Showing papers in "Journal of The Cardiometabolic Syndrome in 2007"

The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease.

Abstract: South Asians have high rates of diabetes and the highest rates of premature coronary artery disease in the world, both occurring about 10 years earlier than in other populations. The metabolic syndrome (MS), which appears to be the antecedent or "common soil" for both of these conditions, is also common among South Asians. Because South Asians develop metabolic abnormalities at a lower body mass index and waist circumference than other groups, conventional criteria underestimate the prevalence of MS by 25% to 50%. The proposed South Asian Modified National Cholesterol Education Program criteria that use abdominal obesity as an optional component and the South Asian-specific waist circumference recommended by the International Diabetes Federation appear to be more appropriate in this population. Furthermore, Asian Indians have at least double the risk of coronary artery disease than that of whites, even when adjusted for the presence of diabetes and MS. This increased risk appears to be due to South Asian dyslipidemia, which is characterized by high serum levels of apolipoprotein B, lipoprotein (a), and triglycerides and low levels of apolipoprotein A1 and high-density lipoprotein (HDL) cholesterol. In addition, the HDL particles are small, dense, and dysfunctional. MS needs to be recognized as a looming danger to South Asians and treated with aggressive lifestyle modifications beginning in childhood and at a lower threshold than in other populations.

The cardiometabolic syndrome and sarcopenic obesity in older persons.

Abstract: The aging of the world's population is a major contributor to the growing prevalence of the cardiometabolic syndrome (CMS) because older persons are more affected by the constellation of cardiovascular risk factors that constitute the syndrome. The prevalence of CMS has been related to the increasing prevalence of obesity, which is growing progressively even among older age groups. Indeed, obesity and aging are 2 overlapping mounting public health problems. It is currently accepted that CMS predicts cardiovascular mortality and/or the development of type 2 diabetes mellitus, and this is also true in studies including older persons. CMS is further complicated by modifications in body composition and fat redistribution during aging; older adults are at higher risk for developing central obesity and sarcopenia or sarcopenic obesity, a condition characterized by an important reduction in lean body mass associated with obesity, linked to an increased production of inflammatory adipokines that may alter insulin sensitivity and muscle mass and strength. A better understanding of the pathophysiologic mechanisms of sarcopenic obesity may help to elucidate the complex relationship between CMS and mortality/morbidity in older adults.

Diabetes and Hypertension: Epidemiology of the Relationship and Pathophysiology of Factors Associated With These Comorbid Conditions

Abstract: Diabetes and hypertension frequently coexist, leading to additive increases in the risk of life-threatening cardiovascular events. Hypertension is a common comorbid condition in patients with type 1 or type 2 diabetes when compared with the general population and occurs in 75% of patients with the more prevalent form of diabetes, type 2. Arterial blood pressure plays an important role in the development of renal damage and presents a complex relationship. It is well-known that hypertension accelerates the course of microvascular and macrovascular complications of diabetes and that hypertension often precedes type 2 diabetes and vice versa. Patients with type 1 and 2 diabetes and nephropathy frequently have circadian changes in blood pressure that correlate to nephropathy risk. Early detection of nocturnal hypertension and early intervention with angiotensin blockade may delay progression of diabetic nephropathy.

Fatty acid consumption and metabolic syndrome components: the GOCADAN study.

Abstract: Fatty acids (FAs) have been related to changes in glucose and lipid metabolism. In this article, the authors assess the association between intake of specific FAs and components of the metabolic syndrome (MS) in adult Eskimos. A total of 691 Inupiat Eskimos (325 men and 366 women), aged 34 to 75 years, were examined as part of the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. The investigation included a physical examination, blood pressure measurements, blood sampling under fasting conditions, 2-hour oral glucose tolerance test, and a personal interview including a validated food frequency questionnaire. Components of MS were defined according to the Third Report of the National Cholesterol Education Program Adult Treatment Panel criteria. Consumption of individual FAs showed associations with MS components. Long-chain omega-3 FAs, from fish and sea mammals, were associated with lower blood pressure, serum triglycerides, and 2-hour glucose and higher high-density lipoprotein cholesterol, fasting insulin, and homeostasis model assessment. Saturated fat consumption was associated with higher triglyceride levels and blood pressure. Trans-FA consumption was associated with higher blood pressure. Consumption of long-chain omega-3 FAs from marine sources may improve certain MS components, and thus may reduce risk for cardiovascular disease. High consumption of saturated FAs and trans-FAs may have an adverse effect on MS.

