How can dapagliflozin affect blood pressure response in a real-life cohort of people with type 2 diabetes and hypertension?

2017 ◽  
Author(s):  
Manuel Cayon-Blanco ◽  
Carolina Garcia-Figueras Mateos
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Blood Pressure Response ◽  
Real Life ◽  
Pressure Response

scholarly journals Hemodynamic abnormalities during muscle metaboreflex activation in patients with type 2 diabetes mellitus

2019 ◽  
Vol 126 (2) ◽  
pp. 444-453 ◽  
Author(s):  
Silvana Roberto ◽  
Raffaele Milia ◽  
Azzurra Doneddu ◽  
Virginia Pinna ◽  
Girolamo Palazzolo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Output ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Blood Pressure Response ◽  
Pressure Response

Metaboreflex is a reflex triggered during exercise or postexercise muscle ischemia (PEMI) by metaboreceptor stimulation. Typical features of metaboreflex are increased cardiac output (CO) and blood pressure. Patients suffering from metabolic syndrome display hemodynamic abnormalities, with an exaggerated systemic vascular resistance (SVR) and reduced CO response during PEMI-induced metaboreflex. Whether patients with type 2 diabetes mellitus (DM2) have similar hemodynamic abnormalities is unknown. Here we contrast the hemodynamic response to PEMI in 14 patients suffering from DM2 (age 62.7 ± 8.3 yr) and in 15 age-matched controls (CTLs). All participants underwent a control exercise recovery reference test and a PEMI test to obtain the metaboreflex response. Central hemodynamics were evaluated by unbiased operator-independent impedance cardiography. Although the blood pressure response to PEMI was not significantly different between the groups, we found that the SVR and CO responses were reversed in patients with DM2 as compared with the CTLs (SVR: 392.5 ± 549.6 and −14.8 ± 258.9 dyn·s−1·cm−5; CO: −0.25 ± 0.63 and 0.46 ± 0.50 l/m, respectively, in DM2 and in CTL groups, respectively; P < 0.05 for both). Of note, stroke volume (SV) increased during PEMI in the CTL group only. Failure to increase SV and CO was the consequence of reduced venous return, impaired cardiac performance, and augmented afterload in patients with DM2. We conclude that patients with DM2 have an exaggerated vasoconstriction in response to metaboreflex activation not accompanied by a concomitant increase in heart performance. Therefore, in these patients, blood pressure response to the metaboreflex relies more on SVR increases rather than on increases in SV and CO. NEW & NOTEWORTHY The main new finding of the present investigation is that subjects with type 2 diabetes mellitus have an exaggerated vasoconstriction in response to metaboreflex activation. In these patients, blood pressure response to the metaboreflex relies more on systemic vascular resistance than on cardiac output increments.

scholarly journals Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes

Diabetologia ◽  
2010 ◽  
Vol 53 (7) ◽  
pp. 1295-1303 ◽  
Author(s):  
E. I. Ekinci ◽  
G. Thomas ◽  
R. J. MacIsaac ◽  
C. Johnson ◽  
C. Houlihan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Hypertensive Patients

Rosiglitazone lowers resting and blood pressure response to exercise in men with type 2 diabetes: A 1‐year randomized study

2018 ◽  
Vol 20 (7) ◽  
pp. 1740-1750 ◽  
Author(s):  
Marie‐Eve Piché ◽  
Anne‐Sophie Laberge ◽  
Patrice Brassard ◽  
Benoit J. Arsenault ◽  
Olivier F. Bertrand ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Blood Pressure Response ◽  
Randomized Study ◽  
Pressure Response ◽  
Response To Exercise

The Blood Pressure Response to Exercise in Youth with Impaired Glucose Tolerance and Type 2 Diabetes

2015 ◽  
Vol 27 (1) ◽  
pp. 120-127 ◽  
Author(s):  
Jane E. Yardley ◽  
Jacqueline Hay ◽  
Freya MacMillan ◽  
Kristy Wittmeier ◽  
Brandy Wicklow ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Blood Pressure Response ◽  
Healthy Weight ◽  
Cross Sectional ◽  
Increased Risk ◽  
Graded Exercise ◽  
Consumption Rates ◽  
Response To Exercise

Type 2 diabetes is associated with hypertension and an increased risk of cardiovascular disease. In adults, blood pressure (BP) responses to exercise are predictive of these complications. To determine if the hemodynamic response to exercise is exaggerated in youth with dysglycemia (DG) compared with normoglycemic overweight/obese (OB) and healthy weight (HW) controls a cross-sectional comparison of BP and heart rate (HR) responses to graded exercise to exhaustion in participants was performed. DG and OB youth were matched for age, BMI z-score, height and sex. Systolic (SBP) and diastolic BP (DBP) were measured every 2 min, and HR was measured every 1 min. SBP was higher in OB and DG compared with HW youth at rest (p > .001). Despite working at lower relative workloads compared with HW, the BP response was elevated during exercise in OB and DG. For similar HR and oxygen consumption rates, BP responses to exercise were slightly higher in OB and DG compared with HW. OB and DG youth both display elevated resting and exercise BP relative to HW peers. Obesity may play a greater role than dysglycemia in the exaggerated BP response to exercise in youth.

