Eliza Dalsasso Ricardo

Blood pressure means rather than nocturnal dipping pattern are related to complications in Type 2 diabetic patients

Aim  To determine whether systolic and diastolic blood pressure (BP) means, during ambulatory BP monitoring (ABPM), are more strongly correlated with microvascular complications and echocardiographic structural alterations than night‐time/daytime (N/D) BP ratio.

Which patients with diabetes should undergo ambulatory blood pressure monitoring

Objective To estimate the daytime ambulatory blood pressure monitoring (ABPM) value corresponding to the target office blood pressure (BP; 130/80 mmHg) for diabetic patients and to identify which patients with diabetes may benefit from ABPM. Methods A cross-sectional study was conducted with type 1 and type 2 diabetic patients. ABPM (Spacelabs90207) and office BP were measured. Target ABPM was estimated by linear regression equation using daytime ABPM and office BP. Office BP values corresponding to ABPM hypertension were determined by receiver operating characteristic curves. Results A total of 554 patients (type 1: n = 200, 36 ± 11 years, diabetes duration 17 ± 9 years; type 2: n = 354; 57 ± 9 years, diabetes duration 10 ± 7 years) were evaluated. Regression equations for SBP and DBP were ABPM = 64.3 + (0.50 office BP) and ABPM = 45.4 + (0.42 office BP), respectively. Daytime ABPM corresponding to the target office BP was 129.3/79 mmHg. Office BP less than 120 for systolic and less than 70 mmHg for diastolic had 90% sensitivity to rule out hypertension diagnosed by ABPM; office BP at least 145 for systolic or at least 90 mmHg for diastolic had 90% specificity to confirm ABPM hypertension. Within these values, 38% of patients were misclassified if only office values were considered. Conclusion In type 1 and type 2 diabetes, the recommended upper limit of daytime ABPM is 130/80 mmHg. Patients with office BP at least 120 for systolic or at least 70 for diastolic and less than 145 for systolic and less than 90 mmHg for diastolic should undergo ABPM to correctly determine their BP status.

Controle inadequado da pressão arterial em pacientes com diabete melito tipo 2

BACKGROUND There is evidence indicating that blood pressure control is more effective in reducing macrovascular complications of diabetes mellitus (DM) than glycemic control. However, the reduction in BP to levels recommended by international guidelines is difficult in clinical practice. OBJECTIVE To assess the percentage of patients with both type 2 diabetes and hypertension (HBP) assisted in a tertiary hospital with adequate blood pressure control and to determine the clinical and laboratory factors related. METHODS Cross-sectional study with 348 patients with type 2 diabetes and hypertension assisted in the outpatient clinic of Endocrinology, Hospital de Clínicas de Porto Alegre. Patients underwent history assessment, physical examination, with measurement of blood pressure (BP), and samples were collected from blood and urine for laboratory analysis. Patients were divided into 3 three groups: optimal (< 130/80 mmHg), regular (130-139/80-89 mmHg) or inadequate blood pressure control (> or = 140/90 mmHg). RESULTS The mean age was 61.2 +/- 10.1 years (46% men, 80% white) and DM duration, 14.8 +/- 9.5 years. Eighteen per cent of the patients studied, 17% of patients had optimal BP value, 22% regular BP value and 61% inadequate BP value. Patients with inadequate BP control had longer diabetes duration, waist circumference and fasting glucose. The other variables were similar in 3 groups. CONCLUSION Most patients assessed had inadequate BP control. Higher BP values are associated with an adverse clinical profile, represented by longer diabetes duration, abdominal obesity, higher fasting glucose and chronic complications of diabetes.Resumen Fundamento: Hay evidencias indicando que el control de presion es mas efectivo en la reduccion de complicaciones macrovasculares de la diabetes melito (DM) que el control glucemico. Sin embargo, la reduccion de la PA para los niveles recomendados por las directrices es dificil en la practica clinica.Objetivo: Evaluar el porcentual de pacientes que presentaban simultaneamente DM tipo 2 y hipertension arterial sistemica (HAS), atendidos en hospital terciario, con control de presion adecuado, y determinar los factores clinicos y laboratoriales asociados.Metodos: Estudio transversal con 348 pacientes con DM tipo 2 y HAS atendidos en el ambulatorio de Endocrinologia del Hospital de Clinicas de Porto Alegre. Los pacientes fueron sometidos a anamnesis, examen fisico, con medicion de la presion arterial (PA), y se recolecto muestra de sangre y orina para analisis laboratorial. Los pacientes se dividieron en tres grupos: control de presion ideal (< 130/80 mmHg), regular (130-139/80-89 mmHg) o inadecuado (≥ 140/90 mmHg).Resultados: El promedio de edad fue de 61,2 ± 10,1 anos (el 46% hombre, 80% blanco) y la duracion del DM, 14,8 ± 9,5 anos. Del total de pacientes, el 17% expresaba valores ideales de PA, el 22% regular y el 61% inadecuados. Los pacientes con control inadecuado de la PA expresaban mayor duracion del DM, cintura abdominal y glucemia de ayuno. Las demas variables se asemejaron en los tres grupos.Conclusion: La mayoria de los pacientes evaluados presento control inadecuado de la PA. Valores mas elevados de PA estan asociados a un perfil clinico adverso, representado por mayor duracion del DM, obesidad abdominal, mayor glucemia de ayuno y complicaciones cronicas del DM. (Arq Bras Cardiol 2010;94(5):633-637)Palabras clave: Presion arterial, diabetes mellitus, obesidad, circunferencia abdominal, complicaciones de la diabetes.continua y para cada descenso de 10 mmHg en la PA sistolica se observa una reduccion promedia del 24% en el riesgo de cualquier complicacion relacionada al DM; del 32% en la mortalidad relacionada al DM; del 44% en los accidentes vasculares encefalicos y del 37% en las complicaciones microvasculares del DM

