Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000100
A. Krentz
Hypertension often co-exists with hyperglycaemia to elevate the risk of vascular disease. The importance of treating hypertension in type 2 diabetes is well appreciated, the benefits of good glycaemic control and effective treatment of hypertension being additive. Treating hyperglyaemia on the one hand and hypertension on the other are usually considered separate strategies of a multifactorial approach to risk reduction requiring specific antihypertensive and glucose-lowering drugs. It is well appreciated that antihypertensive medications can have effects (prodiabetic, neutral, protective against diabetes, according to drug class) on blood glucose levels. Rather less attention has been paid to the effect of glucose-lowering drugs on blood pressure (BP). Positive, neutral and negative effects on BP have been reported for different classes, with some evidence of heterogeneity between individual drugs within certain classes. In this article, the effects of glucose-lowering medication on BP are reviewed. There is a paucity of head-to-head studies of the effects of glucose-lowering medications on BP. Although BP targets in type 2 diabetes continue to be debated, there is a case for more attention to be directed towards the impact of glucose-lowering drugs on BP control.
{"title":"Hypertension in type 2 diabetes: impact of glucose-lowering medications","authors":"A. Krentz","doi":"10.1097/XCE.0000000000000100","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000100","url":null,"abstract":"Hypertension often co-exists with hyperglycaemia to elevate the risk of vascular disease. The importance of treating hypertension in type 2 diabetes is well appreciated, the benefits of good glycaemic control and effective treatment of hypertension being additive. Treating hyperglyaemia on the one hand and hypertension on the other are usually considered separate strategies of a multifactorial approach to risk reduction requiring specific antihypertensive and glucose-lowering drugs. It is well appreciated that antihypertensive medications can have effects (prodiabetic, neutral, protective against diabetes, according to drug class) on blood glucose levels. Rather less attention has been paid to the effect of glucose-lowering drugs on blood pressure (BP). Positive, neutral and negative effects on BP have been reported for different classes, with some evidence of heterogeneity between individual drugs within certain classes. In this article, the effects of glucose-lowering medication on BP are reviewed. There is a paucity of head-to-head studies of the effects of glucose-lowering medications on BP. Although BP targets in type 2 diabetes continue to be debated, there is a case for more attention to be directed towards the impact of glucose-lowering drugs on BP control.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"83 1","pages":"137–143"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79321662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000107
R. Touyz
Blood pressure is a variable and quantitative trait, with a normal blood pressure defined as lower than 120/80mmHg and hypertension defined when systolic blood pressure is higher than 140mmHg and diastolic blood pressure is higher than 90mmHg. These definitions are based in large part on blood pressure distribution and in the population and levels above which blood pressure-related cardiovascular and renal complications develop. Accordingly, major hypertension guidelines suggest that treatment targets should be lower than 140/90mmHg [1–3].
{"title":"Hypertension, diabetes and blood pressure targets: ongoing challenges","authors":"R. Touyz","doi":"10.1097/XCE.0000000000000107","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000107","url":null,"abstract":"Blood pressure is a variable and quantitative trait, with a normal blood pressure defined as lower than 120/80mmHg and hypertension defined when systolic blood pressure is higher than 140mmHg and diastolic blood pressure is higher than 90mmHg. These definitions are based in large part on blood pressure distribution and in the population and levels above which blood pressure-related cardiovascular and renal complications develop. Accordingly, major hypertension guidelines suggest that treatment targets should be lower than 140/90mmHg [1–3].","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"16 1","pages":"120-121"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89708321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000103
N. Rossen, K. Hansen
Globally, diabetes has become one of the major causes of premature morbidity and mortality, and this is mainly attributable to the increased risk of cardiovascular (CV) disease. CV risk stratification is based on well-established risk factors including hypertension, diabetes, dyslipidaemia, smoking, age and sex. However, current assessment models are imperfect. Improved risk stratification may be achieved by the use of home and ambulatory blood pressure (BP) monitoring. Identification of new CV risk factors, which add prognostic information, may also improve risk stratification. Pulse wave velocity and central BP have been suggested as new parameters with independent prognostic ability. Moreover, treatment targets of hypertension are not met in many patients. Strategies to improve BP control include new ways of drug treatment, with chronotherapy offering a cost-free and simple approach. The present paper will review these issues with a specific focus on studies in diabetic patients.
