OPTIMIZATION OF ARTERIAL HYPERTENSION TREATMENT IN DIABETIC PATIENTS

2020 ◽  
pp. 37-41
Author(s):  
Андрей Петрович Бабкин
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Therapy ◽  
Blood Pressure Level ◽  
Load Test ◽  
Diabetic Patients ◽  
Table Salt ◽  
Patients With Diabetes ◽  
Baseline Values ◽  
The Individual

Достижение целевого уровня артериального давления у больных сахарным диабетом является такой же важной задачей, как и коррекция метаболических нарушений. Проведен анализ эффективности комбинированной антигипертензивной терапии у больных сахарным диабетом с диабетической нефропатией на основе динамики гемодинамических и метаболических параметров у больных с различной реакцией артериального давления на нагрузку поваренной солью. Выяснено, что больные с данной патологией не одинаково реагируют на нагрузку поваренной солью - у 23 (53,3 %) пациентов выявлено повышение систолического АД на 10 и более мм рт. ст. (солечувствительные пациенты), а у 21 (46,7%) повышение АД было менее 10 мм рт. ст. или отсутствовало (солерезистентные пациенты). Солечувствительные пациенты имели более высокие исходные значения показателей суточного мониторирования АД - САД ср. у солечувствительных пациентов равнялось 157,4 ± 1,0 мм рт. ст. против 150,7 ± 0,8 мм рт. ст. у солерезистентных пациентов, р<0,01. Обе комбинации лекарственных препаратов показали сопоставимый антигипертензивный эффект. Установлено, что у больных, принимавших комбинацию периндоприла и индапамида и вальсартана и индапамида, более выраженный антигипертензивный эффект был отмечен у больных с солечувствительным характером артериальной гипертонии в каждой группе лечения. Определение солечувствительности АД позволяет прогнозировать индивидуальную эффективность антигипертензивной терапии на основе использования теста с нагрузкой поваренной солью Reaching the target blood pressure level in diabetic patients is as important as correcting metabolic disorders. The analysis of the effectiveness of combined antihypertensive therapy in patients with diabetes mellitus with diabetic nephropathy based on the dynamics of hemodynamic and metabolic parameters in patients with different reactions of blood pressure to the load of table salt. It was found that patients with this pathology do not equally respond to the load of table salt - 23 (53.3%) patients showed an increase in systolic blood pressure by 10 mm Hg or more. Art. (salt-sensitive patients), and in 21 (46.7%) the increase in blood pressure was less than 10 mm Hg. Art. or absent (salt-resistant patients. Salt-sensitive patients had higher baseline values of 24-hour BP monitoring - SBP mean in salt-sensitive patients was 157.4 ± 1.0 mm Hg versus 150.7 ± 0.8 mm Hg in salt-resistant patients, p <0.01. Both drug combinations showed a comparable antihypertensive effect. Determination of blood pressure salt sensitivity makes it possible to predict the individual effectiveness of antihypertensive therapy based on the use of a salt load test

scholarly journals Community-Based Interventions to Improve the Control of Non-Communicable Diseases in Underserved Rural Areas in Brazil: A Before-and-After Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jéssica Caline Lemos Macedo ◽  
Vivian Carla Honorato dos Santos de Carvalho ◽  
Taciana Borges Andrade Cortes ◽  
Daniela Arruda Soares ◽  
Sóstenes Mistro ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Rural Communities ◽  
Rural Areas ◽  
Blood Pressure Level ◽  
The Elderly ◽  
Diabetic Patients ◽  
Community Based Interventions ◽  
Life Years ◽  
Before And After ◽  
Patients With Diabetes

Background: Hypertension and diabetes mellitus are the second and third highest leading causes of disability-adjusted life-years (DALY), respectively, in Brazil. The clinical outcomes of chronic diseases are influenced by various factors. Therefore, there is a need for multifaceted interventions to achieve a decrease in the rate of DALY, with a better control of these diseases.Objective: To verify whether sustainable long-term interventions, such as health worker training and provision of health education to the patients, contribute to health improvements in patients with hypertension and diabetes from rural communities.Methods: Over a 6 month period, educational and medical interventions were provided to optimize the treatment of hypertension and diabetes. Furthermore, blood pressure and glycated hemoglobin (HbA1c) measurements were taken at baseline and after the interventions.Results: The monitored hypertensive patients (n = 276) had a reduction of 13.4 mmHg (p = 0.021) and 5.8 mmHg (p &lt; 0.001) in mean systolic and diastolic blood pressure, respectively. Diabetic patients who were followed-up (n = 71) achieved a 0.55% (p = 0.185) reduction in HbA1c level. The desired blood pressure level (&lt;140/90 mmHg) was achieved in 38.8% of patients with hypertension, whereas the desired level of HbA1c (&lt;7.0% for adults and &lt;8.0% for the elderly) was achieved in 16.9% of patients with diabetes; in addition, 38.0% had a reduction of HbA1c of at least 1%.Conclusion: The results showed that the interventions improved the blood pressure and HbA1c levels in patients with hypertension and diabetes from rural communities in a municipality in Northeast Brazil.