The Metabolic Syndrome in East Asians

Abstract: The metabolic syndrome is an emerging epidemic in developing nations, including East Asian countries such as China, Japan, and Korea. Studies examining the metabolic syndrome have used different definitions, with prevalence often highly dependent on the cut points for abdominal obesity utilized, which have been recommended by the International Diabetes Federation to be lower than standards used in Caucasians and other ethnic groups. Prevalence rates have generally varied from 8% to 13% in men and 2% to 18% in women, depending on ethnic group and definition used, and are consistently lower than most Western Caucasian populations. While recent dramatic changes in lifestyle from Westernization of dietary habits and reduced physical activity present challenges, an emphasis on healthful lifestyle changes remains the cornerstone for metabolic syndrome management. In addition, clinical management focusing on control of obesity, elevated blood pressure, dyslipidemia, and hyperglycemia, with consideration of pharmacologic therapy issues unique to certain Asian populations, remains important for reducing associated cardiometabolic risks.

Myocardial velocity, strain, and strain rate abnormalities in healthy obese children.

Abstract: Childhood obesity is a major health care issue in the United States. This epidemic has important cardiovascular implications. Newer imaging modalities in obese adults have demonstrated abnormal systolic and diastolic cardiac function. The authors proposed to determine whether these abnormalities are present in obese children. A total of 168 children were identified from our echocardiographic database. Body mass index for age was calculated. Echocardiographic clips were analyzed using imaging technology to determine myocardial motion, strain, and strain rate. Patients at risk for obesity and those meeting criteria for obesity had increased late diastolic myocardial motion compared with normal-weight children. Obese patients had decreased systolic strain compared with normal-weight children. As with adults, obese children have significant differences in diastolic function and strain. These abnormalities may be subtle markers for the emergence of future cardiac disease.

Avoiding the looming Latino/Hispanic cardiovascular health crisis: a call to action.

Abstract: Cardiovascular disease (CVD) is the leading cause of death among the largest and fastest growing ethnic minority in the United States, Latinos/Hispanics. To review recent findings on the prevalence of CVD, CVD risk factors, and related illnesses in the US Latino/Hispanic population, an extensive PubMed and Internet literature search for studies published from January 1995 to July 2005 was conducted, using a combination of search terms. Data validity was assessed based on the quality of the source and a consensus of the authors on perceived validity. The review found limitations in current research as well as treatment methods and options for Latino/Hispanic persons at risk for developing CVD and related illnesses. Because of these limitations and the large public health concern, additional research is required to fully determine the best predictors of CVD and diabetes in Latino/Hispanic patients. A combined effort of health-influencing and health-governing bodies is needed on all levels to address the CVD problem in the Latino/Hispanic population.

The Metabolic Syndrome and Subclinical Carotid Atherosclerosis: The Northern Manhattan Study

Abstract: The metabolic syndrome (MetS) is a distinctive phenotype associated with an increased risk of vascular disease. Carotid plaque is a surrogate marker of subclinical atherosclerosis and a powerful predictor of vascular outcomes. The relationship between the MetS and subclinical atherosclerosis in multiethnic populations has not been well characterized. The authors have evaluated the association of the MetS with subclinical atherosclerosis among 1895 community residents from the Northern Manhattan Study (mean age, 68.0±9.7 years; 59% women; 25% black; 22% white; 51% Hispanic). The prevalence of the MetS was 41% (35% in men, 45% in women), and 57% of subjects had carotid plaque. In a multivariate-adjusted logistic regression model, the MetS was a significant predictor of plaque presence (odds ratio, 1.36; 95% confidence interval, 1.10–1.67). Additionally, the number of MetS components was significantly associated with plaque prevalence. Further studies are needed to understand the role of the MetS in the progression from subclinical to clinical atherosclerotic disease.

