Showing papers by "Carl Erik Mogensen published in 2003"

Albuminuria and Cardiovascular Risk in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE Study

Abstract: An increased urine albumin–creatinine ratio (UACR) is associated with increasing cardiovascular risk in hypertensive patients with left ventricular hypertrophy. The authors found no UACR values whe...

Effect of Low-Dose Perindopril/Indapamide on Albuminuria in Diabetes Preterax in Albuminuria Regression: PREMIER

Abstract: Microalbuminuria in diabetes is a risk factor for early death and an indicator for aggressive blood pressure (BP) lowering. We compared a combination of 2 mg perindopril/0.625 mg indapamide with enalapril monotherapy on albumin excretion rate (AER) in patients with type 2 diabetes, albuminuria, and hypertension in a 12-month, randomized, double-blind, parallel-group international multicenter study. Four hundred eighty-one patients with type 2 diabetes and hypertension (systolic BP 140 mm Hg, 180 mm Hg, diastolic BP 110 mm Hg) were randomly assigned (age 599 years, 77% previously treated for hypertension). Results from 457 patients (intention-to-treat analysis) were available. After a 4-week placebo period, patients with albuminuria 20 and 500 g/min were randomly assigned to a combination of 2 mg perindopril/0.625 mg indapamide or to 10 mg daily enalapril. After week 12, doses were adjusted on the basis of BP to a maximum of 8 mg perindopril/2.5 mg indapamide or 40 mg enalapril. The main outcome measures were overnight AER and supine BP. Both treatments reduced BP. Perindopril/indapamide treatment resulted in a statistically significant higher fall in both BP ( 3.0 (95% CI 5.6, 0.4), P0.012; systolic BP 1.5 (95% CI 3.0, 0.1) diastolic BP P0.019) and AER 42% (95% CI 50%, 33%) versus 27% (95% CI 37%, 16%) with enalapril. The greater AER reduction remained significant after adjustment for mean BP. Adverse events were similar in the 2 groups. Thus, first-line treatment with low-dose combination perindopril/indapamide induces a greater decrease in albuminuria than enalapril, partially independent of BP reduction. A BP-independent effect of the combination may increase renal protection. (Hypertension. 2003;41:1063-1071.)

New treatment guidelines for a patient with diabetes and hypertension.

Abstract: Guidelines for medical treatment are becoming increasingly popular and many guidelines have been produced by various societies in diabetes, hypertension, and renal disease as well as general medicine. By their nature, they are outdated considering the rapid and efficient publication of many papers related to the treatment of hypertension in diabetes. Increased blood glucose causes vascular damage and abnormal vascular structure all over the body, an abnormal structure that is especially vulnerable to high blood pressure, even within the so-called normal range. There is now more and more evidence, especially in diabetics, that blood pressure should be as low as possible. In this context, it is important to stress that the so-called J-shaped relationship between blood pressure and mortality may not be so relevant. Major epidemiological studies came from the Framingham and the Multiple Risk Factor Intervention Trial (MRFIT) Diabetic Cohort. The MRFIT Cohort showed that cardiovascular mortality was increased by a factor of 2-4 in diabetic patients, and there was a clear association between systolic blood pressure and complications without any threshold value. It could be suggested that since diabetes is an important cardiovascular risk factor, a lower value (130/85 mmHg) than for non-diabetics (140/90 mmHg) should be proposed. The tight blood pressure control arm of the United Kingdom Prospective Diabetes Study was <150/85 mmHg (achieved 144/82 mmHg) and the aim in the less tight control arm was <180/105 mmHg (achieved 154/87 mmHg). In the tight control group, 29% needed three or more antihypertensive drugs. In the Hypertension Optimal Treatment study, the frequency of major cardiovascular disease events in the group with target <80 mmHg (achieved 144/81 mmHg) was 11.9/1000 patients/year, which was significantly lower than the event rate (24.4/1000 patients/year) in the group with target <90 mmHg (achieved 148/85 mmHg). A reduction in the frequency of diabetic nephropathy by angiotensin-converting enzyme (ACE) inhibitor treatment in normotensive lean microalbuminuric type 2 diabetic patients has been shown. However, it is impossible from the present data to draw any conclusions with respect to effect on the main composite endpoint of ACE inhibition in microalbuminuric type 2 diabetic patients without previous cardiovascular events or without hypertension. Recent published studies have also demonstrated beneficial effects with angiotensin receptor blockers (ARBs) in hypertensive patients with type 2 diabetes and nephropathy. Diuretics form a very important basis for antihypertensive treatment, also often in combination with agents that inhibit the renin-angiotensin system. Several studies show that treatment with the diuretic indapamide reduces the level of microalbuminuria in patients with type 2 diabetes. Diuretics were used as an adjunctive to reduce blood pressure in all studies; it is therefore understandable that many guidelines suggest that diuretics form part of the treatment of hypertension in diabetics. Many studies of an epidemiological nature and follow-up studies in diabetic patients show that blood pressure control is of vital concern in the prevention of diabetic complications, and indeed the usual criteria for good blood pressure control may not be stringent enough in diabetic patients. Many classes of antihypertensives may be used, but it appears that diuretics, such as indapamide sustained release (SR), constitute an important proposal in all treatment strategies.

E-selectin-inducing activity in plasma from type 2 diabetic patients with maculopathy

Abstract: Diabetic maculopathy (DMa) is a leading cause of visual loss in the western world. We examined whether plasma from type 2 diabetic patients with DMa contains factor(s) capable of inducing expressio...

Genetics and Diabetic Renal Disease Still a big black hole

Abstract: Diabetic renal disease is still an extremely important and common complication in both type 1 and type 2 diabetic patients. Every clinician and nephrologist knows that diabetic patients constitute a large proportion of clientele in the dialysis unit, perhaps ∼50% or more, particularly in the U.S. and Japan. The figure is increasing for type 2 diabetes, whereas, encouragingly, a declining number is seen in type 1 diabetes, at least in Scandinavia. The cumulative incidence of proteinuria was previously estimated to be ∼40%, but it is less now, at least in type 1 diabetes, but figures vary from one country to another. Increased basement membrane thickness and mesangial expansion are hallmarks of glomerulopathy, but on the molecular level the exact renal locus or loci as well as detailed mechanisms for development of diabetic renal disease remain unclear, whereas it is well established that the major risk factors for development of nephropathy are poor glycemic control and elevated blood pressure. In particular, the two in combination, the so-called “double jeopardy,” is critical (1), but the concept of a dual jeopardy may have led to some confusion. Some patients who have poor glycemic control escape nephropathy, but such patients seem to have low blood pressure in long-term follow-up studies, also supporting the concept of dual jeopardy (2). A single risk factor like hyperglycemia may thus not always be sufficient to provoke clinical nephropathy. The cumulative absence of nephropathy in 60–80% of patients …