Association of Non-Dipping Blood Pressure Patterns with Diabetic Peripheral Neuropathy: A Cross-Sectional Study among a Population with Diabetes in Greece.

Diabetic peripheral neuropathy (DPN) is present in 20-50% of cases with diabetes. The pathophysiology of DPN is not yet clear regarding hypertension (HTN). The aim of this study was to assess the association between the stages of DPN and HTN in a Greek population with diabetes. We examined 102 adults for diabetic neuropathy (DPN) from November 2020 to December 2021, using the Toronto Clinical Neuropathy Scale System (TCNSS) to categorize them into two groups (no/mild DPN versus medium/severe DPN). Ambulatory blood pressure monitoring was performed to evaluate their hypertensive status. Univariate and multivariate logistic regression analyses were performed to assess the association between the stage of DPN and HTN. The multivariate analysis, considering sex, age, and dipping status, did not show statistically significant associations between stages of HTN and DPN. However, in contrast to dippers, non-dippers had an almost four-times higher risk of developing medium-to-severe DPN (odds ratio (OR) 3.93; 95% confidence interval (CI) [1.33-11.64]); females, in contrast to males, had a 65% lower risk of developing moderate/severe DPN (OR 0.35; 95%CI [0.14-0.92]). In conclusion, our findings showed no statistically significant associations between DPN and HTN; however, dipping status, hyperglycemia, and female sex were shown to play a role in the pathophysiology of DPN.

S100B Levels in Patients with Type 2 Diabetes Mellitus and Co-Occurring Depressive Symptoms.

Depression is a comorbid condition in patients with Type 2 Diabetes mellitus (T2DM). S100B, a glia derived protein, is linked to depression and has been suggested as a biomarker for depression outcomes in several populations. However, to date there is no data about S100B levels and depression in patients with T2DM. Objective. We hypothesized that S100B serum levels are increased in patients with T2DM and recently diagnosed, drug-free depressive symptoms, and could be used for the diagnosis of depression in T2DM. Methods. Overall 52 patients (62 ± 12 years, female 66, 7%) with no history of depression deriving from the Diabetes out-patient clinic of our University Hospital underwent a one-to-one interview with a psychiatrist and filled a self-assessment (Zung) questionnaire. Serum S00B levels were compared between 30 (63±12 years, female 66, 7%) diabetic patients without depressive symptoms vs 22 patients (62 ±12 years, female 68, 2%) with T2DM and depressive symptoms. Results. There was no difference in serum levels of S100B between patients with T2DM without depressive symptoms vs diabetic patients suffering from depressive symptoms (2.1 (1.9-10.9) pg/ml vs 2.4 (1.9-14.8) pg/ml, p=0. 637+). Moreover, linear regression analysis did not show any association between lnS100B levels and depressive symptoms (ß = 0.084, 95% CI 0.470-0.871, and p=0.552), Zung self-assessment score (ß = 0.048, 95% CI -0.024-0.033, and p=0.738), and other patients' characteristics. Conclusions. In patients with T2DM there is no correlation between S100B serum levels and newly detected mild depressive symptoms. The brain biochemistry pathways of depression in T2DM warrant further investigation in a larger scale population.

Cardiac Biomarkers Predict 1-Year Mortality in Elderly Patients Undergoing Hip Fracture Surgery.

