Recommended blood pressure targets 

Recommended blood pressure targets 

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Type 2 diabetes mellitus (T2DM) is commonly accompanied by other cardiovascular disease (CVD) risk factors, such as hypertension, obesity, and dyslipidemia. Furthermore, CVD is the most common cause of death in people with T2DM. It is therefore of critical importance to minimize the risk of macrovascular complications by carefully managing modifiab...

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... On the other hand, the AACE algorithm maintains its recommen- dation of a target in the region of 130/80 mmHg. 26 Table 3 shows only major US and international guidelines issued in the last three years, as these were able to take into account the most recent investigations. Although there are discrep- ancies between the recommendations, what is clear is that patients with diabetes should be treated to a target blood pressure of at least ,140/80 mmHg, but the physician will need to consider the individual's overall health when setting any further targets. ...

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... In most individuals, pharmacological intervention will be required at some point due to the propagative nature of disease. Obesity and hypertension are common comorbidities, both of which lead to a high cardiac disease prevalence (Lorber 2014). ...
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Diabetes mellitus (DM) is a worldwide ailment which leads to chronic complications like cardiac disorders, renal perturbations, limb amputation and blindness. Type one diabetes (T1DM), Type two diabetes (T2DM), Another types of diabetes, such as genetic errors in function of β-cell and action of insulin, cystic fibrosis, chemical-instigated diabetes or following tissue transplantation), and pregnancy DM (GDM). In response to nutritional ingestion, the gut may release a pancreatic stimulant that affects carbohydrate metabolism. The duodenum produces a ‘chemical excitant’ that stimulates pancreatic output, and researchers have sought to cure diabetes using gut extract injections, coining the word ‘incretin’ to describe the phenomena. Incretins include GIP and GLP-1. The ‘enteroinsular axis’ is the link between pancreas and intestine. Nutrient, neuronal and hormonal impulses from intestine to cells secreting insulin were thought to be part of this axis. In addition, the hormonal component, incretin, must meet two requirements: (1) it secreted by foods, mainly carbohydrates, and (2) it must induce an insulinotropic effect which is glucose-dependent. In this review, we clarify the ability of using incretin-dependent treatments for treating DM.
... Diabetes increases the risk for cardiovascular and metabolic diseases thereby reducing the quality of life and increasing the risk for premature mortality [7]. The increasing prevalence of T2D is attributed by ever increasing prevalence of obesity, hypertension and physical inactivity. ...
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Background Type 2 diabetes is a serious public health concern in India, even the indigenous tribal populations are not left unaffected. The present study aims to understand the association of major risk factors i.e. obesity, hypertension, dyslipidemia, ACE I/D polymorphism with impaired fasting glucose (IFG) and type 2 diabetes (T2D) among two different Mendelian populations of North East India. Methods Demographic, somatometric, physiological variables along with fasting blood samples were collected from 609 individuals. The participants were screened for ACE I/D polymorphism. Results ACE I/D polymorphism was found to follow HWE among Liangmai tribe but not among Mizo tribe. Distribution of DD genotype/D allele was found to be significantly higher for T2D among Mizo tribe. Significant association were observed between DD genotype/D allele of ACE I/D polymorphism and TC as well as LDL with both IFG and T2D only in Mizo tribe. Conclusions The present study is an example of gene-environment interaction where DD genotype or D allele and dyslipidemia (high TC and high LDL) are posing risk for IFG and T2D both independently and in combination only among Mizo tribe with relatively less physical activity attributed to their residence in less hilly terrain however Liangmai tribe which resides in high hilly terrain shows no such association.
... Nonetheless, the reductions in circulating IL-6 and TNF-α observed in the present investigation may be clinically significant as the decrease in each individual cytokine may act synergistically to contribute to an overall greater reduction in CVD risk. In fact, targeting risk factors of CVD with a multifactorial approach has been proposed to be more effective in lowering CVD risk compared with modifying a single risk factor by itself 33 . Taken together, findings of the present investigation provide evidence that a shortterm smoking cessation program results in an overall reduction in the systemic inflammatory profile. ...
