Prediction and prognosis of diabetes incidence in treated hypertensive patients

The study is based on a clinical population of 1962 hypertensive men and women consecutively examined as in- or out-patients in our clinic from Jan. 1967 to Dec. 1976. Those having a diabetes (treated for diabetes, or fasting glycemia greater than or equal to 7.75 USI) at initial exam were excluded. In february 1977, all were contacted by mail. 89 p. 100 of the subjects still living at the same address answered. 74 "cases" had developed a diabetes (clinical diagnosis, or fasting glycemia greater than or equal to 9.5 USI); they were matched with "controls" according to sex, age (+/- 2), and date of entry (+/- 4 months); all the controls had answered that they were not diabetic in Feb. 1977. At initial exam, the following abnormalities were significantly more pronounced in cases than in controls (by decreasing level of significance): glycemia 1 h. after glucose load, weight index (W/H2), fasting glycemia (p less than 0.001); ECG abnormalities of T (Minnesota code 5.1-3), and J-ST (4.1-3) (p less than 0.01); angina (p less than 0.05). Incidence of diabetes was studied in the basal population, by life table method, according to two abnormalities: relative weight greater than or equal to 115 p. 100, glycemia after load greater than or equal to 8.33. At five years, the estimations were: 0 p. 100 in both sexes, when both abnormalities were absent; 20 p. 100 in men and 31 p. 100 in women when both abnormalities were simultaneously present; 4 p. 100 in men and 2 p. 100 in women in other cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

New-onset diabetes after transplantation

New-onset diabetes after transplantation (NODAT) is associated with significant morbidity and mortality. Given the availability of simple diagnostic methods and the known benefits of strict glycemic control, patients should be screened frequently after organ transplantation. The management of NODAT is multifaceted and aimed at both treatment and prevention of complications. Evaluation of patient risk for post-transplant diabetes mellitus and its complications is an important consideration in initial selection and subsequent modification of the immunosuppressive regimen.     

New-onset diabetes and antihypertensive drugs

Observational studies have provided evidence that a consistent fraction (approximately 15-20%) of hypertensive patients displays a glucose intolerance state that may be aggravated by antihypertensive drug regimens based on thiazide diuretics or beta-blockers. This review examines the relative and absolute diabetogenic effects of antihypertensive drugs, by comparing the impact of 'new' (calcium antagonists, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) versus 'old' (diuretics and beta-blockers) drugs on new-onset diabetes in recent clinical trials. Evidence is provided that compared with diuretics and beta-blockers, new-onset diabetes is less common with 'new' drugs, and that conventional antihypertensive compounds, particularly when combined together, may amplify the natural time-dependent tendency towards the development of this metabolic disease. This paper provides new insights into the potential mechanisms responsible for the phenomenon and the clinical significance of antihypertensive drug-induced diabetes.     

New-onset diabetes and pancreatic cancer.

BACKGROUND & AIMS: Although many individuals with pancreatic cancer have diabetes, the association between new-onset diabetes mellitus and the subsequent incidence of pancreatic cancer is unclear. METHODS: We conducted a retrospective cohort study to estimate the incidence of pancreatic cancer subsequent to a new diabetes diagnosis and to evaluate factors associated with a subsequent pancreatic cancer diagnosis. We used the Veterans Health Administration National Patient Care Database to assemble a cohort of 1,421,794 US veterans without prior diabetes or pancreatic cancer diagnoses. We recorded coding for new diabetes diagnoses (> or =2 International Classification of Diseases-9 codes for diabetes within a 12-month period), pancreatic cancer, age, sex, race, and common gastrointestinal symptoms. RESULTS: A total of 36,631 (2.6%) of the 1,421,794 veterans were diagnosed with new-onset diabetes in 1999; 149 subsequently received a diagnosis of pancreatic cancer. Pancreatic cancer incidence in patients with new-onset diabetes (83.8/100,000 person-years) was 2.2-fold higher (95% confidence interval, 1.84-2.56) than in nondiabetics, and was highest during the first 2 years after diabetes diagnosis. One additional pancreatic cancer was diagnosed for every 332 new diabetics over 6 years. A subsequent pancreatic cancer diagnosis (among new-onset diabetics) was associated independently with younger age groups, changes in bowel habits, constipation, epigastric pain, and malnutrition. CONCLUSIONS: New-onset diabetes was associated with a significantly increased rate of pancreatic cancer diagnosis, particularly in the first 2 years after diabetes diagnosis. Factors associated with pancreatic cancer diagnosis included younger age groups and the presence of gastrointestinal symptoms. The absolute incidence of pancreatic cancer was low.     