This prospective study included 152 elderly patients (mean age, 80 years; range, 72-88 years) with a hip fracture treated surgically. Comorbidities were evaluated, and B-type natriuretic peptide was measured at baseline and at postoperative days 4 and 5 in addition to troponin I. Major cardiac events were recorded, and 1-year mortality was assessed. Comorbidity models with the important multivariate predictors of 1-year mortality were analyzed. Overall, 9 patients (6%) experienced major cardiac events postoperatively during their hospitalization. Three patients (2%) died postoperatively, at days 5, 7, and 10, from autopsy-confirmed myocardial infarction. Three patients (2%) experienced a nonfatal myocardial infarction, and 3 patients (2%) experienced acute heart failure. At 1-year follow-up, 37 patients (24%) had died. Age older than 80 years (P=.000), renal failure (P=.016), cardiovascular disease (P=.003), respiratory disease (P=.010), Parkinson disease (P=.024), and dementia (P=.000) were univariate predictors of 1-year mortality. However, in the multivariate model, only age older than 80 years (P=.000) and dementia (P=.024) were important predictors of 1-year mortality. In all comorbidity models, age older than 80 years and dementia were important predictors of 1-year mortality. Postoperative increase in B-type natriuretic peptide was the most important predictor of 1-year mortality. Receiver operating characteristic curve analysis showed a threshold of 90 ng/mL of preoperative B-type natriuretic peptide (area under the curve=0.773, 95% confidence interval, 0.691-0.855, P<.001) had 82% sensitivity and 62% specificity to predict 1-year mortality. Similarly, a threshold of 190 ng/mL of postoperative B-type natriuretic peptide (area under the curve=0.753, 95% confidence interval, 0.662-0.844, P<.001) had 70% sensitivity and 77% specificity to predict the study endpoint. [Orthopedics. 2017; 40(3):e417-e424.].

Plasma brain natriuretic peptide: a biochemical marker of effective blood pressure management?

OBJECTIVE: To investigate plasma brain natriuretic peptide (BNP) concentrations in association with blood pressure (BP) at baseline and after antihypertensive drug treatment. PATIENTS AND METHODS: We prospectively examined 186 individuals with newly diagnosed essential hypertension without target organ damage, whose mean age was 48.7 +/- 10.9 years. Treatment initiation began with irbesartan 150 mg/day and was doubled at 4 weeks in cases of inadequate BP control. If indicated, at 8-week-follow-up hydrochlorothiazide 12.5 mg alone or with amlodipine 5-10 mg was added. BNP levels were measured at baseline and after 3 months of antihypertensive treatment. RESULTS: At baseline plasma BNP levels were found to be related to systolic BP (r = 0.27, P < 0.001), independent of age, sex, smoking status, BMI and left ventricular mass index estimated by echocardiography (beta = 11.81, SE = 3.82, P = 0.002). Additionally, higher BNP concentrations were observed in patients with stage 2 hypertension compared with those with stage 1 (median 38.9 vs. 29.9 pg/ml, P = 0.022). Multivariate analysis showed a positive association between BNP and systolic BP variability (beta = 0.03, SE = 0.01, P = 0.034). At follow-up, 64.7% of the participants who had achieved BP control showed decreased BNP levels in contrast to those with poor BP control (median change -14.5 vs. -1.3 and median range from -34.4 to -4.4 vs. -9.6 to 10.9, respectively, P < 0.001). CONCLUSION: In this hypertensive population, increased BNP concentrations are associated with higher BP levels and systolic BP variability. The fall of BNP observed in those who achieved BP control indicates that BNP could be used as a biochemical marker of effective BP control and target organ protection.

Metabolic syndrome and incident cardiovascular morbidity and mortality in a Mediterranean hypertensive population.

BACKGROUND: Although the metabolic syndrome (MetS) is associated with adverse cardiovascular disease (CVD) risk in the general population, it is not clear whether its existence is independently associated with CVD in hypertensives. We investigated the presence of MetS in subjects with hypertension and its impact on the incidence of CVD. METHODS: We prospectively investigated 1007 hypertensive individuals. The MetS was assessed using the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. The incidence of fatal and nonfatal cardiovascular events was ascertained during a median follow-up period of 2.1 years. RESULTS: The prevalence of MetS was 42.1% (39.0% in men and 44.7% in women). In addition to hypertension, four MetS components were present in 3.6% of the individuals, three in 13.7%, two in 24.8%, and only one in 33.7%. The incidence of cardiac, cerebrovascular, and total cardiovascular events/1000 person-years was higher among MetS subjects than among those without (31.0% v 21.3%, P = .050, 25.5% v 13.7%, P = .045, and 55.4% v 35.8% P = .009, respectively). After adjustment, MetS subjects had higher risk for cardiac, cerebrovascular, and total cardiovascular events (by 72%, 90%, and 75%, respectively). Hypertensive subjects with three or more components of MetS had threefold higher risk for cardiac events, 2.59 for cerebrovascular, and 2.26 for total cardiovascular events compared with those with no other component. CONCLUSIONS: The MetS is a significant predictor of cardiovascular morbidity and mortality. The clustering of three or more components of the syndrome in addition to hypertension recognizes a population of even higher cardiovascular risk independently of other traditional risk factors.