Combination of chromium and biotin improves coronary risk factors in hypercholesterolemic type 2 diabetes mellitus: a placebo-controlled, double-blind randomized clinical trial.

Abstract: Dyslipidemia, often found in type 2 diabetes mellitus (T2DM) patients, plays an important role in the progression of cardiometabolic syndrome. Two essential nutrients, chromium and biotin, may maintain optimal glycemic control. The authors report here a randomized, double-blind placebo-controlled trial (N=348; chromium picolinate and biotin combination [CPB]: 226, placebo: 122; T2DM participants with hemoglobin A1c [HbA1c] >or=7%) evaluating the effects of CPB on lipid and lipoprotein levels. Participants were randomly assigned (2:1 ratio) to receive either CPB (600 microg chromium as chromium picolinate and 2 mg biotin) or a matching placebo once daily for 90 days. Statistical analyses were conducted in all eligible participants. Subsequent supplemental analyses were performed in T2DM participants with hypercholesterolemia (HC) and in those using stable doses of statins. In the primary analysis, CPB lowered HbA1c (P<.05) and glucose (P<.02) significantly compared with the placebo group. No significant changes were observed in other lipid levels. In participants with HC and T2DM, significant changes in total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels and atherogenic index were observed in the CPB group (P<.05). Significant decreases in LDL-C, total cholesterol, HbA1c , and very low-density cholesterol levels (P<.05) were observed in the CPB group taking statins. CPB treatment was well tolerated with no adverse effects, dissimilar from those associated with placebo. These data suggest that intervention with CPB improves cardiometabolic risk factors.

Prevalence of the metabolic syndrome in patients with hypertension treated in general practice in Spain: an assessment of blood pressure and low-density lipoprotein cholesterol control and accuracy of diagnosis.

Abstract: This study was designed to evaluate whether primary care physicians in Spain accurately diagnose the metabolic syndrome in hypertensive patients, to define the profile and management of these patients in clinical practice, and to ascertain the level of blood pressure and low-density lipoprotein cholesterol control. Data were analyzed from a cross-sectional survey involving 12,954 patients with hypertension (Prevencion Cardiovascular en Espana en Atencion Primaria: Intervencion Sobre el Colesterol en Hipertension [PRESCOT] study), wherein 52% of the cohort fulfilled the National Cholesterol Education Program-Adult Treatment Panel criteria for the metabolic syndrome. The majority of patients (54.6%) had 3 risk factors, 32.4% had 4, and 13% had 5 risk factors. Physician diagnosis of the metabolic syndrome was poor, with 43.7% of physicians missing the diagnosis and 12.9% wrongly diagnosing the metabolic syndrome. Blood pressure and low-density lipoprotein cholesterol control rates were very low, with only 4.7% of metabolic syndrome patients achieving control for both blood pressure and low-density lipoprotein cholesterol vs 13.5% for non-metabolic syndrome patients (P<.0001). These findings demonstrate that the metabolic syndrome is common in patients with hypertension and that it is generally poorly diagnosed and treated by primary care physicians.

Cardiovascular risk with subclinical hyperthyroidism and hypothyroidism: pathophysiology and management.

Abstract: Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. Similarly, patients with subclinical hyperthyroidism have nearly 3 times the likelihood of atrial fibrillation over a 10-year follow-up interval, raising the question of whether patients with subclinical hyperthyroidism should be treated to prevent atrial fibrillation. A single measurement of low serum TSH in individuals aged 60 years or older has been reported to be associated with increased mortality from all causes and in particular from circulatory and cardiovascular disease in a 10-year follow-up study. Subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications.