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Smoking increases systemic inflammation and circulating endothelin-1 (ET-1), both of which contribute to an elevated risk of cardiovascular disease (CVD). The present study sought to test the hypothesis that a 12-week smoking cessation intervention would contribute to a long-term reduction in circulating ET-1, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). 30 individuals participated in a 12-week evidence-based smoking cessation program at Augusta University. Serum cotinine, plasma inflammatory cytokines, and plasma ET-1 were determined at baseline, immediately after the 12-week cessation program (end of treatment, EOT), and 12-months (12M) following the cessation program. Serum cotinine was significantly reduced ( p < 0.001) at EOT and 12M following the smoking cessation program. Compared to BL (7.0 ± 1.6 pg/mL), TNF-α was significantly reduced at EOT (6.3 ± 1.5 pg/mL, p = 0.001) and 12M (5.2 ± 2.7 pg/mL, p < 0.001). ET-1 was significantly lower at EOT (1.9 ± 0.6 pg/mL, p = 0.013) and at 12M (2.0 ± 0.8 pg/mL, p = 0.091) following smoking cessation compared with BL (2.3 ± 0.6 pg/mL). BL concentrations of cotinine were significantly associated with basal ET-1 (r = 0.449, p = 0.013) and the change in cotinine at 12M following smoking cessation was significantly associated with the change in plasma ET-1 at 12M (r = 0.457, p = 0.011). Findings from the present pilot investigation demonstrate that a 12-week smoking cessation program reduces circulating concentrations of ET-1 and TNF-α for at least a year. The reduction in serum cotinine was associated with the decrease in circulating ET-1. The attenuation in ET-1 and inflammation may in part, contribute to the lower risk of CVD that is observed with smoking cessation.
... Considering that the prevalence of metabolic diseases is not different between the GB polyp group and controls at the baseline, both metabolic and non-metabolic factors may contribute to the progression of IHD. Epidemiological studies have reported that the development of IHD is enhanced when CVD risk factors are combined with obesity and metabolic syndrome, but not T2DM, in the general population (17)(18)(19)(20). This finding may be explained in part by the medications used (e.g., metformin) and life style modifications that may occur after a diagnosis of T2DM. ...
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Background: Gallbladder (GB) polyps and ischaemic heart disease (IHD) share some common risk factors. We investigated the longitudinal effects of gallbladder (GB) polyps, as a surrogate metabolic indicator, on IHD. Methods: We enrolled 19,612 participants from the health risk assessment study (HERAS) and Korean Health Insurance Review and Assessment Service (HIRA) database. The primary outcome was IHD, which consisted of angina pectoris (ICD-10 code I20) or acute myocardial infarction (ICD-10 code I21) that occurred after enrolment into the study. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD according to the presence of GB polyps using multivariate Cox proportional hazards regression models. Results: The median follow-up period was 29.9 months and a total of 473 individuals (2.4%, 473/19,612) developed IHD. Individuals with GB polyps had an increased risk of IHD compared with the control group after adjusting for potential confounding variables (HR = 1.425; 95% CI, 1.028–1.975). Furthermore, the coexistence of hypertension or dyslipidaemia resulted in an increased risk (HR = 2.14, 95% CI, 1.34–3.44 or HR = 2.09, 95% CI, 1.32–3.31, respectively) of new-onset IHD in the GB polyp group. Conclusions: GB polyps was an independent risk factor of IHD. Awareness of these associations will inform clinicians on the need to include cardiovascular risk management as part of the routine management of patients with GB polyps.
... Sustained group support in T2D and CVD control is an impactful approach for health systems with limited medical resources and high prevalence of chronic conditions 2 including obesity, high blood pressure, high cholesterol and tobacco use, all of which increase likelihood of CVD mortality among type 2 diabetics. 3 Clinically-integrated lifestyle interventions that promote primary and secondary T2D control via self-help groups have been established as a priority for both the Mexican government and the WHO. 1,4 Nonetheless, evidence for the feasibility, impact and sustainability of such programmes is not yet well established. ...
