotensive episodes in hypertensive diabetic patients with medication-controlled blood pressure.Patients and methodsThe records of all hypertensive diabetic patients with medication-controlled were obtained between 2017 and 2018. Patients’ demographic data, comorbid conditions, hypotensive symptoms and echocardiography results were obtained and compared to office-based blood pressure and ABPM.ResultsOf 926 patients screened in the department of medicine outpatient clinics, 231 patients had diabetes and hypertension and were taking antihypertension medications, so only 86 patients were recruited. Using 24 h ABPM, hypotensive events were documented in 65 (75.6%) patients without correlated hypotensive symptoms in the patient sheet. Patients who had hypotensive episodes recorded by ABPM tended to have these between 5 and 10 a.m. and were significantly older – 60.71 versus 58.76 (P = .022) – and more likely to have lower ejection fractions by echocardiography 46.31 versus 62.85 (EF) (P < .001).ConclusionIn treated hypertensive diabetic patients with antihypertensive medication, ABPM may be beneficial in capturing bouts of asymptomatic (silent) hypotension readings that occur in the out-of-hospital setting. Diabetic patients with controlled hypertension based on office reading showed a significant number of asymptomatic hypotensive readings detected with ambulatory BP monitoring that can have a role in following up such patients.

Assessment of Thyroid Profile of Type 1 and Type 2 Diabetes Mellitus Patients and Patients with Diabetic Complications

This study was undertaken to assess the thyroid profile of diabetes mellitus (DM) patients and patients with some associated complications in the Edo state, Nigeria. Blood samples from 267 subjects, consisting of 164 diabetic patients (24 type 1 DM and 140 type 2 DM) and 103 nondiabetic apparently healthy individuals (as controls), were analyzed. The thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) levels were determined using the enzyme linked immunosorbent assay (ELISA). From the result obtained, the T3 level was found significantly (p &lt; 0.05) higher in diabetic-nephropathy (D-NEPHR) patients than the control subjects, while the TSH and T4 levels of D-NEPHR were insignificantly (p &gt; 0.05) higher than those of the control group. The mean TSH level was significantly (p &lt; 0.05) lower in diabetic hypertensive patients when compared with the control group, while the plasma T3 level was significantly (p &lt; 0.05) higher in diabetic hypertensive patients when compared with the control group. There was no significant difference (p &gt; 0.05) in the mean value of T4 of diabetic hypertensive patients when compared with the control subjects. The mean plasma T3 and T4 were significantly (p &lt; 0.05) higher in diabetic neuropathy (D-NEUR) patients than those of control subjects. There were no significant (p &gt; 0.05) differences in the mean plasma TSH level of D-NEUR patients when compared with those of control subjects. The mean plasma T3and T4 levels of diabetic patients with coronary heart disease (DM-CHD) were significantly (p &lt; 0.05) higher than those of control subjects while the mean plasma TSH level of DM-CHD was significantly (p &lt; 0.05) lower than that of control subjects. No significant (p &gt; 0.05) difference in the mean plasma TSH, T4, and T3 levels of diabetic retinopathy subjects when compared with those of control subjects was obtained.

Biochemical markers for detection of intracardiac thrombosis

Aims: Intracardiac thrombus is known as the common cause of cardiogenic cerebral ischemia and a useful clinical marker of thrombogenesis. This study aimed to predict the presence of intracardiac thrombosis by noninvasive method using NT-pro-brain natriuretic peptide (BNP) and D-dimer evidenced by trans-esophageal echocardiography (TEE). Methods: A total of 200 patients were included and referred to TEE for the detection of intracardiac thrombi. Measurement of NT-Pro-BNP and D-dimer was done 2 h before the TEE examination. The patients were divided into two groups namely Group A with intracardiac thrombus and Group B without intracardiac thrombus. Results: There was an increased prevalence of intracardiac thrombus in diabetic hypertensive patients and transient ischemic attack patients. Intracardiac thrombus had significantly higher levels of Pro-BNP and D-dimer (P < 0.001). Using the receiver operating characteristic curve, the value of D-Dimer level >788 ng/ml and NT-Pro-BNP >683 ng/ml predicted the presence of intracardiac thrombus. Conclusion: High value of NT-Pro-BNP and D-dimer level can predict the presence of intracardiac thrombosis and its decreased value can predict the absence of thrombosis in patients with suspected intracardiac thrombi.