The pathophysiology of cardiovascular disease in diabetes mellitus and the future of therapy.

Abstract: Diabetes mellitus is a complex disease with several metabolic abnormalities leading to varied, interconnected endothelial and vascular dysfunction and resulting in accelerated atherosclerosis. Cardiovascular disease is the main cause of mortality in patients with diabetes. Apart from traditional therapy for control of hyperglycemia and other associated comorbidities, various newer therapies are being investigated to fight atherosclerosis at a molecular level. In this review, the authors briefly describe the pathophysiology of cardiovascular disease in patients with diabetes mellitus and the future of therapy.

Hypoadiponectinemia as a marker of adipocyte dysfunction--part II: the functional significance of low adiponectin secretion.

Abstract: Low adiponectin expression is common in obesity and is tightly linked to insulin resistance and fat mass expansion. Whereas normal adipocytes offer effective metabolic buffering through well-controlled release and uptake of free fatty acids on demand, adipocyte expansion induced by caloric excess and modulated by genetic, regional, and systemic factors elicits major unfavorable changes in fat cell phenotypes. Large, dysfunctional adipocytes show increased lipolysis and enhanced expression and secretion of proinflammatory and pro-oxidative cytokines. Low adiponectin secretion is a hallmark of impaired adipocyte function; its secretion is inhibited by cytokines such as tumor necrosis factor α, interleukin 6 and plasminogen activator inhibitor 1 and by high oxidative stress induced by increased fatty acids that activate nicotinamide adenine dinucleotide phosphate-oxidase. The ensuing hypoadiponectinemia may aggravate insulin resistance and facilitate the evolution of type 2 diabetes. Only massive weight loss allows true and sustained recovery of normal fat cell function as reflected by adiponectin secretion.

C-reactive protein in cardiovascular risk assessment: a review of the evidence.

Abstract: C-reactive protein (CRP) is an inflammatory biomarker that is strongly associated with coronary heart disease, inflammation, and the metabolic syndrome Large-scale prospective cohort trials have shown that measurement of CRP may add predictive accuracy to the Framingham risk score, but interpretation of these data are conflicting In the primary prevention setting, CRP can be used to reclassify patients in low or intermediate Framingham risk score groups to a higher risk category, thus making them eligible for more intensive pharmacologic interventions

Albuminuria and chronic kidney disease in association with the metabolic syndrome.

Abstract: Chronic kidney disease is a worldwide public health problem because it is an important risk factor for cardiovascular disease and premature death. The metabolic syndrome, which is characterized by abdominal obesity, high blood pressure, impaired glucose tolerance, and dyslipidemia, is also an increasingly common disorder and a major risk factor for diabetes and cardiovascular disease. A close association has been found between the metabolic syndrome and the risk for developing renal impairment, clinically expressed in the form of microalbuminuria or chronic kidney disease. Several potential mechanisms, including insulin resistance, renal atherosclerosis, and inflammation, induce the deterioration of renal function. Despite the close association between the metabolic syndrome and renal impairment, it is still unclear whether and to what extent treating the metabolic syndrome will prevent renal impairment. A clinical trial is needed to clarify whether the effect of preventing and treating metabolic syndrome components will result in improved renal prognosis.

Cardiovascular disease disparities in native Hawaiians

Abstract: Although Hawaii boasts relatively low rates of death from heart disease and stroke, past data suggest that Native Hawaiians bear a disproportionate burden of mortality from cardiovascular disease (CVD). This study examined 2005-2006 data on CVD mortality and risk factors to see if disparities experienced historically by Native Hawaiians have continued, increased, or been reduced. Existing data were reviewed related to CVD and risk factors for Native Hawaiians in Hawaii and compared with statewide and US rates. These data show that Native Hawaiians are experiencing continuing and perhaps growing disparities in CVD mortality rates and risk factor prevalence. Nevertheless, increased support for enlightened social policy and community-directed problem solving can help reduce CVD health disparities experienced by Native Hawaiians. Future research should be directed at better delineation of the various components of cardiometabolic risk and culturally sensitive, and educationally appropriate approaches to CVD risk reduction.

