Treatment of hypertension with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and resting metabolic rate: A cross-sectional study.

Hypertension in obese and overweight patients is associated with an elevated resting metabolic rate (RMR). The aim of this study was to determine whether RMR is reduced in hypertensive patients treated with angiotensin-converting enzyme inhibitors (ACEI) and blockers (ARB). The RMR was determined by indirect calorimetry in 174 volunteers; 93 (46.5 %) were hypertensive, of which 16 men and 13 women were treated with ACEI/ARB, while 30 men and 19 women with untreated hypertension served as a control group. Treated and untreated hypertensives had similar age, BMI, physical activity, and cardiorespiratory fitness. The RMR normalized to the lean body mass (LBM) was 15% higher in the untreated than ACEI/ARB-treated hypertensive women (p = .003). After accounting for LBM, whole-body fat mass, age, the double product (heart rate x systolic blood pressure), and the distance walked per day, the RMR was 2.9% lower in the patients taking ACEI/ARB (p = .26, treatment x sex interaction p = .005). LBM, age, and the double product explained 78% of the variability in RMR (R2  = 0.78, p < .001). In contrast, fat mass, the distance walked per day, and total T4 or TSH did not add predictive power to the model. Compared to men, a greater RMR per kg of LBM was observed in untreated hypertensive overweight and obese women, while this sex difference was not observed in patients treated with ACEI or ARBs. In conclusion, our results indicate that elevated RMR per kg of LBM may be normalized by antagonizing the renin-angiotensin system.

Resting metabolic rate is increased in hypertensive patients with overweight or obesity: Potential mechanisms.

The purpose of this investigation was to determine whether differences in body composition, pharmacological treatment, and physical activity explain the increased resting metabolic rate (RMR) and impaired insulin sensitivity in hypertension. Resting blood pressure, RMR (indirect calorimetry), body composition (dual-energy X-ray absorptiometry), physical activity (accelerometry), maximal oxygen uptake (VO2 max) (ergospirometry), and insulin sensitivity (Matsuda index) were measured in 174 patients (88 men and 86 women; 20-68 years) with overweight or obesity. Hypertension (HTA) was present in 51 men (58%) and 42 women (49%) (p = .29). RMR was 6.9% higher in hypertensives than normotensives (1777 ± 386 and 1663 ± 383 kcal d-1 , p = .044). The double product (systolic blood pressure × heart rate) was 18% higher in hypertensive than normotensive patients (p < .001). The observed differences in absolute RMR were non-significant after adjusting for total lean mass and total fat mass (estimated means: 1702 kcal d-1 , CI: 1656-1750; and 1660 kcal d-1 , CI: 1611-1710 kcal d-1 , for the hypertensive and normotensive groups, respectively, p = .19, HTA × sex interaction p = .37). Lean mass, the double product, and age were the variables with the higher predictive value of RMR in hypertensive patients. Insulin sensitivity was lower in hypertensive than in normotensive patients, but these differences disappeared after accounting for physical activity and VO2max . In summary, hypertension is associated with increased RMR and reduced insulin sensitivity. The increased RMR is explained by an elevated myocardial oxygen consumption due to an increased resting double product, combined with differences in body composition between hypertensive and normotensive subjects.

Ultrasonographic Size of the Thenar Muscles of the Nondominant Hand Correlates with Total Body Lean Mass in Healthy Subjects.

RATIONALE AND OBJECTIVES: Sarcopenia is associated with adverse outcomes in clinical situations such as elderly population, in-hospital setting and oncologic patients. However, no direct measurement of muscular mass is routinely available for clinicians. The aim of this study was to assess the correlation between thenar musculature of the nondominant hand evaluated by ultrasound and body fat-free mass. MATERIALS AND METHODS: In this one-center, cross-sectional, observational study, the width and depth of thenar muscles of both hands was assessed by ultrasonography. Nondominant hand musculature was taken as reference as a better estimator of total body muscular mass. These data were compared to body composition by bioimpedance analysis and dual-energy X-ray absorptiometry (DXA), hand grip strength, arm muscular area and physical activity (with International Physical Activity Questionnaire ). Statistical correlation was determined for each parameter. RESULTS: We obtained ultrasonographic measurements, International Physical Activity Questionnaire and hand grip strength from 83 subjects, whereas bioimpedance was performed in 64 subjects and DXA in 29 subjects. The strongest correlations were found between longitudinal thenar depth vs fat-free mass index (fat-free mass in DXA [kg]/height2 [m]) (r = 0.63, p < 0.001, 95%CI 0.34-0.81), longitudinal depth and hand dynamometry (r = 0.72, p < 0.001, 95%CI 0.59-0.81), longitudinal depth and DXA fat-free total mass (r = 0.76, p < 0.001, 95%CI 0.54-0.88), transversal thenar depth vs fat-free mass index (r = 0.67, p < 0.001, 95%CI 0.41-0.83), transversal width and DXA fat-free total mass (r = 0.62, p < 0.001, 95%CI 0.33-0.8), transversal depth and DXA nonfat total mass (r = 0.81, p < 0.001, 95%CI 0.63-0.91). CONCLUSION: Ultrasonographic examination of the nondominant thenar musculature is a fast and simple way of assessing total body fat-free mass, showing a good correlation with body composition measured by bioimpedance analysis and DXA, hand grip strength and arm muscular area.