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Background Healthy lifestyle interventions offered at points of care, including support groups, may improve chronic disease management, especially in low-resource populations. We assessed the effectiveness of an educational intervention in type 2 diabetes (T2D) support groups to reduce cardiovascular disease (CVD) risk. Methods We recruited 518 participants to a parallel, two-arm, cluster-randomized, behavioural clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018. We delivered a 13-week secondary prevention intervention, Meta Salud Diabetes (MSD), within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centres (Centros de Salud). The primary study outcomes were difference in Framingham CVD risk scores and hypertension between intervention (GAM+MSD) and control (GAM usual care) arms at 3 and 12 months. Results CVD risk was 3.17% age-points lower in the MSD arm versus control at 3 months [95% confidence interval (CI): −5.60, −0.75, P = 0.013); at 12 months the difference was 2.13% age-points (95% CI: −4.60, 0.34, P = 0.088). There was no evidence of a difference in hypertension rates between arms. Diabetes distress was also lower at 3 and 12 months in the MSD arm. Post-hoc analyses showed greater CVD risk reduction among men than women and among participants with HbA1c < 8. Conclusions MSD contributed to a positive trend in reducing CVD risk in a low-resource setting. This study introduced an evidence-based curriculum that provides T2D self-management strategies for those with controlled T2D (i.e. HbA1c < 8.0) and may improve quality of life.
... 19 The positive cardiometabolic effects of smoking cessation observed in our study was reported by several other studies, indicating that smoking cessation improves glycemic control and is associated with cardiovascular benefit. 18,20 Additionally, one study showed that smoking cessation improved both mental and physical healthrelated quality of life among patients with type 2 diabetes. 21 However, several studies reported that smoking cessation might deteriorate glycemic control and cardiometabolic factors and that these changes were primarily secondary to weight gain. ...
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Purpose: Smoking cessation reduces morbidity and mortality of cardiovascular diseases. The purpose of this study was to evaluate the effect during smoking cessation treatment on glycemic control and cardiometabolic risk factors, including blood pressure and lipid levels, in patients with type 2 diabetes. Patients and methods: This retrospective cohort study included patients with type 2 diabetes who participated in a smoking cessation program, which comprised health education and medication prescription at an outpatient clinic in combination with a 3-month follow-up by phone. Data on patient background characteristics, cardiometabolic factors, smoking status, body weight, and body mass index before and after the program were collected for analysis. Results: The analysis included 241 participants with an average age of 58.6 ± 10.6 years. The rate of successful cessation at three months was 34.0%. Compared with the baseline levels, there were significant decreases in the levels of fasting plasma glucose (10.0 ± 46.8 mg/dL, P = 0.001), HbA1c (0.3 ± 1.4%, P = 0.004), systolic blood pressure (4.6 ± 17.5 mmHg, P < 0.001), diastolic blood pressure (2.9 ± 11.3 mmHg, P < 0.001), and total cholesterol (7.9 ± 42.8 mg/dL, P = 0.020) after participation in the smoking cessation program while there was no significant difference in body weight (0.1 ± 1.2 kg, P = 0.444). After adjustment for covariates, the decreases in HbA1c and total cholesterol levels were significantly better in younger participants and higher baseline nicotine dependence scores were associated with decreases in the levels of blood pressure, fasting plasma glucose, and triglycerides. However, the decrease in smoking amount was not associated with the changes in cardiometabolic factors. Conclusion: Participation in a smoking cessation program was associated with improvements in glycemic control and cardiometabolic risk factors in patients with type 2 diabetes. The observed improvements were associated with participation in the program but not with the decrease in smoking amount.
... Ceramide, the product of acid sphingomyelinase (Asm), and its metabolite, sphingosine-1phosphate (S1P) may regulate exosome release at any of several potential control points, including exosome biogenesis, sorting of intraluminal vesicles (ILVs) into MVBs, MVB fusion and exosome budding [19][20][21]. In particular, ceramide and associated sphingolipids as a key regulator of lysosome trafficking and fusion with other vesicles are shown in different cell types [8,[22][23][24][25][26][27]. In previous studies, it has been demonstrated that ceramide contributes to the activation of NLRP3 inflammasomes in podocytes, glomerular inflammation, and consequent glomerular sclerosis during hHcy [28][29][30]. ...
... As mentioned above, however, NLRP3 inflammasomes are activated mainly in the cytosol and their products may not be secreted out of podocytes via a classical and Golgi apparatus-mediated delivery pathway, it is imperative to study how NLRP3 inflammasome activation-derived products such as IL-1β, IL-18, and high mobility group protein B1 (HMGB1) are released out of podocytes to trigger the inflammatory response and ultimate glomerular injury. Given the important role of Asm and its product ceramide in glomerular injury induced by hHcy [28][29][30] and in lysosome trafficking and fusion with other vesicles [8,[22][23][24][25][26][27], the present study tested whether lysosomal Asm-ceramide contributes to NLRP3 inflammasome activation and robust release of inflammatory exosomes in podocytes during hHcy, which trigger glomerular inflammation and sclerosis. By various approaches, enhancement of NLRP3 inflammasome activation and subsequent neutrophil infiltration was found in glomeruli of WT/WT mice fed with FF diet. ...
