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Bastiaan E. de Galan

Bio: Bastiaan E. de Galan is an academic researcher from Maastricht University. The author has contributed to research in topics: Diabetes mellitus & Medicine. The author has an hindex of 20, co-authored 67 publications receiving 7942 citations. Previous affiliations of Bastiaan E. de Galan include Radboud University Nijmegen Medical Centre & Royal Prince Alfred Hospital.


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01 Aug 2019-BMJ Open
TL;DR: The SUGAR-DIP trial aims to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM.
Abstract: Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals.

6 citations

Journal ArticleDOI
TL;DR: A case of artifactual hypoglycaemia in a patient with SSc and a quick method for its diagnosis, which has potential clinical consequences for patients with S Sc and RP at risk for or having been diagnosed with diabetes.
Abstract: SIR, The term artifactual hypoglycaemia has been proposed for the discrepancy between low capillary and normal plasma glucose levels, and has been described in various conditions, including RP [1]. Early recognition is challenging, but is important to prevent anxiety and unnecessary treatment and diagnostic tests. We present a case of artifactual hypoglycaemia in a patient with SSc and propose a quick method for its diagnosis. A 57-year-old man was referred from another hospital because of recurrent, asymptomatic hypoglycaemia. His medical history included SSc and RP, treated with lowdose prednisolone, and aortic valve stenosis with intestinal angiodysplasia for which somatostatin had been recently started. Subsequent monitoring of capillary glucose by finger-stick measurements revealed glucose levels ranging between 2.3 and 7.7 mmol/l, with 15% of these below 3.5 mmol/l. Screening diagnostic analysis for insulinoma, performed before the patient was referred, was reportedly negative. Somatostatin, which was thought to have caused the low glucose levels, had been discontinued, the dose of prednisolone was increased (from 5 to 10 mg daily) and continuous feeding over a nasogastric tube had been initiated. However, none of these interventions had led to a clear, sustainable glucose-increasing effect (Fig. 1), although his body weight had increased by 4 kg. The patient had become increasingly anxious about the apparent treatment resistance of his hypoglycaemia. The patient occasionally reported non-specific symptoms like blurred vision and tremor that were unrelated to the capillary glucose level and did not respond to ingestion of dextrose. We concluded that the criteria of Whipple’s triad for hypoglycaemia were not met [2] and suspected a measurement artefact. Because his sclerosis-affected skin hindered venous access, we performed simultaneous measurements on the patient’s earlobe when finger-stick measurement suggested hypoglycaemia. These measurements revealed glucose levels to be 2.8 mmol/l higher in earlobe capillary blood, with none of them being in the hypoglycaemic range. Screening for diabetes in people at elevated risk is routine practice at all levels of clinical care across medical specialties. Hypoglycaemia in such a patient not treated with glucose-lowering agents should raise the health care provider’s suspicion of artifactual hypoglycaemia, especially when the event is based on capillary blood glucose, measured by finger-stick. Unawareness of this phenomenon may lead to unnecessary diagnostic and therapeutic interventions, as exemplified in our patient. Artifactual hypoglycaemia, previously referred to as pseudo-hypoglycaemia, has been described in patients with RP, circulatory shock, peripheral arterial disease, Eisenmenger syndrome, acrocyanosis or hypothermia [1]. It has been ascribed to reduced perfusion of the peripheral microcirculation with decelerated glucose transit and increased glucose uptake into the surrounding tissue [3]. Additionally, the term has also been used to describe falsely low plasma glucose values resulting from increased glycolysis by leukocytes, e.g. in chronic myeloid leukaemia [1, 3]. Diagnosis of artifactual hypoglycaemia relies on simultaneous glucose measurements in capillary blood and a venous specimen [1]. Because venous access can be difficult in patients with SSc because of their fibrotized skin and stiffened veins, we chose the earlobe as alternative site for glucose measurement. Earlobe measurements reflect also capillary blood glucose; however, the earlobe remains unaffected by SSc, because it lacks connective tissue [4, 5]. In addition, it allows for diagnosis at the bedside with the same glucose metre, thus circumventing any differences in accuracy with laboratory methods. Our case has potential clinical consequences for patients with SSc and RP at risk for or having been diagnosed with diabetes. Indeed, artifactual normal or lower than expected finger-stick glucose values in these patients may give false assumptions of the level of glucose control in people with (coexistent) diabetes or even refute its diagnosis, potentially withholding patients from appropriate treatment. This phenomenon must be particularly considered if there is a discrepancy between the haemoglobin A1c level and glucose values measured by fingerstick. Whenever frequent glucose monitoring is required, e.g. with insulin treatment, switching from finger-stick to earlobe capillary glucose measurement may be considered. This case illustrates the importance of awareness of artifactual hypoglycaemia, not only to avoid unnecessary work-up and therapy, but also to prevent anxiety associated with the belief of having a medical condition that appears unsolvable. We suggest performing simultaneous glucose measurements on the patient’s earlobe and finger-stick whenever this phenomenon is likely to occur, not only in patients with supposedly hypoglycaemia, but also in case of lower than expected glucose levels in patients with (poorly controlled) diabetes mellitus.