Insulin resistance and blood pressure circadian variation in an obese hypertensive population.

Insulin resistance (IR) is related to arterial hypertension and target organ damage. Hypertensive individuals exhibiting a diminished nocturnal blood pressure (BP) reduction (non-dippers) have an increased incidence of cardiovascular events. The association, however, of IR with BP circadian variation has not been evaluated so far. Therefore, this study examined 226 (116 male and 110 female) overweight and obese subjects (BMI > 27kg/m2) with newly diagnosed essential hypertension who underwent clinical and laboratory evaluation, including an oral glucose tolerance test and ambulatory BP measurement (ABPM). IR was estimated using the homeostasis model assessment (HOMA-IR). The population was grouped according to HOMA-IR values > 2.75 (insulin resistance type) or < 2.75 (insulin sensitive type). Results. No significant differences were observed between dippers (n = 137) and non-dippers (n = 89) with respect to age, gender, BMI, serum cholesterol, triglycerides, LDL-C, and HDL-C levels, nor smoking habits. The proportion of IR subjects among dippers (59.1%) and non-dippers (56.7%) was similar (p = 0.833). Moreover, no significant association was found when the HOMA-IR was examined as a continuous component (p = 0.96). Conclusions. Insulin resistance is not associated with nocturnal blood pressure reduction in obese hypertensives. This may be explained by the notion that insulin secretion does not follow a circadian mode of variation.

Intermediate postchallenge hyperglycemia in overweight and obese subjects: a new marker of impaired glucose regulation?

The objective of this study was to compare subjects with intermediate postchallenge hyperglycemia (INPH) to those with normal glycemic status, impaired fasting glucose (IFG), and/or impaired glucose tolerance (IGT), as well as type 2 diabetes mellitus. Furthermore, the authors evaluated the impact of INPH on target organ damage. In total, 487 overweight and obese adults (BMI > or =27 kg/m(2)), 252 men and 235 women, mean age 52.9 +/-10.2 years, were studied. All participants underwent a clinical and laboratory evaluation, as well as an oral glucose tolerance test (OGTT). They were also investigated by echocardiography, carotid ultrasonography, and pulse wave analysis. Overall, 302 (62%) subjects had normal glycemic status, 64 (13.1%) had IFG and/or IGT, 95 (19.5%) had type 2 diabetes mellitus, and 26 (5.4%) had INPH. Individuals with INPH had an increased index of insulin resistance (higher homeostasis model assessment-insulinogenic index [HOMA-IR], p<0.0001), impaired insulin secretion (lower insulinogenic index, p<0.0001), and higher glycosylated hemoglobin (HbA(1c)) levels (p<0.0001) in comparison with the normoglycemic subjects, but not to those with IFG and/or IGT or diabetes (p = 0.6). No difference was observed concerning the risk factors studied, left ventricular mass and vascular remodeling, among subjects with INPH, IFG and/or IGT, and diabetes. However, individuals with INPH had a higher proportion of echolucent carotid artery plaques in comparison with the normoglycemic subjects (p = 0.04) and those with IFG and/or IGT (p = 0.01). Intermediate postchallenge hyperglycemia seems to represent a new category of glucose metabolism disturbances with increased atherogenic impact. Therefore, evaluating intermediate glucose levels in an OGTT could contribute to better identify overweight individuals at risk of developing diabetes mellitus and cardiovascular events.