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Background@#Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. @*Methods@#Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. @*Results@#In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. @*Conclusion@#The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.
ABSTRACT
Background@#Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. @*Methods@#Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. @*Results@#In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. @*Conclusion@#The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.
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Objective To investigate the relationship between the plasma galectin-3 level and the severity of cerebral artery atherosclerosis as well as the prognosis of patients with large artery atherosclerosis (LAA) stroke.Methods According to the TOAST classification,105 patients with LAA stroke,50 patients with small artery occlusion (SAO) stroke,33 patients with asymptomatic cerebral artery stenosis,and 60 healthy controls were enrolled.The plasma galectin-3 level was measured using enzyme-linked immunosorbent assay.According to the number of cerebral arteries with atherosclerosis,the LAA group was divided into single-branch lesions group (n =30),double-branch lesions group (n =30) and multi-branch lesions group (n =45).Plasma galectin-3 levels were compared among the three subgroups,and the associations between galectin-3 and the severity of cerebral atherosclerosis were analyzed.The LAA group patients were followed up for three months,and the value of galectin-3 on predicting the prognosis of patients with LAA stroke was assessed using the receiver operating characteristic (ROC) curve and the modified Rankin scale (mRS) scores.Results The plasma galectin-3 level in LAA group ((13.64 ± 3.08) ng/ml) was significantly higher than in SAO group ((12.20 ± 2.88) ng/ml) and control group ((11.89 ± 2.93) ng/ml;t =2.790,3.617,P =0.006,0.000).Besides,the plasma galectin-3 level in asymptomatic stenosis group ((13.94 ± 2.89) ng/ml) was significantly higher than in SAO group and control group (t =2.695,3.238,P =0.009,0.002).However,the differences between asymptomatic stenosis group and LAA group,SAO group and control group were not statistically significant.In LAA group,the plasma galectin-3 level in multi-branch lesions group ((15.02 ±2.94) ng/ml) was significantly higher than in double-branch lesions group ((13.47 ± 2.88) ng,/ml) and single-branch lesions group ((11.73 ± 2.43) ng/ml;t =2.261,5.080,P =0.027,0.000).The plasma galectin-3 level in double-branch lesions group was significantly higher than in single-branch lesions group (t =2.532,P =0.014).The plasma galectin-3 level and the range of atherosclerosis and mRS scores were positively correlated (r =0.433,0.629;P =0.000,0.000).The area under the ROC curve of plasma galectin-3 level and prognosis was 0.812 (95％ CI O.726-0.897,P =0.000).Conclusions The plasma galectin-3 level was found associated with the severity of cerebral artery atherosclerosis,but not with acute onset of LAA and SAO stroke.Galectin-3 may be involved in the inflammatory pathogenesis and development of cerebral atherosclerosis,and may have the potential to become a plasma marker for evaluating the severity of cerebral artery atherosclerosis and judging the prognosis of patients with LAA stroke.
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Objective To investigate the relationship between osteoprotegerin ( OPG ) gene polymorphisms and ischemic stroke etiological subtypes, as well as the extent and distribution of cerebral atherosclerosis ( AS) lesions.Methods Patients with ischemic stroke included 285 cases of large-artery atherosclerosis (LAA), 91 cases of small-artery occlusion (SAO) and 42 cases of purely AS, and 165 healthy controls were enrolled in this study.The LAA group was respectively divided into 3 subgroups according to the number and the distribution of stenostic vessels.Genotyping of three single nucleotide polymorphisms (SNPs;rs2073617, rs3134069, and rs3102735) in the promoter region of the OPG gene was performed by polymerase chain reaction-restriction fragment length polymorphism.Results Regarding the three SNPs of OPG gene, the frequence of genotype CC/CT and the prevalence of allele C of rs3102735 were higher in the LAA group contrasting with the control group ( 24.04% vs 14.85%, 44.21% vs 27.88%,χ2 =10.758, 11.804, P =0.001,0.024).However, comparisons of other frequences of genotypes or alleles did not reveal any significant differences among the LAA group, the SAO group, the AS group and the control group, as well as among different subgroups of LAA group.Haplotype analysis revealed that the frequencies of haplotype C-C-T in LAA group and SAO group were significantly lower ( 0.023, 0.017 vs 0.068,χ2 =10.399, 5.841,P=0.001, 0.016), while that of haplotype T-A-C was significantly higher in SAO group(0.043 vs 0.016,χ2 =4.708, P=0.030) compared with controls.Conclusions Our findings indicate that OPG gene polymorphisms might be associated with increased susceptibility to LAA ischemic stroke.But we fail to show association of OPG gene with the extent and distribution of AS.