Hypoadiponectinemia as a Marker of Adipocyte Dysfunction—Part I: The Biology of Adiponectin

Abstract: Adiponectin is the most abundantly secreted adipocyte-derived peptide hormone, possessing an array of antidiabetogenic and cardiovascular protective effects. Acting through 2 distinct membrane receptors, adiponectin receptors 1 and 2 (which utilize 5'-adenosine monophosphate-activated protein kinase phosphorylation, p38 mitogen-activated protein kinase, and peroxisome proliferator-activated receptor α as key cell signaling elements), adiponectin increases hepatic and skeletal muscle sensitivity to insulin, enhances fatty acid oxidation, suppresses monocyte-endothelial interaction, supports endothelial cell growth, lowers blood pressure, and moderates adipose tissue growth. The secretion of adiponectin can be suppressed by adipose factors, which are turned on once fat cell mass increases, such as cytokines, adipose renin-angiotensin system, and increased oxidative stress. Inhibition of adiponectin secretion results in the loss of an array of mechanisms, which under normal conditions of fat cell homeostasis provide protection from insulin resistance, diabetes, and atherosclerosis.

Insulin resistance and oxidant stress: an interrelation with deleterious renal consequences?

Abstract: Within the past years, several epidemiologic studies have shown that insulin resistance and hyperinsulinemia are associated with chronic kidney disease, and experimental data suggest that a number of background mechanisms could connect insulin resistance with renal injury. Moreover, the acute sodium-retaining action of insulin at the kidney level has been proposed to participate in the development of salt sensitivity in essential hypertension. Current knowledge suggests that oxidative stress can be involved in the development of renal injury and can also promote primary salt retention at the kidney level. Insulin resistance and hyperinsulinemia seem to be closely connected with oxidative stress in the form of a vicious circle. This article discusses the potential role of oxidative stress as a mediator of the renal effects of insulin resistance/hyperinsulinemia.

The metabolic syndrome in American Indians: the strong heart study

Abstract: Although the underlying cause of the metabolic syndrome (MS) is not entirely clear, it is thought that MS results from central obesity and insulin resistance (IR). IR has long been known to be a predictor of type 2 diabetes in many populations, including American Indians, the group with a rising prevalence of obesity and the highest rate of diabetes in the United States. In addition to being a predictor of diabetes, MS has now been shown to be associated with higher risk of cardiovascular disease, independent of diabetes, in American Indians as well as in other ethnic groups. Furthermore, MS may carry a risk beyond that of single risk factors. Identifying MS in American Indians and treating the factors that comprise it may reduce risk of both diabetes and cardiovascular disease in this population.

Why is blood pressure so hard to control in patients with type 2 diabetes

Abstract: Resistance to antihypertensive drugs is common in hypertensive patients with type 2 diabetes. This is unfortunate because hypertension is one of the most important risk factors for development of cardiovascular events, and the goal blood pressure level is set lower in diabetic subjects than in nondiabetic subjects. Previous outcome trials in diabetic subjects have mainly focused on end points such as microalbuminuria or the incidence of cardiovascular events rather than on reduction of blood pressure; some reports, however, have suggested mechanisms for the drug resistance. These include several clinical conditions known to be associated with difficulty in reducing blood pressure specifically in diabetes mellitus: change in the renin-angiotensin system and chymase, volume overload, central sympathetic hyperactivity, sleep apnea, secondary hypertension, pseudoresistance (white coat hypertension), and poor compliance related to subclinical depression. In this review, the authors focus on the mechanisms of resistance to antihypertensive therapy (particularly for monotherapy with either angiotensin-converting enzyme inhibitors or angiotensin II antagonists) in the treatment of diabetic hypertension.