Inadequate blood pressure control in patients with type 2 diabetes mellitus

BACKGROUND There is evidence indicating that blood pressure control is more effective in reducing macrovascular complications of diabetes mellitus (DM) than glycemic control. However, the reduction in BP to levels recommended by international guidelines is difficult in clinical practice. OBJECTIVE To assess the percentage of patients with both type 2 diabetes and hypertension (HBP) assisted in a tertiary hospital with adequate blood pressure control and to determine the clinical and laboratory factors related. METHODS Cross-sectional study with 348 patients with type 2 diabetes and hypertension assisted in the outpatient clinic of Endocrinology, Hospital de Clínicas de Porto Alegre. Patients underwent history assessment, physical examination, with measurement of blood pressure (BP), and samples were collected from blood and urine for laboratory analysis. Patients were divided into 3 three groups: optimal (< 130/80 mmHg), regular (130-139/80-89 mmHg) or inadequate blood pressure control (> or = 140/90 mmHg). RESULTS The mean age was 61.2 +/- 10.1 years (46% men, 80% white) and DM duration, 14.8 +/- 9.5 years. Eighteen per cent of the patients studied, 17% of patients had optimal BP value, 22% regular BP value and 61% inadequate BP value. Patients with inadequate BP control had longer diabetes duration, waist circumference and fasting glucose. The other variables were similar in 3 groups. CONCLUSION Most patients assessed had inadequate BP control. Higher BP values are associated with an adverse clinical profile, represented by longer diabetes duration, abdominal obesity, higher fasting glucose and chronic complications of diabetes.Resumen Fundamento: Hay evidencias indicando que el control de presion es mas efectivo en la reduccion de complicaciones macrovasculares de la diabetes melito (DM) que el control glucemico. Sin embargo, la reduccion de la PA para los niveles recomendados por las directrices es dificil en la practica clinica.Objetivo: Evaluar el porcentual de pacientes que presentaban simultaneamente DM tipo 2 y hipertension arterial sistemica (HAS), atendidos en hospital terciario, con control de presion adecuado, y determinar los factores clinicos y laboratoriales asociados.Metodos: Estudio transversal con 348 pacientes con DM tipo 2 y HAS atendidos en el ambulatorio de Endocrinologia del Hospital de Clinicas de Porto Alegre. Los pacientes fueron sometidos a anamnesis, examen fisico, con medicion de la presion arterial (PA), y se recolecto muestra de sangre y orina para analisis laboratorial. Los pacientes se dividieron en tres grupos: control de presion ideal (< 130/80 mmHg), regular (130-139/80-89 mmHg) o inadecuado (≥ 140/90 mmHg).Resultados: El promedio de edad fue de 61,2 ± 10,1 anos (el 46% hombre, 80% blanco) y la duracion del DM, 14,8 ± 9,5 anos. Del total de pacientes, el 17% expresaba valores ideales de PA, el 22% regular y el 61% inadecuados. Los pacientes con control inadecuado de la PA expresaban mayor duracion del DM, cintura abdominal y glucemia de ayuno. Las demas variables se asemejaron en los tres grupos.Conclusion: La mayoria de los pacientes evaluados presento control inadecuado de la PA. Valores mas elevados de PA estan asociados a un perfil clinico adverso, representado por mayor duracion del DM, obesidad abdominal, mayor glucemia de ayuno y complicaciones cronicas del DM. (Arq Bras Cardiol 2010;94(5):633-637)Palabras clave: Presion arterial, diabetes mellitus, obesidad, circunferencia abdominal, complicaciones de la diabetes.continua y para cada descenso de 10 mmHg en la PA sistolica se observa una reduccion promedia del 24% en el riesgo de cualquier complicacion relacionada al DM; del 32% en la mortalidad relacionada al DM; del 44% en los accidentes vasculares encefalicos y del 37% en las complicaciones microvasculares del DM