6 citations

Journal ArticleDOI
TL;DR: It remains unknownwhich specific immune cell subsets are recruited in response to hypoglycaemia, and to identify these subsets, blood samples collected during clamped euglycaemia from seven people with type 1 diabetes were analysed.
Abstract: To the Editor: We recently reported enhanced ex vivo cytokine production of immune cells during hypoglycaemia in humans [1]. Chronic inflammation contributes to cardiovascular disease and atherosclerosis and may link hypoglycaemia to increased cardiovascular risk and mortality observed in individuals with diabetes [2]. Hypoglycaemia induces leucocytosis, possibly mediated by marked increases in plasma adrenaline (epinephrine) and cortisol levels. Adrenaline recruits immune cells from themarginal pool (vascular endothelium), likely by interfering with CD11aand CX3CR1-dependent adhesion of leucocytes to the vessel wall [3]. Indeed, gene expression levels of CD11a and CX3CR1were increased in peripheral bloodmononuclear cells (PBMCs) isolated during hypoglycaemia [1]. It remains unknownwhich specific immune cell subsets are recruited in response to hypoglycaemia. To identify these subsets, we analysed blood samples collected during clamped euglycaemia or hypoglycaemia from seven people with type 1 diabetes (three men, age 27.1 ± 9.7 years, HbA1c 55.9 ± 8.9 mmol/mol [7.2 ± 0.8%] and diabetes duration 11.4 ± 5.4 years; mean ± SD) by flow cytometry. This was a substudy of a larger study (ClinicalTrials.gov registration no. NCT03286816), for which we analysed data obtained within the control arm (for study design and endpoints, see [4]). The study was approved by the local institutional review board of Radboud University Medical Center and all study participants gave written informed consent before participation. All participants had normal awareness of hypoglycaemia (assessed by the Dutch version of the Cox questionnaire and normal counter-regulatory responses to the hypoglycaemic clamp). Participants underwent a two-step euglycaemic (5.0mmol/l)– hypoglycaemic (2.8 mmol/l) glucose clamp. At the end of each glycaemic phase, blood was drawn for flow cytometry and to determine catecholamine levels. Undiluted blood (50 μl, BD Vacutainer K2E [EDTA], BD, Plymouth, UK) was incubated for 15 min at room temperature in the dark with the following antibodies (all mouse): CD16-FITC (dilution 1:5), CD56-PE (1:10) (BD Biosciences, Vianen, the Netherlands); CD14-ECD (1:10), CD3-ECD (1:10), CD3-PE (1:5), CD45-PECy7 (1:50), CD8-ECD (1:10), HLA-DRPECy5 (1:10) (Beckman Coul te r, Woerden , the Netherlands); CD4-PECy7 (1:20) (ITK Diagnostics BV, Uithoorn, the Netherlands). After the addition of 1 ml lysis buffer (BD Pharm Lyse, BD Biosciences), samples were mixed, incubated for another 10 min and finally measured on a Beckman Coulter FC500 flow cytometer. Single staining and fluorescence-minus-one control stains were used to determine the position of analysis gates. Flow cytometry data were analysed using Kaluza software (Beckman Coulter). Immune cell subset numbers were calculated based on percentages measured with flow cytometry and cell numbers from blood differentials measured on a Sysmex XN-450 (Sysmex, EttenLeur, the Netherlands). A Spearman’s rank sum test was used for correlation analysis. Wilcoxon signed rank test was used to test differences between two related samples. All data are expressed as mean ± SD. A p value of <0.05 was considered * Jacqueline M. Ratter Jacqueline.Ratter@radboudumc.nl