Resting Energy Expenditure and Body Composition in Overweight Men and Women Living in a Temperate Climate.

This study aimed to determine whether the measured resting energy expenditure (REE) in overweight and obese patients living in a temperate climate is lower than the predicted REE; and to ascertain which equation should be used in patients living in a temperate climate. REE (indirect calorimetry) and body composition (DXA) were measured in 174 patients (88 men and 86 women; 20-68 years old) with overweight or obesity (BMI 27-45 kg m-2). All volunteers were residents in Gran Canaria (monthly temperatures: 18-24 °C). REE was lower than predicted by most equations in our population. Age and BMI were similar in both sexes. In the whole population, the equations of Mifflin, Henry and Rees, Livingston and Owen, had similar levels of accuracy (non-significant bias of 0.7%, 1.1%, 0.6%, and -2.2%, respectively). The best equation to predict resting energy expenditure in overweight and moderately obese men and women living in a temperate climate all year round is the Mifflin equation. In men, the equations by Henry and Rees, Livingston, and by Owen had predictive accuracies comparable to that of Mifflin. The body composition-based equation of Johnston was slightly more accurate than Mifflin's in men. In women, none of the body composition-based equations outperformed Mifflin's.

Seguridad y tolerabilidad de los antidiabéticos orales en el tratamiento de la diabetes mellitus tipo 2 / Safety and tolerability of oral antidiabetes drugs in the treatment of type 2 diabetes mellitus

El tratamiento de la diabetes mellitus tipo 2 requiere de un control global de los múltiples factores de riesgo que suelen asociarse en estos pacientes. Entre ellos, la disminución de la tasa de hipoglucemias y el tratamiento de la obesidad, especialmente de predominio central, son muy importantes. Por este motivo, dentro de los variados enfoques fisiopatológicos para mejorar el control glucémico que no incluyen la insulina, los fármacos que no producen aumento en la tasa de hipoglucemias ni aumento de peso tienen un atractivo añadido. Así, los nuevos antidiabéticos orales basados en potenciar el efecto incretínico destacan por ser capaces de producir pérdidas moderadas de masa corporal. Además, la seguridad es un factor que hay que tener en cuenta en pacientes que estarán expuestos a estos fármacos durante décadas no sólo por evitar efectos adversos graves, lo cual es fundamental, sino también para tratar de garantizar el cumplimiento terapéutico a largo plazo (AU)

The treatment of type 2 diabetes mellitus requires overall control of the multiple risk factors usually found in these patients. Amongst these, avoidance of hypoglycemia and treatment of obesity, especially central obesity, is of utmost importance. Consequently, among the various physiopathological approaches to improve glycemic control that do not include insulin, drugs that are not associated with increased risk of hypoglycaemia or increase weight are of special interest. Hence, the new incretin-based oral antidiabetes drugs are of great relevance, given their weight neutrality and very low risk of hypoglycaemia. Safety is clearly a factor to be considered in patients who will be exposed to these drugs for decades, not only to avoid severe adverse effects –which is essential– but also to guarantee long-term compliance (AU)

[Safety and tolerability of oral antidiabetes drugs in the treatment of type 2 diabetes mellitus]. / Seguridad y tolerabilidad de los antidiabéticos orales en el tratamiento de la diabetes mellitus tipo 2.

The treatment of type 2 diabetes mellitus requires overall control of the multiple risk factors usually found in these patients. Amongst these, avoidance of hypoglycemia and treatment of obesity, especially central obesity, is of utmost importance. Consequently, among the various physiopathological approaches to improve glycemic control that do not include insulin, drugs that are not associated with increased risk of hypoglycaemia or increase weight are of special interest. Hence, the new incretin-based oral antidiabetes drugs are of great relevance, given their weight neutrality and very low risk of hypoglycaemia. Safety is clearly a factor to be considered in patients who will be exposed to these drugs for decades, not only to avoid severe adverse effects--which is essential--but also to guarantee long-term compliance.