... Consistent with our findings, previous studies have demonstrated that ceramide and its metabolites, Sph-1phosphate (S1P) participate in exosome biogenesis, sorting ILVs into MVBs, budding of exosome or MVB fusion to membrane for release of exosomes [19][20][21]. In particular, ceramide and associated sphingolipids as a key regulator of lysosome trafficking and fusion with other vesicles are shown in different cell types [8,[22][23][24][25][26][27]. Although a recent study has shown that exosome may mediate the secretion of inflammatory cytokines in glomeruli during D-ribose stimulation [51], the results from the present study provide the first experimental evidence that hHcy damages lysosome-MVB interaction in glomeruli and amplifies urinary excretion of exosomes containing inflammatory cytokines, which are regulated by Asm-ceramide signaling pathway in podocytes. ...
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The nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) inflammasome has been implicated in podocyte injury and glomerular sclerosis in response to hyperhomocysteinemia (hHcy). However, it remains unknown how the products of NLRP3 inflammasome in cytoplasm are secreted out of podocytes. In the present study, we tested whether exosome release serves as a critical mechanism to mediate the action of NLRP3 inflammasome activation in hHcy-induced glomerular injury. By various approaches, we found that hHcy induced NLRP3 inflammasome activation and neutrophil infiltration in glomeruli of WT/WT mice. Lysosome-MVB interaction in glomeruli remarkably decreased in WT/WT mice fed with FF diet, leading to elevation of urinary exosome excretion of these mice. Podocyte-derived exosomes containing pro-inflammatory cytokines increased in urine of WT/WT mice in response to hHcy. The release of inflammatory exosomes from podocytes was prevented by Smpd1 gene deletion but enhanced by podocyte-specific Smpd1 gene overexpression (Smpd1 encodes Asm in mice). Pathologically, hHcy-induced podocyte injury and glomerular sclerosis were blocked by Smpd1 gene knockout but amplified by podocyte-specific Smpd1 gene overexpression. Taken together, our results suggest that Asm-ceramide signaling pathway contributes to NLRP3 inflammasome activation and robust release of inflammatory exosomes in podocytes during hHcy, which together trigger local glomerular inflammation and sclerosis.
... Epidemiological studies have reported that the development of IHD is enhanced when CVD risk factors are combined with obesity and metabolic syndrome, but not T2DM, in the general population [16][17][18][19]. This nding may be explained in part by the medications used (e.g. ...
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Background: This study aimed to investigate the longitudinal effects of gallbladder (GB) polyps, as a surrogate metabolic indicator, on incident ischaemic heart disease (IHD). We also assessed the combined effects of GB polyps and comorbidities on the risk of developing IHD. Methods: We enrolled 19,612 participants from the health risk assessment study and Korean Health Insurance Review and Assessment Service database. The control group without GB polyps consisted of 18,413 patients, and the GB polyp group comprised 1,119 patients. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD according to the presence of GB polyps using multivariate Cox proportional hazards regression models. Results: The prevalence of newly developed IHD was 2.4% during an average follow-up period of 50 months. Individuals with GB polyps had an increased risk of IHD compared with the control group after adjusting for potential confounding variables (HR = 1.425; 95% CI, 1.028–1.975). Furthermore, the coexistence of hypertension or dyslipidaemia resulted in an increased risk (HR = 2.14, 95% CI, 1.34–3.44 or HR = 2.09, 95% CI, 1.32–3.31, respectively) of new-onset IHD in the GB polyp group. However, this cumulative effect was observed only in patients with impaired fasting blood glucose (HR=1.86, 95% CI, 1.06–3.26), but not in those with type 2 diabetes mellitus. Conclusion: The presence of GB polyps was positively associated with increased risk of developing IHD and was independent of cardiovascular risk factors. In addition, GB polyps in patients with impaired fasting blood glucose increased the risk of IHD as those in the presence of the comorbidities hypertension or dyslipidaemia.
... The most recent meta-analysis that is related to the effects of LCD on CVD risk factors confirmed that this type of diet has a beneficial effect on cardiovascular risk, but long-term studies are needed in order to confirm this [143]. As we know, T2DM is an important cardiovascular risk factor itself and studies including T2DM patients also analyzed the other cardiovascular risk factors that are mentioned above [144][145][146][147]. LCD intervention in patients with T2DM had a positive effect on reducing triglyceride concentration and increasing HDL-C concentrations, without a significant effect on long-term weight loss [144]. ...