New-onset diabetes mellitus after liver transplantation in the patients with acute liver failure

International Journal of Diabetes in Developing Countries - To detect the frequency and possible risk factors of new-onset diabetes after liver transplantation in the patients with acute liver...     

Adverse prognostic significance of new diabetes in treated hypertensive subjects

Diabetes may develop in nondiabetic hypertensive subjects during treatment, but the long-term cardiovascular implications of this phenomenon are not clear. We determined the prognostic value of new diabetes in hypertensive subjects. In a long-term cohort study, 795 initially untreated hypertensive subjects, 6.5% of whom with type 2 diabetes, underwent diagnostic procedures including 24-hour ambulatory blood pressure (BP) monitoring and electrocardiography (ECG). Procedures were repeated after a median of 3.1 years in the absence of cardiovascular events. Follow-up duration was 1 to 16 years (median 6.0). New diabetes occurred in 5.8% of subjects initially without diabetes. Antihypertensive treatment included a diuretic in 53.5% of these subjects, versus 30.4% of those in whom diabetes did not develop (P=0.002). Plasma glucose at entry (P=0.0001) and diuretic treatment on follow-up (P=0.004) were independent predictors of new diabetes. Subsequent to the follow-up visit, a first cardiovascular event occurred in 63 subjects. Event rate in nondiabetic subjects at both visits, new diabetes, and diabetes at entry were 0.97, 3.90, and 4.70x100 person-years, respectively (P=0.0001). After adjustment for several confounders, including 24-hour ambulatory BP, the relative risk of events was 2.92 (95% CI: 1.33 to 6.41; P=0.007) in the group with new diabetes and 3.57 (95% CI: 1.65 to 7.73; P=0.001) in the group with previous diabetes, when compared with the group persistently free of diabetes. In treated hypertensive subjects, occurrence of new diabetes portends a risk for subsequent cardiovascular disease that is not dissimilar from that of previously known diabetes.     

Antioxidative protection in hypertensive patients treated with diuretics

BACKGROUND: Recently results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) showed that a thiazide diuretic was unsurpassed by any other drug class studied in achieving the level of cardiovascular protection, a finding reflected in the recent Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC7) recommendations. Oxidative stress has been found to be one of the key players in the pathophysiology of cardiovascular disease at large. The objective of this study was to check the hypothesis that diuretics may favorably affect the oxidative status of plasma, which could account in part for the results of recent trials. METHODS: In addition to the routine workup in a series of 39 medically treated hypertensive patients, we analyzed the level of antioxidative protection afforded by the ferric-reducing ability of plasma (FRAP), according to class of drug used. RESULTS: We found that patients taking diuretics had significantly better antioxidative protection expressed by the higher levels of FRAP. Although the limited number of patients did not allow us to exclude the influence of other variables in the multiple regression analysis, we did not observe any differences in the level of FRAP when the group was divided according to the other drug classes, gender (men versus women), smoking, diabetes mellitus, duration of treatment, concomitant therapy, or level of uric acid. CONCLUSIONS: The use of thiazide diuretics seems to be associated with better antioxidative protection. This observation may add to the explanation of the results of recent trials in hypertension.     

