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Bachir Cherif A, Bennouar S, Bouamra A, Taleb A, Hamida F, Temmar M, Bouafia MT. Prevalence of diabetes and dyslipidemia in hypertensive patients in the area of Blida (Algeria). Ann Cardiol Angeiol (Paris) 2018; 67:198-203. [PMID: 29753422 DOI: 10.1016/j.ancard.2018.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with an increased risk of cardiovascular complications requiring follow-up and more aggressive therapeutic strategies. The main objective of this study was to describe the prevalence of DM and LD in adult hypertensive patients followed in specialized consultation of hypertension in the region of Blida (North Algeria) during the period from January 2013 to June 2017. MATERIALS AND METHODS We included 3268 hypertensive patients (1453 men and 1815 women), mean age of 58.3±13.8years. Descriptive statistics were used to estimate means by sex and age for subgroups [under 30, 30-39, 40-49, 50-60, over 70]. A linear regression was used to determine annual trends. The age and sex specific results were adjusted to the general population data of the city of Blida for a period of 4years and each year studied. RESULTS The mean prevalence of diabetes was 21.8% and glucose tolerance was 10.9% without significant trend of increase during the study period in the overall population and according to sex, while in the subgroup of hypertensive patients over 60, there has been an increase in the prevalence of diabetes and a decrease in glucose tolerance over the 4 years (R2=0.78, P=0.05 and R2=0.95, P=0.005, respectively). The mean prevalence of LD for the study period was 16.1% without significant trend at 4years. The increase in total cholesterol combined with the increase in low-density lipoprotein (LDL) levels was the most common disorder (32.2%). There was no significant difference in LD prevalence and characteristics in subgroups by sex. Age group analysis showed a greater increase in the frequency of lipid disorders in patients over 60years of age (R2=0.80, P=0.001). CONCLUSIONS Over the 4years of study, age over 60 was associated with an increase in the prevalence of metabolic disorders in hypertensive patients. This trend may explain the poor control of BP. Above all, it must be taken into account for the requirement to achieve therapeutic objectives that effectively reduce the risk of cardiovascular complications occurring in these high-risk patients whose number is becoming increasingly important.
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Affiliation(s)
- A Bachir Cherif
- Clinic of internal medicine and cardiology, university hospital center of Blida, 9000 Blida, Algeria.
| | - S Bennouar
- Central laboratory of biochemistry, university hospital of Blida, 9000 Blida, Algeria
| | - A Bouamra
- Epidemiology department, university hospital of Blida, 9000 Blida, Algeria
| | - A Taleb
- Clinic of internal medicine and cardiology, university hospital center of Blida, 9000 Blida, Algeria
| | - F Hamida
- Clinic of internal medicine and cardiology, university hospital center of Blida, 9000 Blida, Algeria
| | - M Temmar
- Cardiology and angiology center, 47000 Ghardaia, Algeria
| | - M T Bouafia
- Clinic of internal medicine and cardiology, university hospital center of Blida, 9000 Blida, Algeria
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Abstract
OBJECTIVE To investigate the management of hypertension in patients with diabetes mellitus, living in a rural setting. METHOD A community health screening clinic was conducted at Charles Sturt University, Albury-Wodonga, in rural southeastern Australia. Patients with either diagnosed hypertension or high blood pressure who attended the clinic were eligible for inclusion in the present study. The awareness and control of hypertension was compared between patients with and without diabetes mellitus. RESULTS A total of 449 patients with hypertension were analyzed. One hundred twenty-one (26.9%) had hypertension and diabetes mellitus, and 328 (73.1%) had hypertension without diabetes mellitus. Hypertension awareness (61.2% versus 36.9%, P=0.014) and control (17.4% versus 7.0%, P=0.040) were significantly better in the hypertensive patients with diabetes mellitus than in the hypertensive patients without diabetes mellitus. Antihypertensive medication use was also significantly higher in patients with diabetes mellitus than in patients without diabetes mellitus (one antihypertensive medication, 41.3% versus 25.0%, P=0.045). CONCLUSION Awareness and control of hypertension were suboptimal in the patients in the present study. Diabetes mellitus, however, was associated with both higher awareness and better control of hypertension than having hypertension alone. This may be partially due to a higher use of antihypertensive medications by patients with diabetes mellitus.
