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OBJECTIVE--Diabetes is associated with increased brachial and central blood pressure and aortic stiffness. We examined the effect of intensive multi factorial treatment in general practice on indices of peripheral and [...]

OBJECTIVE--Coronary artery disease (CAD) is the major cause of morbidity and mortality in type 2 diabetic patients. Severe vitamin D deficiency has been shown to predict cardiovascular mortality in type [...]

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The evidence on the effects of metformin and insulin in type 2 diabetes patients on quality of life, patient satisfaction, and cardiovascular outcomes is unclear.

Despite aggressive treatment of cardiovascular disease (CVD) risk factors individuals with type 2 diabetes (T2D) still have increased risk of cardiovascular morbidity and mortality. The primary aim of this study was to examine the cross-sectional association between total (25-hydroxy vitamin D (25(OH)D)) and risk of CVD in patients with T2D. Secondary objective was to examine the association between 25(OH)D and bone health. A Danish cohort of patients with T2D participating in a randomised clinical trial were analysed. In total 415 patients (68% men, age 60±9 years (mean±s.d.), duration of diabetes 12±6 years), including 294 patients (71%) treated with insulin. Carotid intima–media thickness (IMT) and arterial stiffness (carotid artery distensibility coefficient (DC) and Young's elastic modulus (YEM)) were measured by ultrasound scan as indicators of CVD. Bone health was assessed by bone mineral density and trabecular bone score measured by dual energy X-ray absorptiometry. In this cohort, 214 patients (52%) were vitamin D deficient (25(OH)D <50 nmol/l). Carotid IMT was 0.793±0.137 mm, DC was 0.0030±0.001 mmHg, YEM was 2354±1038 mmHg and 13 (3%) of the patients were diagnosed with osteoporosis. A 25(OH)D level was not associated with carotid IMT or arterial stiffness (P>0.3) or bone health (P>0.6) after adjustment for CVD risk factors. In conclusion, 25(OH)D status was not associated with carotid IMT, arterial stiffness or bone health in this cohort of patients with T2D. To explore these associations and the association with other biomarkers further, multicentre studies with large numbers of patients are required.

The mechanisms underlying the increased cardiovascular risk in patients with HIV on antiretroviral therapy (ART) are not known. Our aim was to study the endothelial function of the coronary arteries by cardiac perfusion positron emission tomography (PET) in patients with HIV initiating ART. In addition, flow-mediated dilation (FMD) of the brachial artery was measured.

The purpose of the study was to investigate a possible change in compliance of middle-sized conduit arteries in patients with hypertension accompanied by left ventricular hypertrophy (LVH). Included were 48 patients, 21 females and 27 males, age 67 years(55-78) with ECG-determined LVH. They were examined after 14 days on placebo treatment and again after 1 year on randomized treatment of either losartan or atenolol in equipotent dosages of 50-100 mg. Arterial compliance was measured on the upper arm using a volume-oscillometric method (Artcomp®, Critikon®). In result, BP was 160 ± 20/87± 12 mmHg at baseline and 154± 19/81± 11 mmHg after 1 year of treatment. Isobaric arterial compliance at any transmural pressure decreased after 1 year (p<0,05)) but was still elevated compared to normals (p<0.01), matched regarding age and gender. Arterial compliance at mean arterial pressure (MAP) remained unchanged from 2.7 ± 1.1 µl/mmHg/12 cm at baseline to 2.6 ± 1.0 µl/mmHg/12 cm after 1 year of treatment and equal to normals of 2.3 ± 1.0 µl/mmHg/12 cm (ns). In conclusion, isobaric compliance of peripheral conduit arteries is increased in hypertension accompanied by LVH and decreases towards normals after 1 years treatment of atenolol or losartan. This indicates adaptive structural or functional changes in the vessel walls as peripheral arterial compliance at MAP remains unchanged and equal to normals. (See Figure)