{"title":"New diagnostics for hypertension in diabetes and the role of chronotherapy: a new perspective","authors":"N. Rossen, K. Hansen","doi":"10.1097/XCE.0000000000000103","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000103","url":null,"abstract":"Globally, diabetes has become one of the major causes of premature morbidity and mortality, and this is mainly attributable to the increased risk of cardiovascular (CV) disease. CV risk stratification is based on well-established risk factors including hypertension, diabetes, dyslipidaemia, smoking, age and sex. However, current assessment models are imperfect. Improved risk stratification may be achieved by the use of home and ambulatory blood pressure (BP) monitoring. Identification of new CV risk factors, which add prognostic information, may also improve risk stratification. Pulse wave velocity and central BP have been suggested as new parameters with independent prognostic ability. Moreover, treatment targets of hypertension are not met in many patients. Strategies to improve BP control include new ways of drug treatment, with chronotherapy offering a cost-free and simple approach. The present paper will review these issues with a specific focus on studies in diabetic patients.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"1051 1","pages":"144–150"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86469549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000102
M. Cryer, W. Baker, Tariq Horani, D. DiPette
The early diagnosis, appropriate management, and pharmacological treatment of hypertension in those with diabetes mellitus are key in preventing and reducing the significant risk of cardiovascular disease-related morbidity and mortality in this patient population. Despite the universal recognition of the importance of hypertension management in those with diabetes mellitus, there still remains controversy on the appropriate blood pressure at which to initiate pharmacologic therapy and, once initiated, what blood pressure goal to achieve. This paper will review current blood pressure recommendations published in recent major guidelines as well as examine evidence-based medicine used to form the basis of these guidelines for the treatment of hypertension in patients with diabetes mellitus. In addition, we will summarize relevant major clinical studies, which may have a significant impact on future guidelines, published in the interval time since the release of previous major guidelines.
{"title":"Diabetes and hypertension: too many guidelines, not enough data","authors":"M. Cryer, W. Baker, Tariq Horani, D. DiPette","doi":"10.1097/XCE.0000000000000102","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000102","url":null,"abstract":"The early diagnosis, appropriate management, and pharmacological treatment of hypertension in those with diabetes mellitus are key in preventing and reducing the significant risk of cardiovascular disease-related morbidity and mortality in this patient population. Despite the universal recognition of the importance of hypertension management in those with diabetes mellitus, there still remains controversy on the appropriate blood pressure at which to initiate pharmacologic therapy and, once initiated, what blood pressure goal to achieve. This paper will review current blood pressure recommendations published in recent major guidelines as well as examine evidence-based medicine used to form the basis of these guidelines for the treatment of hypertension in patients with diabetes mellitus. In addition, we will summarize relevant major clinical studies, which may have a significant impact on future guidelines, published in the interval time since the release of previous major guidelines.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"27 1","pages":"127–132"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87704584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000105
A. Krentz, P. Nilsson
{"title":"Highlights of selected presentations on clinical aspects of hypertension and type 2 diabetes from the 52nd European Association for the Study of Diabetes conference in Munich September 2016","authors":"A. Krentz, P. Nilsson","doi":"10.1097/XCE.0000000000000105","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000105","url":null,"abstract":"","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77627700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000089
P. Aldiss, H. Budge, M. Symonds
Maintenance of thermal homeostasis within a tight range is regulated not only by a variety of internal and external cues but also by sex and biological age. The major organ responsible for adaptive thermogenesis is brown adipose tissue (BAT) and the recent re-discovery of its presence in adult humans has led to huge interest in the role that it may play in modulating cardiometabolic health. Interestingly, as with maintenance of thermal homeostasis, the total amount and metabolic activity of BAT is modulated by sex and biological age. In this short commentary we discuss the recent finding that core-body temperature is reduced in women post-menopause, a period when excess adiposity and increased risk of cardiometabolic disease is evident and postulate that alterations in sex hormones downregulated the thermogenic activity of BAT cold contribute to this deleterious phenotype.