Effects of dapagliflozin on renin-angiotensin-aldosterone system under renin-angiotensin system inhibitor administration.

Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) are reported to prevent cardiovascular events by a mechanism possibly including diuresis and sodium excretion. In this respect, diuresis-induced compensatory upregulation of the renin-angiotensin-aldosterone (RAA) system should be clarified and we performed a randomized controlled trial using dapagliflozin, an SGLT2I. Hypertensive diabetic patients taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were randomly assigned to a dapagliflozin group (DAPA) or a control group (CTRL) with the difference in the changes in plasma renin activity (PRA) after 24 weeks of the treatment as the primary outcome. PRA, plasma aldosterone concentration (PAC), age, sex, BMI, blood pressure, pulse rate, eGFRcys, and HbA1c were not different between the groups at baseline. After 24 weeks, the changes in the PRA from the baseline of the DAPA (n = 44) and CTRL (n = 39) groups were 6.30 ± 15.55 and 1.42 ± 11.43 ng/mL/h, respectively (p = 0.11) although the power of detection was too small. However, post hoc nonparametric analyses revealed that there was a definite increase in the PRA and PAC in the DAPA group (p < 0.0001 and p = 0.00025, respectively) but not in the CTRL group. The PRA in the DAPA group after 24 weeks treatment was significantly elevated compared to the CTRL group (p = 0.013) but not for the PAC. Accordingly, it would be suggested that dapagliflozin may not induce a profound increase, if any, in PAC after 24 weeks of treatment in hypertensive type 2 diabetic patients under RAA suppression.

Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels

<i>Background</i>: Hypertension and diabetes are major contributors to structural changes including myocardial fibrosis and progressive alteration of LV systolic and diastolic functions. Two-dimensional speckle tracking echocardiography is a reliable imaging modality that overcomes the limitations of Tissue Doppler imaging and allows a more accurate assessment of myocardial deformation at the global and regional levels. <i>Objectives</i>: The investigation aims to assess Left Ventricular functions in patients with hypertension and/or diabetes who have apparently preserved LV systolic function; using speckle tracking echocardiography, and correlate the findings with plasma Brain Natriuretic Peptide levels. <i>Methods</i>: Twenty healthy subjects were enrolled as a control group. Sixty patients with hypertension and/or diabetes were recruited and assembled as three equal groups, hypertensives, diabetics, and hypertensive-diabetics. 2D-STE was performed to assess LV longitudinal strain and strain rate. Plasma BNP levels were measured for all subjects. <i>Results</i>: Global systolic longitudinal strain was significantly reduced in patients compared to controls (P=0.001). It was more reduced in group 4. Global systolic SR was reduced in patients compared to controls, being more significantly reduced in groups 2 and 4 (P=0.001). Global early diastolic SR was reduced in patients compared to controls (P=0.001). Meanwhile, Global late diastolic SR values were higher among patients, especially groups 2 and 4 (P=0.001). BNP levels were significantly higher in group 4 compared to group 1 (P=0.000), group 2 (P=0.000), and group 3 (P=0.000). BNP levels and global systolic strain in group 4 were significantly correlated. <i>Conclusion</i>: LV systolic dysfunction was found among all patients groups, confirmed by the significant reduction in LV global longitudinal systolic SR. Hypertensive-diabetics exhibited lower global strain than patients with hypertension only and patients with diabetes only, even though their EF showed no apparent difference. Elevated BNP levels, being the highest among group 4, indicate the presence of ventricular dysfunction, even before chamber failure occurs.

Rozpoznanie i leczenie nadciśnienia tętniczego u pacjentów ze współistniejącą cukrzycą w świetle zmieniających się wytycznych