6 citations

Journal ArticleDOI
18 Jul 2022-Diabetes
TL;DR: It is concluded that hypoglycemia induces a pro-inflammatory response at the cellular and protein level that is sustained for one week in people with type 2 diabetes and controls.
Abstract: Iatrogenic hypoglycaemia activates the immune system and is associated with an increased risk for atherosclerotic disease. We determined acute and long-term effects of insulin-induced hypoglycemia on inflammatory markers in humans with or without type 2 diabetes. Fifteen adults with type 2 diabetes and 16 matched controls (M/F 17/14, age 59.6±7.1 years, BMI 28.5±4.3 kg/m2) underwent a hyperinsulinemic-euglycemic (5.31±0.32 mmol/L) hypoglycemic (2.80±0.12 mmol/L) glucose clamp. Blood was drawn during euglycemia and hypoglycemia and 1, 3 and 7 days later, to determine circulating immune cell composition, function, and inflammatory proteins. In response to hypoglycemia, absolute numbers of circulating lymphocytes and monocytes significantly increased and remained elevated for one week. The proportion of CD16+ -monocytes increased, and the proportion of CD14+ -monocytes decreased, which sustained for a week in people without diabetes. During hypoglycemia, ex vivo stimulated, monocytes released more TNF-α and IL-1β, and less IL-10, particularly in people with diabetes. Hs-CRP and 25 circulating inflammatory proteins increased, remaining significantly elevated one week after hypoglycemia. While levels at euglycemia differed, responses to hypoglycemia were broadly similar in people with or without type 2 diabetes. We conclude that hypoglycemia induces a pro-inflammatory response at the cellular and protein level that is sustained for one week in people with type 2 diabetes and controls.

5 citations

Journal ArticleDOI
TL;DR: In this article, the authors assess cross-sectional associations between dietary advanced glycation end products (AGEs) intake and generalized microvascular function in a population-based cohort.

5 citations


Cited by
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Giuseppe Mancia1, Robert Fagard, Krzysztof Narkiewicz, Josep Redon, Alberto Zanchetti, Michael Böhm, Thierry Christiaens, Renata Cifkova, Guy De Backer, Anna F. Dominiczak, Maurizio Galderisi, Diederick E. Grobbee, Tiny Jaarsma, Paulus Kirchhof, Sverre E. Kjeldsen, Stéphane Laurent, Athanasios J. Manolis, Peter M. Nilsson, Luis M. Ruilope, Roland E. Schmieder, Per Anton Sirnes, Peter Sleight, Margus Viigimaa, Bernard Waeber, Faiez Zannad, Michel Burnier, Ettore Ambrosioni, Mark Caufield, Antonio Coca, Michael H. Olsen, Costas Tsioufis, Philippe van de Borne, José Luis Zamorano, Stephan Achenbach, Helmut Baumgartner, Jeroen J. Bax, Héctor Bueno, Veronica Dean, Christi Deaton, Çetin Erol, Roberto Ferrari, David Hasdai, Arno W. Hoes, Juhani Knuuti, Philippe Kolh2, Patrizio Lancellotti, Aleš Linhart, Petros Nihoyannopoulos, Massimo F Piepoli, Piotr Ponikowski, Juan Tamargo, Michal Tendera, Adam Torbicki, William Wijns, Stephan Windecker, Denis Clement, Thierry C. Gillebert, Enrico Agabiti Rosei, Stefan D. Anker, Johann Bauersachs, Jana Brguljan Hitij, Mark J. Caulfield, Marc De Buyzere, Sabina De Geest, Geneviève Derumeaux, Serap Erdine, Csaba Farsang, Christian Funck-Brentano, Vjekoslav Gerc, Giuseppe Germanò, Stephan Gielen, Herman Haller, Jens Jordan, Thomas Kahan, Michel Komajda, Dragan Lovic, Heiko Mahrholdt, Jan Östergren, Gianfranco Parati, Joep Perk, Jorge Polónia, Bogdan A. Popescu, Zeljko Reiner, Lars Rydén, Yuriy Sirenko, Alice Stanton, Harry A.J. Struijker-Boudier, Charalambos Vlachopoulos, Massimo Volpe, David A. Wood 
TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