Late afternoon blood pressure increase is associated with diabetic retinopathy in normotensive type 2 diabetes mellitus patients

AIMS To identify if the variability of blood pressure (BP) is associated with diabetic retinopathy (DR) in normotensive type 2 DM patients. METHODS Sixty-five normotensive type 2 DM patients that had 24-h ambulatory BP monitoring (ABPM) were grouped according any degree of DR. RESULTS Fourteen (21%) patients had DR. Office BP and 24-h BP parameters did not differ between groups. At late afternoon period, patients with DR had higher increment in both systolic (11.3+/-12.7mmHg vs. 1.0+/-11.4mmHg, P=0.006) and diastolic (6.7+/-8.6mmHg vs. -0.73+/-10.0mmHg, P=0.017) BP levels than those without. Multivariate logistic analyses were performed with DR as a dependent variable. Each 1mmHg increment in systolic BP at the late afternoon period was associated with a 10.2% increase in DR prevalence [OR 1.102 (CI 95% 1.011-1.202, P=0.027)], after adjustments for A1C test, DM duration, age, albuminuria and current smoking. CONCLUSIONS In conclusion, in normotensive type 2 DM patients, BP increase at late afternoon is associated to DR independently from confounder factors or other ABPM parameters.

Does bacteriuria interfere with albuminuria measurements of patients with diabetes

BACKGROUND Urinary albumin is the main parameter employed to diagnose diabetic nephropathy (DN). The exclusion of bacteriuria has been recommended at the time of DN diagnosis. This approach has been debated and information on this suggestion in patients with diabetes is scarce. The present case-control study was conducted to investigate the interference of bacteriuria in the interpretation of urinary albumin measurements in random urine samples of diabetic patients. METHODS Urinary albumin concentration (UAC) was measured in random urine samples twice in diabetic patients with and without bacteriuria (> or =10(5) colony-forming units/mL). Cases (n = 81) were defined as patients who had baseline UAC measurement in the presence of bacteriuria and had the second UAC measured in a sterile urine sample. Controls (n = 80) had the two UAC measured in sterile urine specimens. RESULTS Baseline UAC was not different between case [15.4 (1.5-2148) mg/L] and control groups [14.2 (1.5-1292) mg/L; P = 0.24], nor was the proportion of patients with normo-, micro- and macroalbuminuria. In cases, UAC measurements in the presence of bacteriuria and in sterile urine specimens were not different [15.4 (1.5-2148) versus 13.7 (1.5-2968) mg/L; P = 0.14)], nor was the proportion of normo- (51.9% versus 61.5%), micro- (40.7% versus 32.1%) and macroalbuminuria (7.4% versus 6.4%; P = 0.46). In the control group, UAC values were also not different in the two urine samples: [14.2 (1.5-1292) versus 9.7 (1.5-1049) mg/L, P = 0.22]. CONCLUSIONS The presence of bacteriuria does not interfere significantly with urinary albumin measurements and its exclusion is not necessary to diagnose DN.