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Affiliation(s)
- Fiona White
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga
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Kostapanos MS, Milionis HJ, Elisaf MS. Current role of statins in the treatment of essential hypertension. Expert Opin Pharmacother 2010; 11:2635-50. [PMID: 20497095 DOI: 10.1517/14656566.2010.491512] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Hypertension and hyperlipidemia often co-exist and seem to be interrelated through common pathophysiological pathways. Drugs employing beneficial effects in both conditions could be advantageous in a concerted effective management of patients at high cardiovascular risk. Statins are known to enhance cardiovascular protection beyond their lipid-lowering capacity. AREAS COVERED IN THIS REVIEW MEDLINE was searched, up to January 2010, for studies assessing the effect of statin treatment on blood pressure control in various populations or animal models of hypertension. The potential mechanisms implicated in the putative antihypertensive action of statins are also reviewed. WHAT THE READER WILL GAIN To learn about the role of statins as potential antihypertensive drugs in various populations. Clinical advice for the use of statins either as monotherapy or in combination with antihypertensive drugs in high-risk populations is also provided. TAKE HOME MESSAGE Statins may exert a mild, but clinically relevant, antihypertensive effect which is probably mediated by mechanisms that are independent of their lipid-lowering effects. Patients with high BP levels at baseline as well as those treated with ACE inhibitors and calcium channel blockers are expected to benefit more in this regard.
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Affiliation(s)
- Michael S Kostapanos
- University of Ioannina, School of Medicine, Department of Internal Medicine, 451 10 Ioannina, Greece
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Milionis HJ, Liberopoulos EN, Elisaf MS, Mikhailidis DP. Analysis of antihypertensive effects of statins. Curr Hypertens Rep 2007; 9:175-83. [PMID: 17519121 DOI: 10.1007/s11906-007-0032-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hypertension and hyperlipidemia, two powerful risk factors of cardiovascular disease (CVD), often coexist. Therefore, treatment should consider the beneficial properties of drugs used to treat either condition. Statins, the mainstay of lipid-lowering therapy, result in a significant clinical benefit both in primary and secondary CVD prevention. In addition to their hypolipidemic capacity, other properties may contribute to statin-induced benefits. Clinical and experimental evidence indicates that statins may modulate blood pressure (BP). The mechanisms by which statins reduce BP seem to be largely independent of their lipid effects. Although small, reductions in BP are possibly clinically relevant. Large landmark studies confirm that statins can reduce CVD risk in hypertensive patients. These findings suggest that statins could be prescribed as an adjunct in treating hypertension with dyslipidemia or even in patients with "normal" cholesterol levels. Whether the effect of statins on BP is accompanied by an additional decrease in clinical outcomes needs to be investigated in long-term, large-scale trials.
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Affiliation(s)
- Haralampos J Milionis
- Department of Clinical Biochemistry, Vascular Disease Prevention Clinics, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Milionis HJ, Liberopoulos EN, Achimastos A, Elisaf MS, Mikhailidis DP. Statins: another class of antihypertensive agents? J Hum Hypertens 2006; 20:320-35. [PMID: 16511505 DOI: 10.1038/sj.jhh.1002001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The assessment of global cardiovascular risk is an essential step in the management of atherosclerotic disease prevention. Among the risk factors to be addressed are hypertension and hyperlipidaemia; these commonly coexist. A neutral or lipid-friendly antihypertensive agent is probably useful in the presence of lipid abnormalities. Similarly, statins have been shown to decrease cardiovascular risk in hypertensive patients. There is also experimental and clinical evidence that statins have blood pressure (BP)-lowering effects. In this review, we discuss the beneficial effects of statins on BP, and provide an overview of the underlying pathophysiology. We also consider the evidence justifying the use of statins in the management of hypertensive patients.
