ABSTRACT
Observational and experimental data reinforce the concept that vitamin D is associated with the pathogenesis of arterial hypertension. We investigated the effect of a single dose of 100,000 IU of cholecalciferol, in office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM) in patients with type 2 diabetes mellitus (DM), hypertension, and hypovitaminosis D. Forty-three patients were randomized to a placebo or cholecalciferol group. BP was assessed by office measurements and 24-h ABPM, before and after intervention. At week 8, a greater decrease in median ABPM values was observed in cholecalciferol supplementation than in the placebo group for systolic 24-h (- 7.5 vs. - 1; P = 0.02), systolic daytime (- 7 vs. - 1; P = 0.007), systolic nighttime (- 7.0 vs. 3; P = 0.009), diastolic 24-h (- 3.5 vs. - 1; P = 0.037), and daytime DBP (- 5 vs. 0; P = 0.01). Office DBP was also reduced after vitamin D supplementation. A single dose of vitamin D3 improves BP in patients with type 2 diabetes, hypertension, and vitamin D insufficiency, regardless of vitamin D normalization. Vitamin D supplementation could be a valuable tool to treat patients with type 2 DM, hypertension, and hypovitaminosis D.Trial registration: Clinicaltrials.gov NCT02204527.
Subject(s)
Blood Pressure/drug effects , Cholecalciferol/administration & dosage , Diabetes Mellitus, Type 2/physiopathology , Dietary Supplements , Hypertension/physiopathology , Vitamin D Deficiency/physiopathology , Aged , Blood Pressure Monitoring, Ambulatory , Double-Blind Method , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
OBJECTIVE: To analyze tests used in routine clinical practice for the diagnosis of myocardial ischemia to predict the development of cardiac events in type 2 diabetic patients. METHODS: The occurrence of cardiac events (new myocardial infarct, myocardial re-vascularization procedures, congestive heart failure, acute pulmonary edema, sudden death, and death after myocardial infarction or pulmonary edema) were prospectively assessed in a cohort of 135 type 2 diabetic patients after up to seven years of follow-up. At baseline, coronary artery disease was assessed by the WHO cardiovascular questionnaire, resting electrocardiogram, and stress myocardial scintigraphy. RESULTS: Forty-eight cardiac events were observed in 41 patients (10.5 events/100 patients-year). In a Cox's proportional-hazard model only the presence of symptoms of coronary artery disease on the WHO cardiovascular questionnaire alone (RR = 2.13, 95% CI 1.11-4.07, P= 0.022) or in combination with abnormalities on resting ECG (RR= 2.03, 95% CI 1.05-3.92, P= 0.034) or on myocardial scintigraphy (RR= 1.89, 95% CI 1.001-3.57, P= 0.050) predicted cardiac events, adjusted for fasting plasma glucose, mean blood pressure, body mass index, peripheral vascular disease and diabetic nephropathy. CONCLUSION: The WHO cardiovascular questionnaire, a simple tool for the diagnosis of coronary artery disease, is a significant predictor of cardiac events in type 2 diabetic patients.
Subject(s)
Diabetes Mellitus, Type 2/complications , Diabetic Angiopathies/diagnosis , Myocardial Ischemia/diagnosis , Surveys and Questionnaires , Cohort Studies , Diabetic Angiopathies/diagnostic imaging , Electrocardiography , Female , Humans , Male , Middle Aged , Myocardial Ischemia/diagnostic imaging , Predictive Value of Tests , Prospective Studies , Radionuclide Imaging , Risk FactorsABSTRACT
OBJETIVO: Analisar os testes usados na prática clínica de rotina para diagnóstico de isquemia miocárdica na predição do desenvolvimento de eventos cardíacos em pacientes com diabetes mellitus tipo 2 (DM2). MÉTODOS: A ocorrência de eventos cardíacos (novo infarto do miocárdio [IM], procedimentos de re-vascularização miocárdica, insuficiência cardíaca congestiva, edema agudo de pulmão, morte súbita e morte após IM ou edema pulmonar) foi avaliada prospectivamente em uma coorte de 135 pacientes com DM2 após até 7 anos de acompanhamento. Na condição basal, a doença arterial coronariana (DAC) foi avaliada pelo questionário cardiovascular da OMS, eletrocardiograma de repouso e cintilografia do miocárdio sob stress. RESULTADOS: 48 eventos cardíacos foram observados em 41 pacientes (10,5 eventos/100 pacientes-ano). No modelo de risco proporcional de Cox apenas a presença de sintomas de DAC no questionário cardiovascular da OMS isoladamente (RR= 2,13, 95% CI 1,114,07, P= 0,022) ou em combinação com anormalidades no ECG de repouso (RR= 2,03, 95% CI 1,053,92, P= 0,034) ou cintilografia do miocárdio (RR= 1,89, 95% CI 1,0013,57, P= 0,050) predisseram eventos cardíacos, ajustados para a glicemia de jejum, pressão arterial média, índice de massa corporal, doença vascular periférica e nefropatia diabética. CONCLUSÃO: O questionário cardiovascular da OMS, um procedimento simples para o diagnóstico da DAC, é um preditor significativo de eventos cardíacos em pacientes com DM2.
Subject(s)
Humans , Male , Female , Middle Aged , /congenital , Myocardial Ischemia/diagnosis , Surveys and Questionnaires , Cohort Studies , Electrocardiography , Myocardial Ischemia , Predictive Value of Tests , Prospective Studies , Risk FactorsABSTRACT
As endotelinas säo peptídeos de 21 aminoácidos produzidas em vários tipos de tecidos, reconhecidas como vasoconstritores endógenos potentes. Há quatro tipos de endotelinas: ET-1, 2, 3 e 4). A Endotelina 1 (ET-1) é o único membro da familia produzida tanto nas células endoteliais como nas células musculares lisas dos vasos. A ET-1 causa vasoconstriçäo de quase todas artérias e veias, além de produzir proliferaçÝo das células musculares lisas dos vasos e modular a produçäo hormonal. A produçäo da endotelina é regulada por vários estímulos mecânicos e químicos como hipóxia, lesäo da parede vascular, trombina, angiotensina II e insulina. Os antagonistas de seus receptores sugerem que esses peptídeos desempenham importantes papéis no desenvolvimento de várias patologias tais como a hipertensäo sistêmica, aterosclerose e insuficiência cardiaca congestiva
