A Clinical Study On The Association Of Glucose And Lipid Metabolism And Hypertension

Part 1.Management of Hypertension and Diabetes Mellitus in Chinese OutpatientsObjective: We investigated the common presence of hypertension and diabetes mellitus in two clinical settings,namely cardiology and endocrinology,and compared the management of hypertension or diabetes mellitus between patients from cardiology and endocrinology and between patients with hypertension or diabetes mellitus alone and with both diseases.Methods: Our multicentre registry was carried out in 40 clinical departments in China from June 2011 to March 2012.Patients seen for hypertension in cardiology or diabetes mellitus in endocrinology were recruited.We administered a standardized questionnaire to collect information on medical history,use of medications and lifestyle.We measured blood pressure(BP)using a validated Omron 7201 oscillometric device(Kyoto,Japan).Plasma fasting glucose and glycosylated hemoglobin(Hb A1c)were measured in all patients.Oral glucose tolerance test(OGTT)was performed in hypertensive patients without known diabetes mellitus.Results: The common presence of hypertension and diabetes mellitus was observed in 32.9% of 1291 hypertensive patients in cardiology and 58.9% of 1168 diabetic patients in endocrinology.It was associated with a significantly(P?0.01)higher use of combination antihypertensive therapy and lower use of oral antidiabetic agents plus insulin in cardiology and a lower use of combination antihypertensive therapy in endocrinology.The control of hypertension and diabetes mellitus was not different between patients with both diseases and those with either condition alone or the management setting(P?0.08),regardless of the definitions of therapeutic target(systolic/diastolic BP<140/90 mm Hg or 130/80 mm Hg and Hb A1 c <7.0% or 6.5%).Conclusions: The common presence of hypertension and diabetes mellitus was prevalent,especially in the endocrinology setting.Since there was apparent divergence of treatment intensity between settings,a common platform for both disease conditions may be needed in the future.Part 2.Hypertension and,Diabetes Mellitus in relation to Target Organ DamageChapter 1.Hypertension and,Diabetes mellitus in relation to Left ventricular HypertrophyObjective: We investigated electrocardiographic left ventricular hypertrophy(ECG-LVH)in patients with hypertension or diabetes mellitus alone and those with both diseases.Methods: Our multicentre registry was carried out in 40 clinical departments in China from June 2011 to March 2012.Patients seen for hypertension in cardiology or diabetes mellitus in endocrinology were recruited.We administered a standardized questionnaire to collect information on medical history,use of medications and lifestyle.We measured BP using a validated Omron 7201 oscillometric device(Kyoto,Japan).ECG-LVH was defined according to the Cornell product:(Ra VL+SV3)×QRS duration >260 mv·ms(men)and >170 mv·ms(women).Results: The prevalence of ECG-LVH was 4.0% in 477 patients with diabetes mellitus alone,7.9% in 843 patients with hypertension alone and 7.6% in 1088 patients with both diseases.In patients with diabetes mellitus alone,Hb A1 c of <7.0% was associated with a lower risk of ECG-LVH(Odds ratio [OR]: 0.23 vs.Hb A1c?7.0%,P=0.01).In patients with hypertension alone,controlled BP(<140/90 mm Hg)tended to be associated with a lower risk of ECG-LVH(OR: 0.62 vs.BP ?140/90 mm Hg,P=0.08).In patients with both diseases,only those patients with both controlled BP and Hb A1 c of <7.0% showed a lower risk of ECG-LVH(OR:0.31 vs.BP ?140/90 mm Hg and Hb A1 c ?7.0%,P=0.06).Conclusions: Uncontrolled hypertension and diabetes mellitus were associated with higher risk of ECG-LVH,regardless of whether these diseases were present alone or in combination.Chapter 2.Hypertension and,Diabetes mellitus in relation to AlbuminuriaObjective: We investigated albuminuria in patients with hypertension or diabetes mellitus alone and those with both diseases.Methods: Our multicentre registry was carried out in 40 clinical departments in China from June 2011 to March 2012.Patients seen for hypertension in cardiology or diabetes mellitus in endocrinology were recruited.We administered a standardized questionnaire to collect information on medical history,use of medications and lifestyle.We measured BPusing a validated Omron 7201 oscillometric device(Kyoto,Japan).We defined albuminuria as an albumin/creatinine ratio(ACR)?30mg/g.Results: The prevalence of albuminuria was higher among patients with the common presence of hypertension and diabetes mellitus(n=652,23.3%)than patients with hypertension(n=613,12.6%)or diabetes mellitus(n=232,15.9%)alone.There was significant interaction between the presence of diabetes mellitus and systolic blood pressure in relation to the risk of albuminuria(Pint=0.02).The prevalence of albuminuria increased with higher systolic blood pressure more in the common presence of hypertension and diabetes mellitus(Ptrend<0.0001)than in patients with hypertension alone(Ptrend=0.05).The prevalence of albuminuria increased significantly and similarly with higher Hb A1 c among diabetic patients with hypertension(Ptrend<0.0001)or without(Ptrend=0.0006).Conclusions: The common presence of hypertension and diabete mellitus was associated with higher risk of albuminuria,and required intensive control of both diseases,especially hypertension.Part 3.Prevalence of the metabolic syndrome components in adolescent hypertensive patientsObjective: We investigated various components of the metabolic syndrome in adolescent hypertensive patients.Methods: The study subjects were adolescent primary hypertensive patients admitted in the hypertension ward of Ruijin Hospital from January 2000 to December 2014.Metabolic syndrome was defined according to the ATP III criteria for adolescents in patients of younger than 20 years and,the ATP IV criteria in patients of at least 20 years.Results: In 224 patients with primary hypertension,the proportion of the abnormalities for the various components of the metabolic syndrome was 50.4% for waist circumference,32.1% for triglycerides,29.5% for high-density lipoprotein cholesterol and 3.1% for hyperglycemia.The proportion of the subjects with one(only blood pressure without other component of the metabolic syndrome),two(blood pressure plus one of the other components)and three(blood pressure plus two other components)metabolic abnormalities was 32.1%,34.4% and 33.5%,respectively.Conclusions: In adolescents with primary hypertension,central obesity and lipid disorders,but not hyperglycemia,are frequent abnormalities of the metabolic syndrome components.