14,173 citations

01 Jan 2014
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care.
Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

9,618 citations

Journal ArticleDOI
TL;DR: In this paper, a randomized clinical trial was conducted to evaluate the effect of preterax and Diamicron Modified Release Controlled Evaluation (MDE) on the risk of stroke.
Abstract: ABI : ankle–brachial index ACCORD : Action to Control Cardiovascular Risk in Diabetes ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation AGREE : Appraisal of Guidelines Research and Evaluation AHA : American Heart Association apoA1 : apolipoprotein A1 apoB : apolipoprotein B CABG : coronary artery bypass graft surgery CARDS : Collaborative AtoRvastatin Diabetes Study CCNAP : Council on Cardiovascular Nursing and Allied Professions CHARISMA : Clopidogrel for High Athero-thrombotic Risk and Ischemic Stabilisation, Management, and Avoidance CHD : coronary heart disease CKD : chronic kidney disease COMMIT : Clopidogrel and Metoprolol in Myocardial Infarction Trial CRP : C-reactive protein CURE : Clopidogrel in Unstable Angina to Prevent Recurrent Events CVD : cardiovascular disease DALYs : disability-adjusted life years DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Trial ED : erectile dysfunction eGFR : estimated glomerular filtration rate EHN : European Heart Network EPIC : European Prospective Investigation into Cancer and Nutrition EUROASPIRE : European Action on Secondary and Primary Prevention through Intervention to Reduce Events GFR : glomerular filtration rate GOSPEL : Global Secondary Prevention Strategies to Limit Event Recurrence After MI GRADE : Grading of Recommendations Assessment, Development and Evaluation HbA1c : glycated haemoglobin HDL : high-density lipoprotein HF-ACTION : Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing HOT : Hypertension Optimal Treatment Study HPS : Heart Protection Study HR : hazard ratio hsCRP : high-sensitivity C-reactive protein HYVET : Hypertension in the Very Elderly Trial ICD : International Classification of Diseases IMT : intima-media thickness INVEST : International Verapamil SR/Trandolapril JTF : Joint Task Force LDL : low-density lipoprotein Lp(a) : lipoprotein(a) LpPLA2 : lipoprotein-associated phospholipase 2 LVH : left ventricular hypertrophy MATCH : Management of Atherothrombosis with Clopidogrel in High-risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke MDRD : Modification of Diet in Renal Disease MET : metabolic equivalent MONICA : Multinational MONItoring of trends and determinants in CArdiovascular disease NICE : National Institute of Health and Clinical Excellence NRT : nicotine replacement therapy NSTEMI : non-ST elevation myocardial infarction ONTARGET : Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial OSA : obstructive sleep apnoea PAD : peripheral artery disease PCI : percutaneous coronary intervention PROactive : Prospective Pioglitazone Clinical Trial in Macrovascular Events PWV : pulse wave velocity QOF : Quality and Outcomes Framework RCT : randomized clinical trial RR : relative risk SBP : systolic blood pressure SCORE : Systematic Coronary Risk Evaluation Project SEARCH : Study of the Effectiveness of Additional Reductions in Cholesterol and SHEP : Systolic Hypertension in the Elderly Program STEMI : ST-elevation myocardial infarction SU.FOL.OM3 : SUpplementation with FOlate, vitamin B6 and B12 and/or OMega-3 fatty acids Syst-Eur : Systolic Hypertension in Europe TNT : Treating to New Targets UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use VITATOPS : VITAmins TO Prevent Stroke VLDL : very low-density lipoprotein WHO : World Health Organization ### 1.1 Introduction Atherosclerotic cardiovascular disease (CVD) is a chronic disorder developing insidiously throughout life and usually progressing to an advanced stage by the time symptoms occur. It remains the major cause of premature death in Europe, even though CVD mortality has …