The aim of the study was to evaluate compliance of middle-sized conduit arteries in patients with isolated systolic hypertension (ISH) and high prevalence of left ventricular hypertrophy (LVH). Included were 58 patients, 24F and 34M, age 69 years (55-80) with ECG-determined LVH and they were examined after 14 days on placebo treatment. Arterial compliance was measured on the upper arm using a volume-oscillometric method (Artcomp®, Critikon® ). In results overall BP was 163 ± 22/89 ± 14 mmHg. ISH defined as SBP > 149 mmHg and DBP < 90 mmHg was found in 14 patients (7 males/7 females) with BP 161 ± 12/79 ± 10 mmHg. Arterial compliance at isobaric pressures was the same in the two groups (ns) and increased compared to normals at any transmuralpressure (p<0.01). Arterial compliance at mean arterial BP (MAP) was 3.2 ± 1.4 µl/mmHg/12 cm in the ISH and 2.6 ± 1.0 µl/mmHg/12 cm in the non-ISH patients (p=0.05). Arterial compliance at MAP was increased compared to normals (2.3 ± 1.0 µl/mmHg/12 cm) in ISH only (p<0.05). A positive correlation was seen between pulse pressure (PP) and arterial compliance at MAP (r=0.53, p<0.001) for the 58 patients. Results are controlled for age, gender, BMI and HR. In conclusion peripheral compliance of middle-sized conduit arteries at MAP is normal in non-ISH hypertension in contrast to earlier belief, but in agreement with findings of other groups. But in ISH, peripheral compliance at MAP is increased compared to normals and in all patients, compliance at MAP correlates positively to PP. This could be interpreted as a peripheral adaptation to a decreased central compliance and an increased PP. The underlying mechanisms might be increased stretch of the elastic fibers in the vessel wall or perhaps more likely decreased muscle tone and could be more pronounced when accompanied by LVH.

The aim of the study was to test if an automated blood pressure measuring device could be used as a simple screening test for peripheral vascular disease. Blood pressure at the ankle level is a good predictor of vascular disease in the lower limbs. The ankle/arm index (AAI), i.e. the ratio between the ankle systolic blood pressure and arm (brachial) systolic blood pressure, is an useful non-invasive screening tool for the early detection of atherosclerosis. Ankle blood pressure is normally measured by techniques that involve specially designed and expensive equipment, often unavailable to the general practitioner, whereas the available ordinary blood pressure measuring equipment is considered unreliable for quantification of ankle blood pressure. The study included 46 consecutive patients (22 women, 24 men) with a mean age of 73 years (sd:11 years). The patients were suspected of having intermittent claudication. Blood pressure was measured on the upper arm and at the ankle level using an automated oscillometric measuring unit (Omron HEM-705CP). Immediately following this, blood pressure was measured at the ankle level using a standard plethysmographic technique. In normal individuals, blood pressure at the ankle is usually slightly higher than on the upper arm resulting in an AAI =1.0. Using the standard method, we found systolic blood pressure levels between 82 and 220 mmHg on the upper arm and between 55 and 230 mmHg at the ankle. One of 92 ankle pressures could not be measured with any technique due to a skin lesion at the ankle. In all cases with AAI=1.0, the oscillometric method gave result that were closely correlated to those obtained by the standard plethysmographic method. Measurements with the oscillometric device failed in 30% of the cases with AAI<1.0 covering a broad spectrum of absolute pressure levels. It is concluded that an oscillatory measuring device is able to record blood pressure at the ankle level in normal subjects with a sufficient accuracy. It is also concluded that if the device fails in measuring the blood pressure or shows a reduced AAI then it is highly probable that the subject is suffering from peripheral vascular disease. It is finally concluded that an inexpensive blood pressure device can be used for the initial screening for peripheral vascular disease due to a high sensitivity. This greatly increases the possibility for early detection of vascular disease in general practice.

This study shows the association between smoking and both office and ambulatory blood pressure. By means of stratification, a uniform number of subjects of both sexes and spanning 6 decades (aged 20 to 79 years) were recruited randomly from the local community register. A total of 352 subjects participated, including 161 smokers. Smokers (both sexes and all age groups summed), as compared with nonsmokers had statistically significant lower office blood pressure as follows (mean systolic ± SED/mean diastolic ± SED): (systolic and diastolic, -6.8 ± 2.1/-3.9 ± 1.3); day ambulatory blood pressure (diastolic, /-2.8 ± 1.0); and night ambulatory blood pressure (systolic and diastolic, -4.2 ± 1.8/-3.9 ± 1.1). The intraperson variability of the day ambulatory blood pressure (as measured every 15 min) was identical for the smokers and the nonsmokers. Smokers were found to have a diminished “white coat” effect; this diminished white coat effect has not previously been described. The major white coat effect was seen in the older nonsmokers, whereas the diminished white coat effect was most pronounced in the older male smokers and in the younger female smokers. Smokers seem to have a diminished white coat effect, as well as a lower ambulatory blood pressure throughout the day (diastolic) and at night (systolic and diastolic). The similar intraperson variability found in the smokers’ and nonsmokers’ blood pressure further speaks for a consistently lower blood pressure in smokers as compared with nonsmokers. Am J Hypertens 1997; 10:483–491; © 1997 by the American Journal of Hypertension, Ltd.