Sexual dysfunction in hypertensive patients treated with losartan

BACKGROUND: Impaired erectile function in men is a component of the dysmetabolic syndrome of high blood pressure as well as a sequela of antihypertensive therapy. This prospective interventional study in men with uncontrolled hypertension (blood pressure > or =140/90 mm Hg) used a survey instrument to assay sexual dysfunction before and after therapy with losartan. METHODS: We evaluated the influence of a 12-week therapy with losartan in 82 hypertensive subjects with (n = 82) and without (n = 82) a diagnosis of erectile dysfunction using a self-administered questionnaire validated in another 60 subjects with hypertension. RESULTS: From an initial sample of 323 hypertensive men and women, 82 men, aged 30 to 65 years, with sexual dysfunction underwent a 12-week regimen of losartan therapy (50-100 mg/day). Losartan treatment improved sexual satisfaction from an initial 7.3 to 58.5% (chi2; P = 0.001). Subjects reporting a high frequency of sexual activity improved from 40.5% initially to 62.3% after drug treatment, whereas the number of patients with low or very low frequency of sexual activity decreased significantly (chi2; P = 0.001). At the completion of the 12-week losartan regimen, only 11.8% of the treated subjects reported in improvement in sexual function. Improvement on quality of life was demonstrated in 73.7% of subjects medicated with losartan, 25.5% reported no changes, and only 0.8% felt worse. In the group without sexual dysfunction, losartan had a nonsignificant effect on sexual function. CONCLUSIONS: Our data suggest that losartan improved erectile function and both satisfaction and frequency of sexual activity. Because side effects are one of the most influential factors in the management of hypertension, an added benefit of losartan therapy may be its positive impact on quality of life.     

Stress hemodynamics in hypertensive patients treated with nifedipine

In 10 male juvenile hypertensives WHO stage I who are active in sports echocardiographic investigations were performed at rest and on exertion (up to 2 Watt/kg body-weight) without therapy as well as 1 hour after sublingual administration of 20 mg nifedipine and after a six-week treatment with 3 times 20 mg nifedipine a day. 51 normotensives of the same age served as reference test persons. The antihypertensive effect was distinct, but not so expressive as under the beta-blockade. From the behaviour of the heart rate (reduction under permanent therapy) of the stroke volume (increase to the highest step of exertion) and of the reduction of blood-pressure can be concluded to an economizing effect of the central haemodynamics by nifedipine on exertion. Negative inotropic effects could be excluded particularly from the behaviour of the medium circumferential speed of the velocity of the shortening of fibres on exertion. Nifedipine can be recommended for the treatment of bodily active hypertensives, when the administration of beta-blockers is not to be represented.     

Prognosis of adequately treated hypertensive patients.

Adequate antihypertensive therapy will lower blood pressure to normotensive or near normotensive levels in 80-85% of patients. Long-term treatment results in a marked decrease in strokes and stroke recurrence, heart failure, renal failure, and progression to accelerated hypertension. The effects of long-term therapy on the occurrence of coronary artery disease are unclear.     

Tele-monitoring of home blood pressure in treated hypertensive patients

AIM: To compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the assessment of antihypertensive effect. METHODS: 362 patients on antihypertensive medication performed HBP measurement (5 days, duplicate measurements, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. RESULTS: CBP was much higher than ABP and average HBP (p < 0.001). There was a progressive decline in HBP over the course of the study, achieving the level of daytime ABP on the last 2 monitoring days. The correlation between CBP and ABP was weak (systolic: r = 0.343, diastolic r = 0.430), whereas strong correlations existed between HBP and ABP (systolic r = 0.804, diastolic r = 0.776). A progressive improvement in the strength of the correlation between average HBP of single days and ABP was obtained over the 5 monitoring days. The HBP readings taken in the afternoon showed a stronger correlation with ABP than the values measured in the morning, at noon and in the evening. Averaging more HBP readings taken on succeeding days resulted in a progressive improvement in the agreement with ABP with a further benefit when readings of day 1 were included. CONCLUSIONS: The accuracy of telemedical HBP measurement is substantially better than that of CBP. The results suggest, that HBP should be measured for 5 days, and afternoon measurements should be preferred in assessing control of hypertension.     

Haemodynamic studies in hypertensive patients treated by oral proranolol

Haemodynamic studies have been performed in 9 patients whose blood pressures had been satisfactorily controlled with oral propranolol for 7 to 29 months. A postural drop of blood pressure or a fall of blood pressure on exercise did not occur. Pulse rate and cardiac output were below normal at rest and on exercise; peripheral resistance was high. The results are similar to those obtained in a comparable group of hypertensives after acute administration of propranolol. These findings are discussed in relation to the mode of action of propranolol in hypertension.