Ja Ker

Hypertension and Diabetes: bad companions

Diabetics are more likely to suffer from hypertension than non-diabetics. Factors that may contribute to the increased prevalence of hypertension in diabetics include: (i) Obesity(ii) Insulin resistance(iii) Renal disease (i. e. diabetic nephropathy). More than two thirds of diabetic patients have hypertension with a resultant sevenfold increase in mortality. Hypertensive diabetics with nephropathy have a 37-fold increase in mortality! The major problem in diabetes, especially type 2 diabetes, is an increase in cardiovascular disease. Hypertension is also an important contributor to cardiovascular disease in diabetics.

The correlation between the health-related fitness of healthy participants measured at home as opposed to fitness measured by sport scientists in a laboratory

Background: Fitness is defined in the health context as a state of good health or physical condition, primarily as a result of exercise and proper nutrition. Conventional methods of measuring fitness are expensive, time consuming and require specialised methods. There is a need for noninvasive, fast methods of assessing health-related fitness and activity in athlete and non-athlete populations. The aim of this study was to establish any correlation between participants’ self-assessed health-related fitness (HRF) index and the HRF index determined by sports scientists, as well as the laboratory-assessed HRF index and maximum oxygen uptake (VO2max) determined by sports scientists via direct methods in a laboratory, and finally, to determine any potential correlation between an activity-recall questionnaire (Kasari) and VO2max. Method: The participants consisted of 169 male and female volunteers between the ages of 18 and 55 years, taking neither supplements nor medication. The University of Pretoria’s HRF index protocol was first carried out by participants on their own at home, and then in the laboratory under the supervision of sport scientists. The complete datasets of 150 participants were statistically analysed to establish correlations. Results: The results indicated highly significant and substantial correlations (ρ = 0.696, p < 0.001) between the participants’ self-assessed HRF index and measurements by the sports scientists. There were moderate correlations between the laboratory-assessed HRF index and the direct VO2max (ρ = 0.512, p < 0.005), as well as the indirect VO2max (ρ = 0.588; p < 0.001). A significant correlation was found between the self-assessed HRF index and the indirect VO2max (ρ = 0.454; p < 0.001). The Kasari questionnaire correlated only weakly with the indirect VO2max (ρ = 0.278, p < 0.002) and not at all with the direct VO2max (ρ = 0.072, p < 0.731). Conclusion: Indications are that this test protocol may be conducted at home by individuals, without supervision, to determine exercise ability or fitness, or to monitor changes in physical fitness, thereby limiting expenses and costs.

Hypertension and the eye.

This feature in SA Family Practice emphasises the importance of ophthalmoscopy in general practice. Identifying target organ damage in a hypertensive patient is of cardinal importance. It immediately warrants anti-hypertensive therapy in those with even Stage I (mild) hypertension. A clinical workshop and clinical atlas will further enable the general practitioner to master the technique and diagnosis.

Hypertension and the kidney

INTRODUCTION The reduction in myocardial infarctions and strokes seen with antihypertensive therapy is not matched by a decline in renal failure. In fact, there seems to be a steady increase in end-stage renal failure, more so in black patients. Available evidence strongly suggests that in patients with hypertension, even minor abnormalities of renal function, predicts a worse cardiovascular outcome. Mild to moderate renal insufficiency in patients with essential hypertension is due to an expression of renal microvasculopathy (pre-glomerular arteriolar arteriosclerosis and tubulo-interstitial changes). The microangiopathy may be triggered by: (a) sympathetic overactivity; (b) over stimulated renin-angiotensin system; or (c) any other factor that causes renal vasoconstriction.

The use of NT-proBNP in clinical practice

Abstract Early detection of heart failure and the accurate diagnosis of heart failure remains a huge clinical challenge to family practitioners. ECGs and chest x-rays merely serve as baseline investigations and the diagnosis is eventually only confirmed by a two-dimensional echocardiogram coupled with Doppler-flow studies. Another biomarker of left ventricular dysfunction that could be added to the armamentarium of the generalist is the blood test proBNP, the precursor of brain natriuretic peptide (BNP). Studies have shown that, already in early phases of left-ventricular systolic dysfunction (asymptomatic left ventricular systolic dysfunction and diastolic dysfunction), BNP proved to be a good marker of both development of heart failure and prognosis. This article gives the generalist an approach to using proBNP in general practice for early detection of left ventricular dysfunction, exclusion of heart failure and prudent referral to the cardiologist.