{"title":"Is a reduction in brown adipose thermogenesis responsible for the change in core body temperature at menopause","authors":"P. Aldiss, H. Budge, M. Symonds","doi":"10.1097/XCE.0000000000000089","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000089","url":null,"abstract":"Maintenance of thermal homeostasis within a tight range is regulated not only by a variety of internal and external cues but also by sex and biological age. The major organ responsible for adaptive thermogenesis is brown adipose tissue (BAT) and the recent re-discovery of its presence in adult humans has led to huge interest in the role that it may play in modulating cardiometabolic health. Interestingly, as with maintenance of thermal homeostasis, the total amount and metabolic activity of BAT is modulated by sex and biological age. In this short commentary we discuss the recent finding that core-body temperature is reduced in women post-menopause, a period when excess adiposity and increased risk of cardiometabolic disease is evident and postulate that alterations in sex hormones downregulated the thermogenic activity of BAT cold contribute to this deleterious phenotype.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"21 1","pages":"155-156"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73047778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000101
M. Brunström, B. Carlberg
Blood pressure targets in patients with type 2 diabetes are currently being debated. This review summarizes the current treatment recommendations provided in American and European guidelines, and findings from systematic reviews and meta-analyses published during the last decade. We critically assess the basis for the recommendations provided in relation to the evidence presented in reviews. When reviews differ in their results, we discuss the reasons for such differences. The results from recent studies in patients without diabetes and their potential implications for recommendations in patients with diabetes are commented upon. Finally, we conclude what targets are best in line with the totality of the available evidence.
{"title":"Blood pressure targets in type 2 diabetes: a general perspective","authors":"M. Brunström, B. Carlberg","doi":"10.1097/XCE.0000000000000101","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000101","url":null,"abstract":"Blood pressure targets in patients with type 2 diabetes are currently being debated. This review summarizes the current treatment recommendations provided in American and European guidelines, and findings from systematic reviews and meta-analyses published during the last decade. We critically assess the basis for the recommendations provided in relation to the evidence presented in reviews. When reviews differ in their results, we discuss the reasons for such differences. The results from recent studies in patients without diabetes and their potential implications for recommendations in patients with diabetes are commented upon. Finally, we conclude what targets are best in line with the totality of the available evidence.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"27 1","pages":"122–126"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/XCE.0000000000000101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72532087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1097/XCE.0000000000000078
Lisa M. Neff, Mindy E. Hoffmann, Dinah M. Zeiss, K. Lowry, Monica Edwards, Sarah M. Rodriguez, K. Wachsberg, R. Kushner, L. Landsberg
ObjectiveWeight gain during the menopausal transition is common. Although studies have suggested that weight gain is more likely related to aging than menopause, there is a reduction in resting energy expenditure with surgical or natural menopause that is independent of age and changes in body composition. The underlying mechanisms could include a reduction in core body temperature. MethodsData were obtained from two related studies. Sample size was 23 men and 25 women (12 premenopausal, 13 postmenopausal). In the Clinical Research Unit, core temperature was measured every minute for 24 h using an ingested temperature sensor. ResultsThe mean 24-h core body temperature was 0.25±0.06°C lower in postmenopausal than premenopausal women (P=0.001). The mean 24 h core temperature was 0.34±0.05°C lower in men than in premenopausal women (P<0.001). ConclusionPostmenopausal women, like men, had lower core body temperatures than premenopausal women. This may have implications for midlife weight gain.
