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The aim of this study was to assess the basic biochemical and clinical characteristics of patients with hypertension and type 2 diabetes mellitus (T2DM), office blood pressure (BP) and 24-h BP profile, their risk factors and associated comorbidities. Compared with non-diabetics, hypertensive patients with T2DM were older, with a longer duration of hypertension (5.9 vs. 4.7 years), greater office blood pressure and ambulatory BP values, increased incidence of multiple risk factors, target organ damage and cardiovascular disease. Biochemical data in hypertension with T2DM revealed significantly high levels of LDL cholesterol, triglycerides, creatinine, micro- and macro-albuminuria and a reduced estimated glomerular filtration rate. The presence of diabetes was associated with obesity, represented by a BMI ]30 kg/m2 (OR 2.08 [95% CI 1.26-3.45], p = 0.004), abdominal obesity (OR 1.85 [95% CI 1.11-3.04], p = 0.016), high LDL cholesterol (OR 2.02 [95% CI 1.22-3.35], p = 0.006) and high triglycerides (OR 1.86 [95% CI 1.11-3.11], p = 0.017).

The present cross-sectional observational study was made in family medicine offices of Timi� County, Romania. The aim of the study was to investigate the prevalence of urinary microalbumin excretion (MAU) in resistant systemic arterial hypertension (RH), to analyze patients� biochemical and clinical characteristics, and the predictive factors for MAU. From a total number of 347 patients, MAU was detected in 76 cases (21.9%). The microalbuminuria positive patients were older, with significant higher office systolic blood pressure (BP) (155 � 13.50 vs 148 � 12.40 mmHg, p [ 0.0001) and diastolic blood pressure (94 � 12.20 vs 88 � 14.6 mmHg, p = 0.0013), higher prevalence of left ventricular hypertrophy, diabetes mellitus, obesity, ischemic and peripheral arterial disease. MAU positive patients presented statistical significant differences in biochemical data concerning: fasting plasma glucose (FPG) (118.80 � 32.02 vs 108.01 � 26.01 mg/dL, p = 0.003), impaired glucose tolerance (IGT) (10.52 % vs 4.94 %), glycated hemoglobin (HbA1c) (6.56 � 0.98% vs 5.96 � 0.91%, p [ 0.001), reduced estimated glomerular filtration rate (eGFR) (56.10 � 15.4 vs 69.30 � 17.5 ml/min/1.73m2, p [ 0.001) and higher potassium levels (4.71 � 0.43 vs 4.59 � 0.44 mg/dL, p = 0.0378). No significant differences were noticed regarding LDL- and HDL-cholesterol, triglycerides, uric acid and serum creatinine. In a logistic multivariate analysis independent predictors for MAU were: systolic BP (odds ratio, OR = 1.024, 95% confidence interval, CI:1.011-1.039, p [ 0.001), HbA1c (OR = 1.324, 95% CI: 1.078-1.724, p = 0.008) and eGFR (OR = 0.989, 95% CI: 0.977-0.999, p = 0.01). Our findings suggest that an important part of RH patients have microalbuminuria and highlight the importance of controlling its predictors, in order to improve patients� outcome.

The objectives of the study were to evaluate the prevalence of microalbuminuria (MAU) in patients with hypertension, monitored in primary care and to analyse the correlation between MAU, risk factors and associated parameters. Material and methods. During 2010-2014 we evaluated a number of 910 patients from 19 family medicine offices of Timiş County. The general practitioners took a standardized history, performed a physical examination, measured height, weight, blood pressure, ABPM and heart rate, calculated body mass index and tested urine for MAU with Arkray test strips. The patients with hypertension and MAU were referred to diagnosis centres where they underwent echocardiography. Results. After exclusion of patients with a history of renal disease and diabetes, MAU was present in 61 cases, 7.1%. The mean age of the MAU positive patients was 56±13.1 years, ranging from 29 to 79. The duration of hypertension was under 5 years in 4 (2.44%) patients, between 5-10 years in 35 (57.3%) and over 10 years in 22 (36%) Six patients with MAU (9.83%) had mild hypertension, 25 (40.9%) moderate and 30 (49.1%) severe hypertension. LVMI was 125 ± 28 g/m2 in the MAU absent group and 157 ± 56 g/m2 in the MAU present group (<0.04). A stepwise logistic regression analysis showed significant positive effects of 24 h systolic blood pressure, weight and LVH (p<0.001 for all comparisons) on MAU. No other variable had a significant predictive effect on the presence or absence of MAU. Conclusions. In patients with essential hypertension MAU was present in 7.1%, with a higher prevalence in uncontrolled than in controlled hypertension. MAU was associated with high blood pressure levels, obesity and LVH.

The objectives of the present study were to evaluate the prevalence of resistant hypertension (RH) in primary care setting and to analyse its biochemical and clinical characteristics. After 3 months of treatment and evaluation, 721 (14.01%) of 5,146 patients with hypertension did not reach target office blood pressure of [ 140/90 mmHg. After exclusion of �white-coat effect� with ambulatory blood pressure, of secondary and pseudo- resistant hypertension, prevalence of RH was 6.74%. Lifestyle factors associated with RH were physical inactivity, obesity, high salt intake, smoking and excessive alcohol ingestion. Compared to controlled hypertension, RH patients presented higher incidence of family history of cardiovascular disease (38.90% vs 25.94%), diabetes mellitus (34.87% vs 19.01%), impaired fasting glucose (21.91% vs 19.07%), target organ damage (29.1% vs 15.95%), and cardiovascular disease (27.09% vs 17.06%). Dyslipidaemia (52.90% vs 42.03%), fasting plasma glucose (116.10�38.9 vs 107.80�37.2), HbA1c (6.41�1.42 vs 5.96�0.94), serum creatinine (1.09�0.27 vs 1.03�0.24) and microalbuminuria (21.90% vs 10.95%) were significantly higher in RH. Predictors of RH, determined by a multivariate logistic regression analysis were left ventricular hypertrophy (OD 2.14, 95% CI 1.32-3.69), renal impairment expressed as eGFR [ 60 ml/min/1.73m2 (OD 1.62, 95% CI 1.21-2.21) and the presence of cardiovascular disease (OD 1.48, 95% CI 1.02-2.16).

The aim of this study was to establish the correlation between the value of serum cystatin C (Cys C) and carotid atherosclerosis in patients without chronic kidney disease and to determine the serum Cys C cut-off level for carotid atherosclerosis diagnosis. The study was performed between October 2014 and June 2018, and included 256 patients from 20 family medicine offices of Timis County, both from urban and rural areas. The patients completed a socio-demographic questionnaire, and were clinically examined by their general practitioner and investigated by laboratory tests and carotid ultrasound. The mean age of the patients with high serum Cys C (study group 1) was 74 years (82% male), while in study group 2 (with low serum Cys C values) the mean age was 56 years old (63% male). Cys C levels were significantly correlated with serum creatinine and estimated glomerular filtration rate. In the group with elevated levels of Cys C we found an increased incidence of obesity, hypertension, diabetes and carotid atherosclerosis. Multivariate analysis showed that the increased levels of Cys C were associated with a maximum carotid plaque thickness (MCPT) �2 mm (OR: 2.86, 95% C.I.: 1.13-7.97). The serum Cys C cut-off level for the diagnosis of atherosclerosis determined by ROC (receiver operating characteristic) curve was 0.73 mg/dL.

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