Article
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The incidence of cardiometabolic diseases, such as obesity, diabetes, and cardiovascular diseases, is constantly rising. Successful lifestyle changes may limit their incidence, which is why researchers focus on the role of nutrition in this context. The outcomes of studies carried out in past decades have influenced dietary guidelines, which primarily recommend reducing saturated fat as a therapeutic approach for cardiovascular disease prevention, while limiting the role of sugar due to its harmful effects. On the other hand, a low-carbohydrate diet (LCD) as a method of treatment remains controversial. A number of studies on the effect of LCDs on patients with type 2 diabetes mellitus proved that it is a safe and effective method of dietary management. As for the risk of cardiovascular diseases, the source of carbohydrates and fats corresponds with the mortality rate and protective effect of plant-derived components. Additionally, some recent studies have focused on the gut microbiota in relation to cardiometabolic diseases and diet as one of the leading factors affecting microbiota composition. Unfortunately, there is still no precise answer to the question of which a single nutrient plays the most important role in reducing cardiometabolic risk, and this review article presents the current state of the knowledge in this field.
... Epidemiological surveys show that the main driving factors for the global type 2 diabetes epidemic are rising obesity rates, sedentary lifestyles, high-energy diets and an aging population, among which obesity is the most important independent risk factor for T2DM. [2][3][4] The occurrence and development of obesity are closely related to the body's food intake and energy expenditure. In the state of excess energy, it can promote the occurrence of obesity, and obesity is closely related to the occurrence and development of T2DM and insulin resistance (IR). ...
... In the state of excess energy, it can promote the occurrence of obesity, and obesity is closely related to the occurrence and development of T2DM and insulin resistance (IR). 4,5 Alarin is the newest member of the galanin neuropeptide family. It is a peptide composed of 25 amino acids, which is involved in the body's food intake regulation and energy metabolism. ...
... Studies have shown that the galanin neuropeptide family is involved in the regulation of appetite, insulin resistance, obesity, hypertension and metabolism. 4,5 Alarin is the newly discovered galanin neuropeptide family member and was first discovered in the ganglion cells of neuroblastoma. Follow-up studies have confirmed that Alarin also exists in the perivascular area of the skin, locus coeruleus, arcuate nucleus, olfactory bulb, amygdala, and so on. ...
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Objective: To investigate the plasma alarin level in newly diagnosed obese type 2 diabetes mellitus (T2DM) and its correlation with glucose and lipid metabolism and insulin resistance. Methods: From October 2018 to June 2020, 239 newly diagnosed T2DM patients were collected. According to obesity, patients were divided into T2DM obese group (n=135) and T2DM non-obese group (n =104). Gender, age, body mass index (BMI), blood lipids, blood glucose, glycosylated hemoglobin A1c (HbA1c), fasting insulin (FINS), plasma alarin concentration, homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for β-cell function (HOMA-β) and other clinical data were collected and analyzed. Results: BMI, triacylglycerol (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), fasting blood glucose (FPG), HbA1c, FINS, plasma alarin levels and HOMA-IR in the control group, T2DM non-obese group and T2DM obese group increased sequentially, and high-density lipoprotein-cholesterol (HDL-L) and HOMA-β decreased sequentially (P<0.05). Correlation analysis results showed that plasma alarin levels in T2DM patients were positively correlated with waistline, BMI, TC, LDL-C, FPG, HbA1c, FINS and HOMA-IR (P<0.05), and negatively correlated with HDL-C and HOMA-β (P <0.05), and the correlation coefficient of T2DM obese group was significantly higher than that of T2DM non-obese group (P<0.05). Multiple linear stepwise regression analysis showed that BMI, FPG, HbA1c, HOMA-β, and HOMA-IR were independent factors related to plasma alarin levels in T2DM non-obese and T2DM obese patients, and the correlation coefficient of the T2DM obese group was significantly higher than that of the T2DM non-obese group (P <0.05). Conclusion: Plasma alarin levels increase in newly diagnosed T2DM and obese T2DM patients, which are affected by TC, BMI, FPG, HbA1c, HOMA-β and HOMA-IR, and may be involved in development of T2DM.