Effect of fosinopril sodium on early carotid atherosclerosis in diabetic patients with hypertension.

An increased thickness of the carotid artery wall is thought to be a sign of early atherosclerosis. We have investigated the effects of fosinopril sodium in asymptomatic diabetic hypertensive subjects on the 12-month progression of arterial wall thickness. Forty non-insulin-dependent diabetics with hypertension and without hyperlipidemia were studied. After a 4-week run-in-diet phase, oral fosinopril sodium was administered (20 mg once daily) to 20 patients randomly selected, while 20 subjects were treated only with diet. The two groups were matched for age, sex, body mass index (BMI), duration of diabetes and glycemic control. Arterial wall thickness was measured as the mean of the maximum intimal-media thickness (IMT) in 16 carotid segments by B-mode ultrasound. The IMT increase over 12 months was 4.3% in the fosinopril sodium group vs 15.1% in subjects with diet. We conclude that fosinopril sodium treatment may be useful in decreasing the progression rate.

Effect of gemfibrozil on early carotid atherosclerosis in diabetic patients with hyperlipidaemia.

BACKGROUND: An increased thickness of the carotid artery wall is thought to be a sign of early atherosclerosis. We have investigated the effects of gemfibrozil in asymptomatic diabetic hyperlipidaemic subjects on the 12-month progression of arterial wall thickness. METHODS: Forty non-insulin-dependent diabetics with hyperlipidaemia and without hypertension were studied. After a 4-week run-in-diet phase, oral gemfibrozil was administered (900 mg once daily) in 20 patients randomly selected, while 20 subjects were treated only with diet. The two groups were matched for age, sex, body mass index (BMI), duration of diabetes and glycaemic control. Arterial wall thickness was measured as the mean of the maximum intima of media thickness (IMT) in 16 carotid segments by B-mode ultrasound. RESULTS: Baseline size of IMT and lipid values were similar in both groups. The IMT increase over 12 months was 5% in the gemfibrozil group vs 15.2% in subjects treated by diet alone. CONCLUSIONS: We conclude that gemfibrozil treatment may be useful in decreasing the progression rate of arterial wall thickness.

Ambulatory blood pressure measurement in type-II diabetic patients with autonomic neuropathy.

The aim of our study was to access the 24-hr ambulatory blood pressure (BP) in diabetic patients with autonomic neuropathy (AN). Twenty-two NIDDM patients without hypertension, being treated with sulfonylureas, were studied. The 24-hr ambulatory blood pressure recordings were performed using portable non-invasive automatic system. Autonomic neuropathy was assessed by standard cardiovascular reflex tests. There were ten patients with and 12 without AN, matched for age, body mass index, duration of diabetes and glycemic control. Mean BP increased at night in four of the subjects with AN and decreased in the remaining 18 patients. The group of subjects with nocturnal increases in BP had more severe autonomic nerve dysfunction compared with those with decreases in nocturnal BP. No significant difference between clinical and ambulatory day-time measurements was found. In three patients with AN after 5 weeks intensified therapy. 24-hr BP did not show any significant difference.

Diabetic retinopathy and urinary albumin excretion rate in type II (non-insulin-dependent) diabetic patients.

The aim of this study was to access the associations between urinary albumin excretion rate (AER) and diabetic retinopathy and its major risk factors in 105 type II non-insulin-dependent diabetic (NIDDM) patients. In 44.7% of the patients, there were no signs of retinopathy (NR), whereas 30.4% had background (BR) and 24.7% proliferative retinopathy (PR). Patients with retinopathy, both BR and PR, were older and the duration of diabetes was longer, than in the group consisting of patients with NR. Patients with retinopathy had elevated AER (BR: 9.4 +/- 2.8 micrograms/min, PR: 19.3 +/- 1.7 micrograms/min; vs. NR: 4.3 +/- 2.1 micrograms/min, p < 0.001). Patients with retinopathy had a higher systolic blood pressure and the metabolic control was worse than those without retifiopathy. In the diabetic group as a whole, raised AER was correlated with the duration of diabetes (rs = 0.287, p < 0.01) and systolic blood pressure (rs = 0.269; p < 0.01).