7,482 citations

Journal ArticleDOI
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Abstract: Because of new evidence on several diagnostic and therapeutic aspects of hypertension, the present guidelines differ in many respects from the previous ones. Some of the most important differences are listed below: 1. Epidemiological data on hypertension and BP control in Europe. 2. Strengthening of the prognostic value of home blood pressure monitoring (HBPM) and of its role for diagnosis and management of hypertension, next to ambulatory blood pressure monitoring (ABPM). 3. Update of the prognostic significance of night-time BP, white-coat hypertension and masked hypertension. 4. Re-emphasis on integration of BP, cardiovascular (CV) risk factors, asymptomatic organ damage (OD) and clinical complications for total CV risk assessment. 5. Update of the prognostic significance of asymptomatic OD, including heart, blood vessels, kidney, eye and brain. 6. Reconsideration of the risk of overweight and target body mass index (BMI) in hypertension. 7. Hypertension in young people. 8. Initiation of antihypertensive treatment. More evidence-based criteria and no drug treatment of high normal BP. 9. Target BP for treatment. More evidence-based criteria and unified target systolic blood pressure (SBP) (<140 mmHg) in both higher and lower CV risk patients. 10. Liberal approach to initial monotherapy, without any all-ranking purpose. 11. Revised schema for priorital two-drug combinations. 12. New therapeutic algorithms for achieving target BP. 13. Extended section on therapeutic strategies in special conditions. 14. Revised recommendations on treatment of hypertension in the elderly. 15. Drug treatment of octogenarians. 16. Special attention to resistant hypertension and new treatment approaches. 17. Increased attention to OD-guided therapy. 18. New approaches to chronic management of hypertensive disease

7,018 citations

Journal ArticleDOI
TL;DR: Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up.
Abstract: From the Diabetes Trials Unit (R.R.H., S.K.P., M.A.B.), the Division of Public Health and Primary Health Care (H.A.W.N.), and the National Institute of Health Re- search (NIHR) School for Primary Care Research (H.A.W.N.), Oxford Centre for Diabetes, Endocrinology, and Metabo- lism (R.R.H., S.K.P., M.A.B., D.R.M., H.A.W.N.); and the NIHR Oxford Bio- medical Research Centre (R.R.H., D.R.M., H.A.W.N.) — both in Oxford, United Kingdom. Address reprint requests to Dr. Holman at the Diabetes Trials Unit, Ox- ford Centre for Diabetes, Endocrinology, and Metabolism, Churchill Hospital, Head- ington, Oxford OX3 7LJ, United Kingdom, or at rury.holman@dtu.ox.ac.uk. Background During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose con- trol persisted and whether such therapy had a long-term effect on macrovascular outcomes. Methods Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned thera- pies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories. Results Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P = 0.04) and microvascular disease (24%, P = 0.001), and risk reductions for myocardial infarction (15%, P = 0.01) and death from any cause (13%, P = 0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-relat- ed end point (21%, P = 0.01), myocardial infarction (33%, P = 0.005), and death from any cause (27%, P = 0.002). Conclusions Despite an early loss of glycemic differences, a continued reduction in microvascu- lar risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number, ISRCTN75451837.)

6,565 citations