Refractory and resistant hypertension in patients with type 2 diabetes mellitus: differences in metabolic profile and endothelial function

Abstract

Aim. To determine the prevalence of refractory hypertension (RfH) in patients with and without type 2 diabetes mellitus (DM), as well as to evaluate whether diabetic patients with RfH significant differ from those with uncontrolled resistant hypertension (RH) in clinical phenotype, metabolic profile and endothelial function.
 Materials and methods. The study included 193 patients with RH: RH 74 patients with diabetes and 119 patients without DM. Uncontrolled RH and RfH were defined by the presence of uncontrolled blood pressure BP (140 and/or 90 mm Hg) despite the use of 3 but 5 antihypertensive drugs (for RH) and 5 antihypertensive drugs, including a mineralocorticoid receptor antagonist (for RfH). Clinical examination, lab tests were performed. Flow-mediated dilation (FMD) and vasoreactivity of middle cerebral artery (MCA) using both breath-holding and hyperventilation test were measured by high-resolution ultrasound.
 Results. The prevalence of refractory hypertension in patients with and without DM was similar (30% vs 28%, respectively). No differences in BP levels, data of echocardiography and clinical phenotype were found between the diabetic groups, but value of HOMA index, plasma resistin level and postprandial glycaemia were higher in patients with RfH. FMD and MCA reactivity to the breath-holding test were worse in patients with RfH, and they had a more pronounced vasoconstrictor response of MCA to the hyperventilation test compared to patients with RH.
 Conclusion. The prevalence of RfH is the same in patients with and without diabetes. Diabetic patients with refractory hypertension have a more unfavorable metabolic profile and greater impairment of endothelial function than patients with uncontrolled resistant hypertension.

Effects of Carvedilol on Blood Pressure, Blood Sugar, and Blood Lipids in Elderly Patients with Refractory Hypertension

“…The mean ± standard deviation (X ± S) was used to express the results using independent sample t-test. Computational and Mathematical Methods in Medicine blocker, which can fully block β receptors and also selectively block α1 receptors without endogenous sympathomimetic activity and peripheral β agonism [10]. Carvedilol, as a third-generation β-blocker, has characteristics unmatched by other β2-blockers and is widely used in the treatment of hypertension, congestive heart failure, and coronary artery disease with proven efficacy [11].…”

Beta-adrenergic reactivity of erythrocyte membranes in various phenotypes of uncontrolled hypertension

“…Суточная экскреция катехоламинов в моче, в отличие от уровня β-АРМэ, в сравниваемых группах была сопоставимой. При этом следует отметить, что сведения о различиях уровня катехоламинов у больных рфАГ и РАГ весьма противоречивы [5,13], что может быть обусловлено ограничениями данного метода в оценке симпатической активности, а также особенностями выборок пациентов. Прямых корреляционных связей β-АРМэ с уровнем суточной экскреции катехоламинов мы также не обнаружили.…”