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Affiliation(s)
- H J Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Ho PM, Prochazka AV, Magid DJ, Sales AE, Grunwald GK, Hammermeister KE, Rumsfeld JS. The association between processes, structures and outcomes of secondary prevention care among VA ischemic heart disease patients. BMC Cardiovasc Disord 2006; 6:6. [PMID: 16469100 PMCID: PMC1413554 DOI: 10.1186/1471-2261-6-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 02/09/2006] [Indexed: 11/25/2022] Open
Abstract
Background Hyperlipidemia and hypertension are well-established risk factors for recurrent cardiovascular events among patients with ischemic heart disease (IHD). Despite national recommendations, concordance with guidelines for LDL cholesterol and blood pressure remains inadequate. The objectives of this study were to 1) determine concordance rates with LDL cholesterol and BP recommendations; and 2) identify patient factors, processes and structures of care associated with guideline concordance among VA IHD patients. Methods This was a cross sectional study of veterans with IHD from 8 VA hospitals. Outcomes were concordance with LDL guideline recommendations (LDL<100 mg/dl), and BP recommendations (<140/90 mm Hg). Cumulative logit and hierarchical logistic regression analyses were performed to identify patient factors, processes, and structures of care independently associated with guideline concordance. Results Of 14,114 veterans with IHD, 55.7% had hypertension, 71.5% had hyperlipidemia, and 41.6% had both conditions. Guideline concordance for LDL and BP were 38.9% and 53.4%, respectively. However, only 21.9% of the patients achieved both LDL <100 mg/dl and BP <140/90 mm Hg. In multivariable analyses, patient factors including older age and the presence of vascular disease were associated with worse guideline concordance. In contrast, diabetes was associated with better guideline concordance. Several process of care variables, including higher number of outpatient visits, higher number of prescribed medications, and a recent cardiac hospitalization were associated with better guideline concordance. Among structures of care, having on-site cardiology was associated with a trend towards better guideline concordance. Conclusion Guideline concordance with secondary prevention measures among IHD patients remains suboptimal. It is hoped that the findings of this study can serve as an impetus for quality improvement efforts to improve upon secondary prevention measures and reduce the morbidity and mortality of patients with known IHD.
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Affiliation(s)
- P Michael Ho
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
- Medical Service, Denver VA Medical Center, Denver, CO, USA
| | - Allan V Prochazka
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
- Medical Service, Denver VA Medical Center, Denver, CO, USA
| | - David J Magid
- Clinical Research Unit, Kaiser Permanente of Colorado, Denver, CO, USA
- Division of Emergency Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
- Department of Biometrics and Preventive Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
| | - Anne E Sales
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Gary K Grunwald
- Department of Biometrics and Preventive Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
| | - Karl E Hammermeister
- Colorado Health Outcomes Program, University of Colorado Health Sciences Center, Denver, CO, USA
| | - John S Rumsfeld
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
- Medical Service, Denver VA Medical Center, Denver, CO, USA
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Abstract
PURPOSE OF REVIEW Despite clear treatment guidelines, a major part of the population is not achieving the recommended LDL cholesterol target levels. This fact is more prominent among high-risk populations in which the majority of patients are untreated or undertreated. RECENT FINDINGS The review will elaborate on the key issues of treating large populations: patient compliance, drug efficacy, cost-benefit, and physician quality of care. SUMMARY A programme aimed at improving control of hyperlipidemia should address all four issues. The primary care physician should be empowered and given tools for optimizing treatment.
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Affiliation(s)
- Eyal Leibovitz
- Department of Medicine, Wolfson Medical Center, Holon, Israel.
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Niemann B, Rohrbach S, Catar RA, Muller G, Barton M, Morawietz H. Native and oxidized low-density lipoproteins stimulate endothelin-converting enzyme-1 expression in human endothelial cells. Biochem Biophys Res Commun 2005; 334:747-53. [PMID: 16023075 DOI: 10.1016/j.bbrc.2005.06.163] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 06/24/2005] [Indexed: 12/30/2022]
Abstract
This study addressed the question how different lipoproteins modulate the expression of endothelin-converting enzyme-1 (ECE-1) in human endothelial cells. The effect of native and oxidized low-density lipoproteins (nLDL, oxLDL) on expression of ECE-1, prepro-endothelin-1, and endothelin-1 peptide was studied in primary cultures of human endothelial cells. Native and oxidized LDL increased ECE-1 mRNA after 1 h, reaching its maximum at 100 microg/ml (1.9- and 2.5-fold, respectively). Furthermore, ECE-1 protein expression, prepro-endothelin-1 mRNA, and endothelin-1 peptide release were increased in response to nLDL or oxLDL. Induction of ECE-1 by nLDL and of prepro-endothelin-1 by oxLDL was reduced by protein kinase C inhibition. Increased expression of ECE-1 mRNA by oxLDL and of prepro-endothelin-1 by nLDL was blocked by an angiotensin II receptor type 1 antagonist. Our data provide evidence for a new mechanism how increased LDL plasma levels might contribute to enhanced endothelin-1 release in patients with hypercholesterolemia.
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Affiliation(s)
- Bernd Niemann
- Department of Vascular Endothelium and Microcirculation, Medical Faculty Carl Gustav Carus, University of Technology Dresden, D-01307 Dresden, Germany
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