{"title":"Core body temperature is lower in postmenopausal women than premenopausal women: potential implications for energy metabolism and midlife weight gain","authors":"Lisa M. Neff, Mindy E. Hoffmann, Dinah M. Zeiss, K. Lowry, Monica Edwards, Sarah M. Rodriguez, K. Wachsberg, R. Kushner, L. Landsberg","doi":"10.1097/XCE.0000000000000078","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000078","url":null,"abstract":"ObjectiveWeight gain during the menopausal transition is common. Although studies have suggested that weight gain is more likely related to aging than menopause, there is a reduction in resting energy expenditure with surgical or natural menopause that is independent of age and changes in body composition. The underlying mechanisms could include a reduction in core body temperature. MethodsData were obtained from two related studies. Sample size was 23 men and 25 women (12 premenopausal, 13 postmenopausal). In the Clinical Research Unit, core temperature was measured every minute for 24 h using an ingested temperature sensor. ResultsThe mean 24-h core body temperature was 0.25±0.06°C lower in postmenopausal than premenopausal women (P=0.001). The mean 24 h core temperature was 0.34±0.05°C lower in men than in premenopausal women (P<0.001). ConclusionPostmenopausal women, like men, had lower core body temperatures than premenopausal women. This may have implications for midlife weight gain.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"38 4 1","pages":"151–154"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89433278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-01DOI: 10.1097/XCE.0000000000000099
P. Nilsson
Hypertension is a major cardiovascular risk factor and can be treated. The cardiovascular risk associated with hypertension, however, cannot be fully reversed by treatment with blood pressure-lowering drugs. One reason could be that not all risk factors are addressed at the same time, but another reason could well be that structural changes and remodelling of the arterial wall are not diminished nor normalized. One component that has attracted considerable research efforts in recent years is arterial stiffness, primarily involving the arteria media (elastin, collagen), but also the arterial intima and adventitia. Arterial stiffness in large elastic arteries can be measured by aortic pulse wave velocity from the carotid artery to the femoral artery and is considered to be both a cause and a consequence of hypertension. The treatment of arterial stiffness involves traditional antihypertensive drugs such as renin–angiotensin blocking agents, but new experimental drugs are under development such as the angiotensin-II agonist compound 21 currently being tested in humans.
{"title":"Early vascular ageing as a new model to understand hypertension and arterial disease","authors":"P. Nilsson","doi":"10.1097/XCE.0000000000000099","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000099","url":null,"abstract":"Hypertension is a major cardiovascular risk factor and can be treated. The cardiovascular risk associated with hypertension, however, cannot be fully reversed by treatment with blood pressure-lowering drugs. One reason could be that not all risk factors are addressed at the same time, but another reason could well be that structural changes and remodelling of the arterial wall are not diminished nor normalized. One component that has attracted considerable research efforts in recent years is arterial stiffness, primarily involving the arteria media (elastin, collagen), but also the arterial intima and adventitia. Arterial stiffness in large elastic arteries can be measured by aortic pulse wave velocity from the carotid artery to the femoral artery and is considered to be both a cause and a consequence of hypertension. The treatment of arterial stiffness involves traditional antihypertensive drugs such as renin–angiotensin blocking agents, but new experimental drugs are under development such as the angiotensin-II agonist compound 21 currently being tested in humans.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"110 1","pages":"133–136"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87591315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-01DOI: 10.1097/XCE.0000000000000104
A. Krentz, P. Nilsson
Welcome to this special issue of Cardiovascular Endocrinology focused on hypertension in patients with type 2 diabetes [1]. Both disorders are highly prevalent on a global basis and often cosegregate in individuals. This conjunction elevates the risk of the development and progression of long-term microvascular and macrovascular complications [2]. Hence, we believe that this is a topic worthy of in-depth consideration.
{"title":"Introduction to a special issue: Hypertension in type 2 diabetes","authors":"A. Krentz, P. Nilsson","doi":"10.1097/XCE.0000000000000104","DOIUrl":"https://doi.org/10.1097/XCE.0000000000000104","url":null,"abstract":"Welcome to this special issue of Cardiovascular Endocrinology focused on hypertension in patients with type 2 diabetes [1]. Both disorders are highly prevalent on a global basis and often cosegregate in individuals. This conjunction elevates the risk of the development and progression of long-term microvascular and macrovascular complications [2]. Hence, we believe that this is a topic worthy of in-depth consideration.","PeriodicalId":72529,"journal":{"name":"Cardiovascular endocrinology","volume":"17 1","pages":"118-119"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72859219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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