Liraglutide effects on glycaemic control, body weight, blood pressure and lipid profile in obese patients with type 2 diabetes: real-life clinical practice

2014 ◽  
Author(s):  
Jose Carlos Fernandez-Garcia ◽  
Isabel Mancha-Doblas ◽  
Carmen Maria Cortes-Salazar ◽  
Maria Jose Picon-Cesar ◽  
Ana Maria Gomez-Perez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Body Weight ◽  
Clinical Practice ◽  
Glycaemic Control ◽  
Lipid Profile ◽  
Real Life ◽  
Obese Patients ◽  
Control Body

scholarly journals Molecular Basis of Human Salt Sensitivity: The Role of the 11β-Hydroxysteroid Dehydrogenase Type 2*

1999 ◽  
Vol 84 (10) ◽  
pp. 3745-3749
Author(s):  
Emanuela Lovati ◽  
Paolo Ferrari ◽  
Bernhard Dick ◽  
Kristin Jostarndt ◽  
Brigitte M. Frey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Microsatellite Marker ◽  
Mineralocorticoid Receptor ◽  
Salt Intake ◽  
Blood Pressure Response ◽  
Salt Sensitivity ◽  
Pressure Response ◽  
Polymorphic Microsatellite Marker ◽  
Polymorphic Microsatellite

Abstract Salt-sensitive subjects (SS) increase their blood pressure with increasing salt intake. Because steroid hormones modulate renal sodium retention, we hypothesize that the activity of the 11β-hydroxy-steroid dehydrogenase type 2 (11βHSD2) enzyme is impaired in SS subjects as compared with salt-resistant (SR) subjects. The 11βHSD2 enzyme inactivates 11-hydroxy steroids in the kidney, thus protecting the nonselective mineralocorticoid receptor from occupation by glucocorticoids. We performed an association study using a recently identified single AluI polymorphism in exon 3 and a polymorphic microsatellite marker of the HSD11B2 gene in 149 normotensive white males (37 SS and 112 SR). The activity of the enzyme 11βHSD2 was assessed by determining the urinary ratio of cortisol (THF+5αTHF) to cortisone (THE) metabolites by gas chromatography in all the 37 SS subjects and in 37 age- and body habitus-matched SR volunteers. Mean (THF+5αTHF)/THE ratio was markedly elevated in SS subjects compared with SR subjects (1.51 ± 0.34 vs. 1.08 ± 0.26, P &lt; 0.00001), indicating enhanced access of glucocorticoids to the mineralocorticoid receptor in SS subjects. In 58% of SS subjects this ratio was higher than the maximum levels in SR subjects. The salt-induced elevation in arterial pressure increased with increasing (THF+5αTHF)/THE ratio (r2 = 0.51, P &lt; 0.0001). A total of 12 alleles of the polymorphic microsatellite marker were detected. Homozygosity for the allele A7 was higher in SS subjects than in SR subjects (41 vs. 28%, P &lt; 0.005), whereas the occurrence of the allele A7 with allele A8 was lower in SS subjects than in SR subjects (8 vs. 15%, P&lt; 0.03). The prevalence of salt sensitivity was 35% in subjects with allele A7/A7, whereas salt sensitivity was present in only 9% of the subjects with allele A7/A8. The (THF+5αTHF)/THE ratio was higher in subjects homozygous for the A7 microsatellite allele as compared with the corresponding control subjects. The prevalence of the AluI allele was 8.0% in SR subjects and 5.4% in SS subjects and did not correlate with blood pressure. The decreased activity of the 11βHSD2 in SS subjects indicates that this enzyme is involved in salt-sensitive blood pressure response in humans. The association of a polymorphic microsatellite marker of the gene with a reduced 11βHSD2 activity suggests that variants of the HSD11B2 gene contribute to enhanced blood pressure response to salt in humans.

Combined mental task and metaboreflex impair cerebral oxygenation in patients with type 2 diabetes mellitus

2021 ◽  
Vol 320 (4) ◽  
pp. R488-R499
Author(s):  
Virginia Pinna ◽  
Azzurrra Doneddu ◽  
Silvana Roberto ◽  
Sara Magnani ◽  
Giovanna Ghiani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Blood Pressure Response ◽  
Mental Task ◽  
Muscle Metaboreflex

Cardiovascular regulation is altered by type 2 diabetes mellitus (DM2), producing an abnormal response to muscle metaboreflex. During physical exercise, cerebral blood flow is impaired in patients with DM2, and this phenomenon may reduce cerebral oxygenation (COX). We hypothesized that the simultaneous execution of a mental task (MT) and metaboreflex activation would reduce COX in patients with DM2. Thirteen individuals suffering from DM2 (6 women) and 13 normal age-matched controls (CTL, 6 women) participated in this study. They underwent five different tests, each lasting 12 min: postexercise muscle ischemia (PEMI) to activate the metaboreflex, control exercise recovery (CER), PEMI + MT, CER + MT, and MT alone. COX was evaluated using near-infrared spectroscopy with sensors applied to the forehead. Central hemodynamics was assessed using impedance cardiography. We found that when MT was superimposed on the PEMI-induced metaboreflex, patients with DM2 could not increase COX to the same extent reached by the CTL group (101.13% ± 1.08% vs. 104.23% ± 2.51%, P < 0.05). Moreover, patients with DM2 had higher mean blood pressure and systemic vascular resistance as well as lower stroke volume and cardiac output levels compared with the CTL group, throughout our experiments. It was concluded that patients with DM2 had reduced capacity to enhance COX when undertaking an MT during metaboreflex. Results also confirm that patients with DM2 had dysregulated hemodynamics during metaboreflex, with exaggerated blood pressure response and vasoconstriction. This may have implications for these patients’ lack of inclination to exercise.

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