Treatment of Cardiovascular and Renal Risk Factors in the Diabetic Hypertensive

Abstract

CaseA 38-year-old black woman is see 1 n on referral from a family physician. Her medical records indicate that she has had type 2 diabetes diagnosed 3 years previously. She has been treated for her diabetes with diet and a sulfonylurea, Glucotrol X-L 10 mg daily. Her last glycohemoglobin 6 months ago was 8.8%. She has had hypertension for Ϸ10 years and is currently receiving 10 mg amlodipine daily, 25 mg hydrochlorothiazide daily, and 4 mg doxazosin every morning. In her records, her physician notes that her blood pressure (BP) has been relatively well controlled, with BPs generally Ϸ150/90 mm Hg. She had an EKG 1 year previously, which was remarkable only for left ventricular hypertrophy (LVH) by voltage criteria. Her last total cholesterol was 230 mg/dL, with LDL cholesterol of 145 mg/dL. Her records indicated that she was not started on lipid therapy because her LDL was Ͻ150 mg/dL. She has a strong family history of diabetes, hypertension, coronary artery disease, stroke, and kidney disease requiring dialysis. Physical ExaminationThe patient's BP was 154/92 mm Hg, with a pulse of 88 bpm. Her weight was 190 lbs (body mass index, 35 kg/m 2 ). Examination of the head, ears, eyes, nose and throat (HEENT) revealed fundi with background retinopathy (hemorrhages and exudates). Examination of the heart showed that the point of maximum impulse (PMI) was shifted to the anterior auxiliary line and sustained, with an S 4 gallop present. Examination of the patient's abdomen revealed a waist circumference of 38 inches, a slightly enlarged liver, and no abdominal bruits. Examination of the patient's lower extremities showed that the dorsalis pedis and posterior tibial pulses were noticeably decreased in amplitude, and 2ϩ pretibial pitting edema was present. Laboratory ValuesLaboratory values were as follows: fasting glucose, 140 mg/dL; glycosylated hemoglobin [HbA1c], 8.5%; creatinine, 2.0 mg/dL; urinary albumin, 0.8 mg/dL; total cholesterol, 250 mg/dL (HDL cholesterol, 35 mg/dL; LDL cholesterol, 165 mg/dL; and triglycerides [TGs], 250 mg/dL), and electrolytes serum potassium, 4.7 mmol/L. The EGK showed LVH by voltage criteria.

Greater Impact of Coexistence of Hypertension and Diabetes on Silent Cerebral Infarcts

“…The clinical impact of DM coexisting with hypertension on cardiovascular disease was recently reviewed; this status can worsen the cardiovascular prognosis. 23 The risk factors for stroke previously reported were diabetic history, SBP, 24 and insulin resistance. 25 In a report on poststroke patients, 26 hypertension and DM were closely related to multiple SCIs.…”

Inhibition of adipocyte differentiation by mechanical stretching through ERK-mediated downregulation of PPARγ2

“…Obesity often promotes a range of cardiovascular diseases, including atherosclerosis, hypertension and type 2 diabetes (Sowers and Haffner, 2002). Recent advances in adipocyte biology have established that fat tissue not only serves as a means of energy storage in the form of triglycerides but also exerts secretory/endocrine gland functions, producing various secretory molecules such as hormones and cytokines (Kahn and Flier, 2000).…”

Metabolic syndrome and insulin signaling in kidney

“…Uzu and colleagues have reported associations between the presence of MetS and salt-sensitive hypertension [15]. In essential hypertension, there are several reports that describe impaired insulin signaling [16][17][18][19][20][21][22]. McFarlane and Sechi showed direct correlation between plasma insulin levels and blood pressure in such patients [17,18].…”