Refractory and resistant hypertension in patients with type 2 diabetes mellitus: differences in metabolic profile and endothelial function

Aim. To determine the prevalence of refractory hypertension (RfH) in patients with and without type 2 diabetes mellitus (DM), as well as to evaluate whether diabetic patients with RfH significant differ from those with uncontrolled resistant hypertension (RH) in clinical phenotype, metabolic profile and endothelial function. Materials and methods. The study included 193 patients with RH: RH 74 patients with diabetes and 119 patients without DM. Uncontrolled RH and RfH were defined by the presence of uncontrolled blood pressure BP (140 and/or 90 mm Hg) despite the use of 3 but 5 antihypertensive drugs (for RH) and 5 antihypertensive drugs, including a mineralocorticoid receptor antagonist (for RfH). Clinical examination, lab tests were performed. Flow-mediated dilation (FMD) and vasoreactivity of middle cerebral artery (MCA) using both breath-holding and hyperventilation test were measured by high-resolution ultrasound. Results. The prevalence of refractory hypertension in patients with and without DM was similar (30% vs 28%, respectively). No differences in BP levels, data of echocardiography and clinical phenotype were found between the diabetic groups, but value of HOMA index, plasma resistin level and postprandial glycaemia were higher in patients with RfH. FMD and MCA reactivity to the breath-holding test were worse in patients with RfH, and they had a more pronounced vasoconstrictor response of MCA to the hyperventilation test compared to patients with RH. Conclusion. The prevalence of RfH is the same in patients with and without diabetes. Diabetic patients with refractory hypertension have a more unfavorable metabolic profile and greater impairment of endothelial function than patients with uncontrolled resistant hypertension.

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POS-364 TO STUDY THE CLINICAL PHENOTYPE OF NON - PROTEINURIC KIDNEY DISEASE IN TYPE 2 DIABETIC PATIENTS

Kidney International Reports ◽

10.1016/j.ekir.2021.03.381 ◽

2021 ◽

Vol 6 (4) ◽

pp. S158

Author(s):

R.K. YADAV ◽

S. Sangha ◽

A. S Kumar ◽

S. Bagchi ◽

S. Mahajan ◽

...

Keyword(s):

Kidney Disease ◽

Clinical Phenotype ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

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Antihypertensive Drugs and Diabetic Retinopathy in Patients with Type 2 Diabetes

Ophthalmologica ◽

10.1159/000441958 ◽

2015 ◽

Vol 235 (2) ◽

pp. 87-96

Author(s):

Jen-Chieh Lin ◽

Mei-Shu Lai

Keyword(s):

Diabetic Retinopathy ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Incidence Rates ◽

Diabetic Patients ◽

Channel Blockers ◽

Type 2 Diabetic Patients ◽

Converting Enzyme Inhibitors ◽

Type 2 Diabetic

Objective: To evaluate the association between the development of sight-threatening diabetic retinopathy (STDR) and antihypertensive drugs (AHDs) use among type 2 diabetic patients with concomitant hypertension. Methods: Type 2 diabetic patients aged 20-100 years who had at least one prescription for AHDs between 2000 and 2011 were identified from the Longitudinal Health Insurance Database (LHID) 2005. The incidence rates of STDR were followed and Cox proportional hazard models were used to analyze the risk associated with AHDs. Results: Users of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were associated with a significantly higher risk than users of calcium channel blockers (CCBs), independent of baseline characteristics. After adjusting for time-varying use of concomitant medications for propensity score-matched or -unmatched cohorts, the results showed that patients receiving ACEIs/ARBs and CCBs were associated with a significantly greater risk compared with β-blocker users. Conclusions: Our study did not support a superiority of ACEIs/ARBs and CCBs over β-blockers for lowering the progression of diabetic retinopathy.