scholarly journals Prevalence and Control of Hypertension in Iraqi Diabetic Patients: A Prospective Cohort Study

2012 ◽  
Vol 6 (1) ◽  
pp. 68-71 ◽  
Author(s):  
Abbas Ali Mansour
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Blood Pressure Level ◽  
Target Blood Pressure ◽  
Diabetic Patients ◽  
Study Cohort ◽  
Patients With Diabetes

Objectives: Diabetes and hypertension are major risk factors for cardiovascular disease, a leading cause of death in humans. The aim of our study was to determine the prevalence of hypertension, and hypertension control among adults with diabetes in Basrah (Southern Iraq). Methods: A prospective cohort study was conducted at Al-Faiha Diabetes and Endocrine Center in Basrah. It was started in August 2008 to April 2011. The total number of recruited patients with diabetes was 5578. Results: Hypertensive diabetic patients constituted 89.6% of this study cohort, with 45.3% of them newly discovered in the center. From hypertensive patients, 48.2% achieved the target blood pressure of less than 130/80 mmHg. The results of the multivariate analyses showed that the factors independently associated with the hypertension were aged > 50 years (odds ratio, 0.4; 95% CI, 0.3 to 0.5; p < 0.001), body mass index equal or more than 25 (odds ratio, 0.5; 95% CI, 0.4 to 0.6; p < 0.001), insulin use (odds ratio, 0.6; 95% CI, 0.5 to 0.8; p < 0.001) and duration of diabetes > 5 years (odds ratio, 0.6; 95% CI, 0.5 to 0.7; p < 0.001) . Conclusion: This study confirmed that hypertension was seen in ~90% of diabetic patients in Iraq, and approximately half of them were achieving target blood pressure level.

Positive Association Between the Lys198 Asn Polymorphism in the Endothelin-1 and Blood Pressure in Obese Japanese Subjects: Ohasama Study

Hypertension ◽  
2000 ◽  
Vol 36 (suppl_1) ◽  
pp. 714-714
Author(s):  
Tomohiro Katsuya ◽  
Takayoshi Ohkubo ◽  
Yuxiao Fu ◽  
Ichiro Tsuji ◽  
Kenichi Nagai ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Level ◽  
Positive Association ◽  
Epidemiological Studies ◽  
Buffy Coat ◽  
Baseline Characteristic ◽  
Endothelin 1 ◽  
Overweight People ◽  
Obese Subjects

P117 A recent report by Tiret et al. (Hypertension 33, 1999) revealed that a G/T polymorphism with an amino acid substitution (Lys to Asn) at codon 198 in the exon 5 of endothelin 1 gene (ET1) is associated with blood pressure in overweight people using two epidemiological studies, ECTIM and Glasgow Heart Scan Study. They suggested that G/T polymorphism strongly interacted with body mass index (BMI) in the determination of blood pressure levels. To examine the interaction among G/T polymorphism of ET1, BMI and blood pressure, we carried out an association study using a general population. Subjects (n=1,446) were recruited from Ohasama population, which is a cohort in a rural community of northern Japan. The research protocol was approved by the Institutional Review Board of the Tohoku University. DNA was extracted from the buffy coat of the participants using QIAamp DNA Blood Kit (Qiagen Inc.). G/T polymorphism of ET1 was determined by TaqMan PCR method, which is a powerful tool for semiautomatic genotype determination in a large number of samples. The frequency of T198 allele in Japanese (26%) was significantly higher than that in Caucasians (23%). The baseline characteristic (age, BMI, SBP, DBP, antihypertensive treatment) of all subjects was not significantly different according to the genotype of G/T polymorphism. In the obese subjects (≥25kg/m2), however, SBP and DBP were significantly associated with G/T polymorphism. Blood pressure level in the subjects carrying T198 allele was 2.6 mmHg in systolic (p<0.02) and 2.3 mmHg in diastolic (p<0.005) higher than that in those with GG genotype in overweight people. That the same result was obtained from different races suggested that the T198 allele of ET1 is involved in the determination of blood pressure levels in obese subjects.

