RESUMEN
Diabetes mellitus often develops in patients with hypertension. We investigated predictors of diabetes mellitus development in hypertensives at risk of developing the disease in the VALUE trial population. Among the 9995 non-diabetic hypertensive patients at baseline, 1298 patients developed diabetes mellitus during the average follow-up of 4.2 years. New-onset diabetes mellitus was defined from adverse event reports, information about new antidiabetic medication and/or a fasting glucose >or=7.0 mmol l(-1) at the end of trial. Twenty-five potential baseline predictors of new-onset diabetes mellitus were analysed by univariate logistic regression and 14 of 25 predictors were found to be statistically significant with a P-value <0.05. The predictors were in order of decreasing significance; glucose, body mass index (BMI), age, uric acid, non-Caucasian race, haemoglobin, heart rate, randomized study treatment, history of coronary heart disease (CHD), gender, total cholesterol, proteinuria, potassium and creatinine. Multivariate stepwise logistic regression analyses were used and potential baseline predictors of new-onset diabetes mellitus were considered significant by four different models (P-value <0.001). The final multivariate model selected included all patients, but not treatment group as a potential predictor, and the six significant predictors identified from this model were glucose, BMI, non-Caucasian race, age, heart rate and history of CHD. In conclusion, glucose and BMI were the most important predictors of new-onset diabetes mellitus in hypertensive patients at high cardiovascular risk, and easily accessible clinical characteristics strongly predict patients at risk of developing diabetes mellitus.
Asunto(s)
Amlodipino/uso terapéutico , Diabetes Mellitus/etiología , Hipertensión/tratamiento farmacológico , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Bloqueadores del Receptor Tipo 1 de Angiotensina II , Antihipertensivos/uso terapéutico , Glucemia/metabolismo , Presión Sanguínea/fisiología , Peso Corporal , Bloqueadores de los Canales de Calcio/uso terapéutico , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Método Doble Ciego , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Incidencia , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Valina/uso terapéutico , ValsartánRESUMEN
We aimed to compare the effects of two different vasodilating principles, angiotensin II-receptor blockade and calcium channel blockade, on peripheral insulin-mediated glucose uptake in patients with hypertension and other cardiovascular risk factors. Twenty-one hypertensive patients (11 women and 10 men) with mean age 58.6 years (range 46-75 years), body mass index 29.2 +/- 1.0 kg/m(2) and blood pressure 160 +/- 3/96 +/- 2 mm Hg entered a 4-week run-in period with open-label amlodipine 5 mg. Thereafter they were randomized double-blindly to additional treatment with amlodipine 5 mg or losartan 100 mg. After 8 weeks of treatment, all patients underwent clinical examination and laboratory testing, and 17 of them underwent a hyperinsulinaemic isoglycaemic glucose clamp. After a 4-week open-label wash-out phase, the participants crossed over to the opposite treatment regimen and final examinations with hyperinsulinaemic isoglycaemic glucose clamp after another 8 weeks. Blood pressure was lowered to the same level in both treatment periods. The glucose disposal rate was significantly higher after treatment with losartan 100 mg + amlodipine 5 mg compared to amlodipine 10 mg (4.9 +/- 0.4 vs 4.2 +/- 0.5 mg/kg/min, P = 0.039). Thus our data suggest that angiotensin II-receptor blockade with losartan improves glucose metabolism at the cellular level beyond what can be expected by the vasodilatation and blood pressure reduction alone.
Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Hipertensión/sangre , Hipertensión/tratamiento farmacológico , Insulina/sangre , Losartán/uso terapéutico , Anciano , Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Biomarcadores/sangre , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedades Cardiovasculares/fisiopatología , Estudios Cruzados , Método Doble Ciego , Femenino , Técnica de Clampeo de la Glucosa , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipertensión/metabolismo , Hipertensión/fisiopatología , Resistencia a la Insulina , Lípidos/sangre , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento , Ácido Úrico/sangre , Vasodilatación/efectos de los fármacosRESUMEN
INTRODUCTION: In evaluating syncope, a 45-60 minutes head-up tilt test at 60 degrees with or without pharmacological stimulation is often used. MATERIAL AND METHODS: We report our experience with a faster, ten minute tilt test at 80 degrees with retilting during isoprenaline infusion, on 15 healthy volunteers and 27 patients who subsequently were followed up during a period of 1-3 1/2 years. RESULTS: One volunteer had a positive response (presyncope), while seven of the 27 patients reproduced their clinical symptoms. Among the 20 patients with normal test responses, the clinical course revealed the diagnosis in 11. For the remaining nine patients a definite diagnosis has not been made, but they have not experienced further syncopal episodes. INTERPRETATION: This study demonstrates that the abbreviated tilt test is useful for evaluating recurrent vasovagal and orthostatic syncope.