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Fenofibrate improves endothelial function in the brachial artery and forearm resistance arterioles of statin-treated Type 2 diabetic patients

Clinical Science ◽

10.1042/cs20090568 ◽

2010 ◽

Vol 118 (10) ◽

pp. 607-615 ◽

Cited By ~ 29

Author(s):

Sandra J. Hamilton ◽

Gerard T. Chew ◽

Timothy M.E. Davis ◽

Gerald F. Watts

Keyword(s):

Endothelial Dysfunction ◽

Endothelial Function ◽

Statin Therapy ◽

Brachial Artery ◽

Ldl Cholesterol ◽

Density Lipoprotein ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

Dyslipidaemia contributes to endothelial dysfunction and CVD (cardiovascular disease) in Type 2 diabetes mellitus. While statin therapy reduces CVD in these patients, residual risk remains high. Fenofibrate corrects atherogenic dyslipidaemia, but it is unclear whether adding fenofibrate to statin therapy lowers CVD risk. We investigated whether fenofibrate improves endothelial dysfunction in statin-treated Type 2 diabetic patients. In a cross-over study, 15 statin-treated Type 2 diabetic patients, with LDL (low-density lipoprotein)-cholesterol <2.6 mmol/l and endothelial dysfunction [brachial artery FMD (flow-mediated dilatation) <6.0%] were randomized, double-blind, to fenofibrate 145 mg/day or matching placebo for 12 weeks, with 4 weeks washout between treatment periods. Brachial artery FMD and endothelium-independent NMD (nitrate-mediated dilatation) were measured by ultrasonography at the start and end of each treatment period. PIFBF (post-ischaemic forearm blood flow), a measure of microcirculatory endothelial function, and serum lipids, lipoproteins and apo (apolipoprotein) concentrations were also measured. Compared with placebo, fenofibrate increased FMD (mean absolute 2.1±0.6 compared with −0.3±0.6%, P=0.04), but did not alter NMD (P=0.75). Fenofibrate also increased maximal PIFBF {median 3.5 [IQR (interquartile range) 5.8] compared with 0.3 (2.1) ml/100 ml/min, P=0.001} and flow debt repayment [median 1.0 (IQR 3.5) compared with −1.5 (3.0) ml/100 ml, P=0.01]. Fenofibrate lowered serum cholesterol, triacylgycerols (triglycerides), LDL-cholesterol, apoB-100 and apoC-III (P≤0.03), but did not alter HDL (high-density lipoprotein)-cholesterol or apoA-I. Improvement in FMD was inversely associated with on-treatment LDL-cholesterol (r=−0.61, P=0.02) and apoB-100 (r=−0.54, P=0.04) concentrations. Fenofibrate improves endothelial dysfunction in statin-treated Type 2 diabetic patients. This may relate partly to enhanced reduction in LDL-cholesterol and apoB-100 concentrations.

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1418Refractory and resistant hypertension in diabetic patients: different metabolic profile, different response to renal denervation

European Heart Journal ◽

10.1093/eurheartj/ehy565.1418 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

A Falkovskaya ◽

V Mordovin ◽

S Pekarskiy ◽

T Ripp ◽

E Sitkova ◽

...

Keyword(s):

Resistant Hypertension ◽

Metabolic Profile ◽

Renal Denervation ◽

Diabetic Patients ◽

Different Response

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Evaluation of the EndoPAT as a Tool to Assess Endothelial Function

International Journal of Vascular Medicine ◽

10.1155/2012/904141 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 28

Author(s):

M. Moerland ◽

A. J. Kales ◽

L. Schrier ◽

M. G. J. van Dongen ◽

D. Bradnock ◽

...

Keyword(s):

Confidence Interval ◽

Endothelial Function ◽

Healthy Volunteers ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Noninvasive Measurements ◽

Discriminating Power ◽

Different Populations ◽

Acute Changes

Endothelial dysfunction is a potential target for (pharmaceutical) intervention of several systemic pathological conditions. We investigated the feasibility of the EndoPAT to evaluate acute changes in endothelial function with repeated noninvasive measurements and assessed its discriminating power in different populations. Endothelial function was stable over a longer period of time in renally impaired patients (coefficient of variation 13%). Endothelial function in renally impaired and type 2 diabetic patients was not decreased compared to healthy volunteers (2.9±1.4and1.8±0.3, resp., versus1.8±0.5,P>0.05). The EndoPAT did not detect an effect of robust interventions on endothelial function in healthy volunteers (glucose load: change from baseline0.08±0.50, 95% confidence interval −0.44 to 0.60; smoking: change from baseline0.49±0.92, 95% confidence interval −0.47 to 1.46). This suggests that at present the EndoPAT might not be suitable to assess (changes in) endothelial function in early-phase clinical pharmacology studies. Endothelial function as measured by the EndoPAT could be physiologically different from endothelial function as measured by conventional techniques. This should be investigated carefully before the EndoPAT can be considered a useful tool in drug development or clinical practice.

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