Control inadecuado de la presión arterial en pacientes con diabetes melito tipo 2

BACKGROUND There is evidence indicating that blood pressure control is more effective in reducing macrovascular complications of diabetes mellitus (DM) than glycemic control. However, the reduction in BP to levels recommended by international guidelines is difficult in clinical practice. OBJECTIVE To assess the percentage of patients with both type 2 diabetes and hypertension (HBP) assisted in a tertiary hospital with adequate blood pressure control and to determine the clinical and laboratory factors related. METHODS Cross-sectional study with 348 patients with type 2 diabetes and hypertension assisted in the outpatient clinic of Endocrinology, Hospital de Clínicas de Porto Alegre. Patients underwent history assessment, physical examination, with measurement of blood pressure (BP), and samples were collected from blood and urine for laboratory analysis. Patients were divided into 3 three groups: optimal (< 130/80 mmHg), regular (130-139/80-89 mmHg) or inadequate blood pressure control (> or = 140/90 mmHg). RESULTS The mean age was 61.2 +/- 10.1 years (46% men, 80% white) and DM duration, 14.8 +/- 9.5 years. Eighteen per cent of the patients studied, 17% of patients had optimal BP value, 22% regular BP value and 61% inadequate BP value. Patients with inadequate BP control had longer diabetes duration, waist circumference and fasting glucose. The other variables were similar in 3 groups. CONCLUSION Most patients assessed had inadequate BP control. Higher BP values are associated with an adverse clinical profile, represented by longer diabetes duration, abdominal obesity, higher fasting glucose and chronic complications of diabetes.Resumen Fundamento: Hay evidencias indicando que el control de presion es mas efectivo en la reduccion de complicaciones macrovasculares de la diabetes melito (DM) que el control glucemico. Sin embargo, la reduccion de la PA para los niveles recomendados por las directrices es dificil en la practica clinica.Objetivo: Evaluar el porcentual de pacientes que presentaban simultaneamente DM tipo 2 y hipertension arterial sistemica (HAS), atendidos en hospital terciario, con control de presion adecuado, y determinar los factores clinicos y laboratoriales asociados.Metodos: Estudio transversal con 348 pacientes con DM tipo 2 y HAS atendidos en el ambulatorio de Endocrinologia del Hospital de Clinicas de Porto Alegre. Los pacientes fueron sometidos a anamnesis, examen fisico, con medicion de la presion arterial (PA), y se recolecto muestra de sangre y orina para analisis laboratorial. Los pacientes se dividieron en tres grupos: control de presion ideal (< 130/80 mmHg), regular (130-139/80-89 mmHg) o inadecuado (≥ 140/90 mmHg).Resultados: El promedio de edad fue de 61,2 ± 10,1 anos (el 46% hombre, 80% blanco) y la duracion del DM, 14,8 ± 9,5 anos. Del total de pacientes, el 17% expresaba valores ideales de PA, el 22% regular y el 61% inadecuados. Los pacientes con control inadecuado de la PA expresaban mayor duracion del DM, cintura abdominal y glucemia de ayuno. Las demas variables se asemejaron en los tres grupos.Conclusion: La mayoria de los pacientes evaluados presento control inadecuado de la PA. Valores mas elevados de PA estan asociados a un perfil clinico adverso, representado por mayor duracion del DM, obesidad abdominal, mayor glucemia de ayuno y complicaciones cronicas del DM. (Arq Bras Cardiol 2010;94(5):633-637)Palabras clave: Presion arterial, diabetes mellitus, obesidad, circunferencia abdominal, complicaciones de la diabetes.continua y para cada descenso de 10 mmHg en la PA sistolica se observa una reduccion promedia del 24% en el riesgo de cualquier complicacion relacionada al DM; del 32% en la mortalidad relacionada al DM; del 44% en los accidentes vasculares encefalicos y del 37% en las complicaciones microvasculares del DM