Hypertension and diabetes are, after smoking, obesity and hypercholesterolemia, the most important cardiovascular risk factors. It is common for these diseases to coexist, which leads to a poorer prognosis. There are differing medical association guidelines regarding the values of blood pressure when treatment should start, but instructions are consistent with the goals of treatment for diabetic patients. The guidelines published in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA) suggest a value of 130/80 mm Hg for both diagnosis and starting treatment. The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines published in 2018 recommend a value of 140/90 mm Hg when we should start therapy, with the goal of treatment below 130/80 mm Hg, but only if drug tolerance is good. The exception is patients aged over 65, for whom we should maintain systolic blood pressure in the range 130–140 mm Hg. The new Polish 2019 guidelines from the Polish Diabetology Association (PTD, Polskie Towarzystwo Diabetologiczne ) and the Polish Society of Hypertension (PTNT, Polskie Towarzystwo Nadciśnienia Tetniczego ) have been adjusted to align with the ESC/ESH guidelines. In this article, we look at changes in the guidelines over the last 20 years. We also look back at the clinical trials which have had the biggest impact on the guidelines. We describe the optimal treatment of hypertension in diabetic patients. Among all the hypotensive drugs recommended as a first choice are angiotensin-converting enzyme inhibitors or angiotensin AT 1 receptor blockers, together with calcium channel blockers and/or diuretics. There is increasing evidence regarding the positive influence of diabetic drugs on blood pressure, especially sodium-glucose cotransporter 2 inhibitors.

Highlights of the December issue.

Highlights of the December issue.

Diabetic Nephropathy: Review of Novel Experimental and Clinical Strategies

Background: Diabetic nephropathy (DN) is considered a severe disorder which affects health worldwide. New more active treatment options are required. Despite a large number of drugs already being available for treatment of hyperglycemia in diabetes, current oral antidiabetic agents often do not provide adequate glycemic control. Renin-angiotensin-aldosterone system (RAAS) blockers are novel agents to slow the progression of DN. Method: The present review provides an overview of recent studies on DN management, especially the use RAAS blockers and their antidiabetic effects. References were mainly identified through PubMed search until December 2016 and backtracking of references in pertinent studies. Results: This review reporting the novel mechanisms and benefits of targeting the RAAS by the use of ACEIs; ARB or direct renin inhibitors in glucose lowering, antioxidant and anti-inflammatory effects and kidney protection. Conclusion: These drugs targeting the RAAS can be used as monotherapy or in combination therapy in hypertensive-diabetic patients to protect them from DN.

Nothnagel Syndrome: A rare case of Ischemic Brain Stem Syndrome

‘Nothnagel Syndrome' is a brainstem syndrome which is often underdiagnosed by the physicians due to rarity of the disease and complex clinical presentation. We present a case of brainstem midbrain syndrome caused by ischemic stroke. The male hypertensive diabetic patient presented with sudden onset of diplopia, ptosis and gait imbalance. Right-sidedgaze palsy with nystagmus and ataxic gait were the clinical findings. Brain imaging (MRI and DWI) showed high signal intensity at upper midbrain. The patient was finally diagnosed as ischemic stroke in the brainstem called Nothnagel syndrome. Up to now, there was no case reported as Nothnagel Syndrome due to ischemic stroke.&#x0D; J MEDICINE JAN 2020; 21 (1) : 62-64

Pay for performance scheme for general practitioners in France: results in 2018

Abstract Methods A pay-for-performance scheme, known as Remuneration on public health objectives (ROSP) and based on meeting targets on quality and efficiency indicators, was introduced for general practitioners in France in 2012. Since 2017, following the 2016 medical agreement between Health Insurance and doctors’ unions, ROSP has consisted of 29 indicators: 8 about chronic disease management, 12 about prevention and 9 about appropriate and efficient prescriptions. The aim of this work was to describe the 2018 results and the overall evolution of the indicators for office-based practitioners. Data are from the French national health system database. Results Follow-up of diabetic patients is steady: diabetic retinopathy screening and regular HbA1c measurement have been performed in 63% and 79% of them since 2016, respectively. Screening for chronic kidney disease improved for diabetic patients (29% in 2015 to 39% in 2018) and hypertensive patients (6% to 11%) but remain low. Influenza vaccination among people over 65 years increased in 2018 (55%) while a downward trend has been observed since 2011 (58% in 2011, 53% in 2016). The number of antibiotic treatments has decreased since 2011, from 46 out of 100 adults without long-term disease to 36 in 2018. In contrast, breast cancer and cervical cancer screening indicators have stagnated for several years around 66% and 56%, respectively. In terms of efficiency, all the indicators improved, most of them consisting in biosimilar and generic drugs prescription. By 2018, ROSP represents 3% of doctors’ revenue (including fee-for-service and lump sum payments). Conclusions By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations. Key messages By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations.