Hypertension in diabetes

Oxidative stress and pediatric diabetic cardiovascular complications: emerging research and clinical applications

The prevalence and incidence of diabetes in pediatrics have dramatically increased over the last three decades. Comparatively, pediatric diabetes has faster pancreatic β-cells decline and early progression to complications compared with adult diabetes. Therefore, diabetic complications are a major concern in children and adolescents with diabetes. Diabetes has detrimental effects on the macro- and microvascular systems, resulting in cardiovascular diseases, leading causes of morbidity and mortality in youth with diabetes. Oxidative stress plays a critical role in developing cardiovascular complications in the context of pediatric diabetes. In pediatric patients with diabetes, several factors can contribute to the development of excess reactive oxygen species and oxidative stress, including nutritional deficiencies, puberty, environmental exposures, and metabolic disorders such as obesity and high blood pressure. The present study aims to raise awareness of diabetic cardiovascular complications in children and adolescents with diabetes and the role of oxidative stress and their molecular mechanisms in the pathogenesis of cardiovascular complications. In addition, some novel therapeutic strategies for the treatment and prevention of diabetic cardiovascular complications in the pediatric populations are highlighted. In summary, children and adolescents with diabetes no matter type 1 diabetes (T1D) or type 1 diabetes (T2D), have many features similar to those in adults with same kinds of diabetes, but also have many their own features distinct from adults. By developing targeted therapies and preventive measures, healthcare providers can better address the rising incidence of diabetes-related complications in children and adolescents.

Blood pressure and the risk of diabetes: A longitudinal observational study based on Chinese individuals

BACKGROUND

With lifestyle changes, the incidence of diabetes has been steadily increasing, and hypertension remains a significant risk factor impacting cardiovascular health. Understanding the potential effects of blood pressure on diabetes risk is, therefore, crucial. This study aims to comprehensively explore the relationship between blood pressure and diabetes risk.

METHODS

A total of 211,809 individuals undergoing health check-ups were included in this analysis. Participants were divided into four groups based on the quartiles of systolic and diastolic blood pressure, with the primary outcome being the incidence of new-onset diabetes.

RESULTS

Over an average follow-up period of 3.1 years (±0.94 years), 3,000 men (1.42%) and 1,173 women (0.55%) were newly diagnosed with diabetes. Multivariable Cox regression analysis demonstrated that blood pressure is an independent predictor of new-onset diabetes (systolic blood pressure HR 1.07 per SD increase, 95% CI: 1.01-1.12, P for trend <0.001; diastolic blood pressure HR 1.11 per SD increase, 95% CI: 1.06-1.17, P for trend 0.001). The optimal cutoff for systolic blood pressure in predicting new-onset diabetes was found to be 123 mmHg (area under the curve 0.7014, sensitivity 0.65, specificity 0.64), which was superior to the predictive efficacy of diastolic blood pressure (area under the curve 0.6645, sensitivity 0.63, specificity 0.62). Subgroup analyses indicated that the risk of blood pressure-related diabetes was significantly higher in middle-aged individuals compared to older adults (P for interaction <0.05). Additionally, women showed a higher risk of systolic blood pressure-related diabetes than men, and normal-weight individuals exhibited a higher risk than those with obesity (P for interaction <0.05).

CONCLUSIONS

This cohort study within a Chinese population highlights that, after adjusting for other confounding factors, blood pressure is an independent risk factor for diabetes. This association is particularly pronounced among middle-aged individuals, women, and those of normal weight. Moreover, systolic blood pressure demonstrates superior predictive efficacy for diabetes compared to diastolic blood pressure.

Associations between stages of diabetic polyneuropathy and quality of life, neuropathic pain, and well-being: A multicenter, cross-sectional analysis based on electroneuromyographic findings

AIM

This study aimed to investigate the relationship between electrophysiological findings of diabetic neuropathy (DN) and patients' quality of life, neuropathic pain levels, and well-being.

MATERIALS AND METHODS

A cross-sectional study was conducted in 12 centers in Turkey. DN patients were categorized into four stages based on electrophysiological findings using the Baba classification. Scales such as Short Form-36 (SF-36), Douleur Neuropathique 4-Questions (DN4), Brief Pain Inventory (BPI), and WHO-5 Well-Being (WHO-5 WB) were used to assess quality of life, pain, and well-being. Additional factors like HbA1c levels and diabetes duration were analyzed.

RESULTS

Among 323 DN patients, 90 were in stage 1, 84 in stage 2, 72 in stage 3, and 77 in stage 4. There were no significant differences in age or gender between the stages. Diabetes duration and HbA1c levels were significantly lower in stage 1 compared to later stages. SF-36 and WHO-5 WB scores declined, while DN4 and BPI pain interference scores increased in the later stages. These findings persisted after adjusting for confounders such as age, BMI, comorbidities, and diabetes duration.

CONCLUSION

Patients with advanced-stage DN experienced a poorer quality of life, greater pain, and more frequent comorbidities compared to early-stage patients. Electrophysiological findings should be considered in the clinical management of DN.

Evaluating the potential impact of sodium-glucose cotransporter-2 inhibitor "canagliflozin" on the hepatic damage triggered by hypertension in rats

Hypertension (HTN) is a prevalent chronic disease. HTN and liver disease association is extensively noted. Thus, finding a medication that can alleviate HTN and its accompanying liver insult would be promising. This study investigated the potential impacts of canagliflozin "sodium-glucose cotransporter-2 inhibitor" on the liver of the Nω-nitro-L-arginine methyl ester (L-NAME)-induced HTN rat model. Twenty-four adult male rats were divided into four groups; negative control group, canagliflozin group, L-NAME group: 50 mg/kg of L-NAME was injected daily for 5 weeks and L-NAME + canagliflozin group: 1 week after L-NAME injection both L-NAME + canagliflozin (40 mg/kg) were given concomitantly daily for further 4 weeks. Liver functions, serum lipid profile, hepatic oxidative/nitrative stress biomarkers, gene expression of lipogenic enzymes, B-cell lymphoma 2 (Bcl2), and DNA fragmentation, were measured. Besides, hepatic histology and immunohistochemistry of nuclear factor kappa B (NF-κB) and endothelial nitric oxide synthase (eNOS) were assessed. Canagliflozin improved hepatic lipogenesis via the downregulation of fatty acid synthase (FAS) and transcriptional regulatory element binding protein 1c (SREBP1c) genes leading to an improved serum lipid profile. Further, canagliflozin modified the eNOS/inducible nitric oxide synthase (iNOS) pathway and decreased the NF-κB immunoreactivity besides restoring the oxidants-antioxidants balance; increased reduced glutathione concomitant with declined malondialdehyde. This improvement of the liver was mirrored by the significant restoration of liver architecture and confirmed by the preserved liver DNA content and upregulation of the antiapoptotic Bcl2 mRNA level and attenuation of the alanine transaminase, aspartate aminotransferase. In conclusion, canagliflozin is a promising anti-hypertensive and hepatic-supportive medication. RESEARCH HIGHLIGHTS: Canagliflozin's antioxidant, anti-inflammatory, anti-lipogenic, and antiapoptotic characteristics mitigate remote liver compromise caused by hypertension. Canagliflozin can be exploited as a hepatoprotective and antihypertensive medication.

Threshold effect of atherogenic index of plasma on type 2 diabetes mellitus and modification by uric acid in normal-weight adults with hypertension

Background

The association between atherogenic index of plasma (AIP) and type 2 diabetes mellitus (T2DM) in normal-weight individuals with hypertension remains unclear. This study seeks to elucidate this relationship in normal-weight adults with hypertension.

Methods

This cross-sectional study included 8,258 normal-weight adults with hypertension from the China Hypertension Registry Study. The AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). The multivariate logistic regression, generalized additive model, smooth fitting curve, sensitivity analyses, two-part logistic regression, and subgroup analyses were conducted to detect the correlation between AIP and T2DM.

Results

The mean age of the study population was 64.89 ± 8.97 years, with an overall prevalence of T2DM of 15.55%. Multivariate logistic regression analyses indicated that there was a positive and independent relationship between AIP and T2DM (OR: 3.73; 95% CI: 2.82, 4.94). Threshold effect analysis identified a J-shaped association between AIP and T2DM, with an inflection point at 0. Additionally, an interaction between hyperuricemia and AIP was observed (P for interaction = 0.034).

Conclusions

In normal-weight adults with hypertension, there was a J-shaped association between AIP and T2DM, with an inflection point at 0. the correlation between AIP and T2DM was more pronounced in individuals with hyperuricemia compared to those with normal uric acid.

Analysis of the Associations of Measurements of Body Composition and Inflammatory Factors with Cardiovascular Disease and Its Comorbidities in a Community-Based Study

The associations of cardiovascular disease (CVD) with comorbidities and biochemical and body composition measurements are repeatedly described but have not been studied simultaneously. In the present cross-sectional study, information on CVD and comorbidities [type 2 diabetes mellitus (T2DM), hypertension (HTN), and hyperlipidemia (HDL)], body composition, levels of soluble markers, and other measures were collected from 1079 individuals. When we examined the association of each comorbidity and CVD, controlling for other comorbidities, we observed a clear pattern of the comorbidity-related specific associations with tested covariates. For example, T2DM was significantly associated with GDF-15 levels and the leptin/adiponectin (L/A) ratio independently of two other comorbidities; HTN, similarly, was independently associated with extracellular water (ECW) levels, L/A ratio, and age; and HDL was independently related to age only. CVD showed very strong independent associations with each of the comorbidities, being associated most strongly with HTN (OR = 10.89, 6.46-18.38) but also with HDL (2.49, 1.43-4.33) and T2DM (1.93, 1.12-3.33). An additive Bayesian network analysis suggests that all three comorbidities, particularly HTN, GDF-15 levels, and ECW content, likely have a main role in the risk of CVD development. Other factors, L/A ratio, lymphocyte count, and the systemic inflammation response index, are likely indirectly related to CVD, acting through the comorbidities and ECW.

The burden of diabetes and hypertension on healthy life expectancy in Bangladesh

Diabetes and hypertension are among the leading causes of death in Bangladesh. This study examined hypertension, diabetes, and either or both, free life expectancy, to measure the effect of the diseases on the overall health of individuals in Bangladesh with regional variations. We utilized data from Bangladesh Sample Vital Statistics 2018 for mortality and Bangladesh Demographic and Health Survey 2017-2018 for diabetes and hypertension. The Sullivan method was employed to estimate age-specific hypertension and diabetes-free life expectancy. Altogether, 10.3% of the people aged 18-19 years lived with either diabetes or hypertension. The hypertension-free life expectancy was 40.4 years, and the diabetes-free life expectancy was 53.2 years for those aged 15-19. Overall, individuals would expect to spend 38.7% of their lives with either of the diseases. Females suffered more from hypertension and males from diabetes. Still, females suffered more from the aggregate of both. Rural people had more diabetes and hypertension-free life expectancy than those of urban. Individuals of Mymensingh had the highest life expectancy free of both diseases compared to other divisions of Bangladesh. Diabetes and hypertension affect a considerable proportion of the life of the population in Bangladesh. Policy actions are needed to guide the prevention, diagnosis, and treatment of both diseases, specifically focusing on women and urban populations. Widespread health-enhancing actions need to be taken to diminish the effect of these two diseases in Bangladesh.