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

scholarly journals THE UTILIZATION OF VISUAL BASIC.NET APPLICATION FOR DETERMINATION OF INDIVIDUAL DRUG DOSAGES IN DIABETIC PATIENTS OF CHRONIC RENAL DISORDER COMPLICATIONS

2018 ◽  
Vol 11 (13) ◽  
pp. 234
Author(s):  
Ari Usman ◽  
Nilsya Febrika Zebua
Keyword(s):  
Creatinine Clearance ◽  
Medical Records ◽  
Diabetes Complications ◽  
Diabetic Patients ◽  
Dose Calculations ◽  
Inclusion Criteria ◽  
Renal Disorder ◽  
Descriptive Research ◽  
Patients With Diabetes

  Objective: This research aims to apply the Visual Basic.Net (VB.NET) of individual dose calculations based on the formula of pharmacokinetics for diabetic patients of chronic renal disorder complication in Dr. Pirngadi Hospital because the dosage administered was not based on the patient’s creatinine clearance.Methods: This descriptive research was conducted using a simulated creatinine cleavage calculation using VB.NET programming language applications with variable patient data, the value of creatinine, the name of drug, and dosage.Results: This study obtained data about the use of drugs 40 patients who met the inclusion criteria of 320 medical records of diabetic patients, there are 6 types of drugs that are not in accordance with the dose based on the calculation of creatinine clearance are ceftriaxone(18 of 18 cases), furosemide (19 of 19 cases), ciprofloxacin (2 of 8 cases), ranitidine (4 of 24 cases), metformin (2 of 7 cases), and captopril (16 of 16 cases).Conclusions: This research aims to apply the VB.NET is it able to apply individual doses for patients with diabetes complications of renal failure have not been applied in accordance with creatinine clearance calculations at this hospitalwhere this work is difficult to do.

Screening for microalbuminuria in patients with diabetes mellitus: frozen storage of urine samples decreases their albumin content.

1989 ◽  
Vol 35 (2) ◽  
pp. 308-310 ◽  
Author(s):  
L D Elving ◽  
J A Bakkeren ◽  
M J Jansen ◽  
C M de Kat Angelino ◽  
E de Nobel ◽  
...  
Keyword(s):  
Frozen Storage ◽  
Urine Samples ◽  
Diabetic Patients ◽  
Albumin Concentration ◽  
Low Concentrations ◽  
Albumin Content ◽  
Patients With Diabetes ◽  
The Difference ◽  
Urinary Albumin Concentration

Abstract The influence of storage on urinary albumin concentration was prospectively studied with use of overnight urine specimens (Albustix negative) from 73 diabetic patients. From each urine sample four aliquots were taken. One was stored at 4 degrees C and assayed within two weeks, the other three were stored at -20 degrees C and assayed within two weeks and after two and six months. Albumin concentration was measured with laser immunonephelometry. The detection limit, 1 mg/L, suffices for the screening of diabetic patients for microalbuminuria. After storage for two and six months at -20 degrees C, significantly lower albumin concentrations were found. The difference was mainly caused by lower concentrations found in urine samples in which a precipitate had formed, which was the case in 22 and 25 samples, respectively. Thus, freezing of urine samples for determination of low concentrations of albumin may yield falsely low results. Urine samples are best stored at 4 degrees C and assayed within two weeks.

scholarly journals Plasma osteoprotegerin levels are associated with glycaemic status, systolic blood pressure, kidney function and cardiovascular morbidity in type 1 diabetic patients

2006 ◽  
Vol 154 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Lars Melholt Rasmussen ◽  
Lise Tarnow ◽  
Troels Krarup Hansen ◽  
Hans-Henrik Parving ◽  
Allan Flyvbjerg
Keyword(s):  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Systolic Blood Pressure ◽  
Kidney Function ◽  
Vascular Complications ◽  
Diabetic Patients ◽  
Diabetic Vascular Complications ◽  
Patients With Diabetes ◽  
Type 1 Diabetic Patients

Objective: The bone-related peptide osteoprotegerin (OPG) has recently been found in increased amounts in the vasculature in diabetes. It is produced by vascular smooth muscle and endothelial cells, and may be implicated in the development of vascular calcifications. OPG is present in the circulation, where increased amounts have been observed in patients with diabetes. In this study, we examined whether plasma OPG is associated with the glycaemic and vascular status of patients with type 1 diabetes. Methods: Two gender-, age- and duration-comparable groups of type 1 diabetic patients either with (n = 199) or without (n = 192) signs of diabetic nephropathy were studied. Plasma OPG was determined by an ELISA. Results: The plasma OPG concentration was significantly higher in patients with nephropathy than those without (3.11 (2.49–3.99) vs 2.57 (2.19–3.21) (median (interquartiles), ng/ml), P < 0.001). Plasma OPG correlated with haemoglobin A1c (HbA1c), systolic blood pressure and age in both groups and, in addition, with kidney function in the nephropathic group. These correlations remained significant in multivariate models. In addition, we found that plasma OPG concentrations were increased among patients with cardiovascular diseases (CVD), both in the normoalbuminuric and the nephropathic groups. The differences between nephropathic and normoalbuminuric, as well as subgroups with and without CVD, could largely be ascribed to changes in HbA1c, age, systolic blood pressure and creatinine. Conclusion: OPG is associated with glycaemic control and CVD in patients with type 1 diabetes, compatible with the hypothesis that OPG is associated with the development of diabetic vascular complications.

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