Prediabetes in rural and urban children in 3 states in Mexico.

Abstract: The authors studied the frequency, distribution, and factors associated with prediabetes (fasting glucose, 100–125 mg/dL) in rural and urban children from San Luis Potosi, Leon, and Queretaro in central Mexico. Family history, somatometry, and levels of fasting insulin, glucose, and lipids were collected in 1238 children 6 to 13 years of age. The authors found no cases of type 2 diabetes and a 5.7% frequency of prediabetes. The group with prediabetes had higher homeostasis model assessment of insulin resistance scores and total cholesterol and high-density lipoprotein cholesterol levels. Prediabetes was more frequent in Leon, with similar distribution in rural and urban children. The frequency of insulin resistance was 24.1%, with higher figures in urban groups and in San Luis Potosi. In multivariate analysis, prediabetes was associated with insulin resistance and residence in Leon. The authors concluded that in central Mexico the frequency of prediabetes is significant, and it is associated with insulin resistance and a geographic location, but not with obesity or urban vs rural dwelling.

Serum Uric Acid Is Significantly Related to the Components of the Metabolic Syndrome in Japanese Workingmen

Abstract: The aim of this study was to examine whether serum uric acid (SUA) concentration was related to the metabolic syndrome (MS). A total of 981 Japanese workingmen were studied. MS was diagnosed based on the modified criteria of the International Diabetes Federation. MS was present in 8.0% of the target participants. Logistic regression analysis using a cutoff value of the SUA of 7.0 mg/dL showed that some components of MS and the logarithmic value of the serum C-reactive protein were associated with a significant odds ratio for predicting elevated SUA. The odds ratios and 95% confidence intervals (CIs) of a high logarithmic value of the serum C-reactive protein, large waist girth, elevated blood pressure, and dyslipidemia for elevated SUA were 1.76 (CI, 1.21–2.55), 1.72 (CI, 1.21–2.45), 1.42 (CI, 1.01–2.00), and 1.87 (CI, 1.30–2.69), respectively. Most of the components of MS were significant determinants of SUA.

Impact of the metabolic syndrome on total arterial compliance in essential hypertension patients.

Abstract: The aim of the study was to cross-sectionally analyze, in a group of essential hypertension patients without diabetes mellitus, the influence of the metabolic syndrome (MS) on the stroke volume index to pulse pressure (SVi/PP) ratio, a measure of total arterial compliance. A total of 528 essential hypertension patients, aged 18 to 72 years, free from cardiovascular and renal disease (41% of whom had MS) were enrolled. All participants underwent routine blood chemistry, echocardiographic examination, and 3 blood pressure measurements at the end of echocardiographic examination. When compared with participants who did not have MS, hypertensive patients with MS exhibited lower SVi/PP ratio (0.65+/-0.22 vs 0.73+/-0.21 mm Hg; P=.0003). The independent association of MS with SVi/PP ratio (beta=0.10; P=.02) was confirmed in a multivariate regression model including age, sex, and other potential confounders as covariates. The authors' finding may help to explain the enhanced cardiovascular risk associated with MS.

New evidence confirms risks associated with prehypertension and benefits of therapeutic lifestyle changes in management.

Abstract: TJ is a 57-year-old female high school biology teacher who presents for a routine checkup. She has a strong family history of heart disease and wants to ensure that she does everything possible to keep her risk low. TJ is postmenopausal and stopped hormone replacement therapy 3 years ago. Physical examination is unremarkable other than the fact that the patient is overweight, with a body mass index of 29.2 kg/m2, and her blood pressure (BP) is 132/84 mm Hg. Her fasting plasma glucose level is 103 mg/dL, high-density lipoprotein cholesterol level 38 mg/dL, and triglyceride level 165 mg/dL. Based on her BP and concurrent cardiometabolic syndrome, what do you tell her about the risks associated with her BP, and how do you approach her management?

The cardiometabolic syndrome in persons of the African diaspora: challenges and opportunities.

Abstract: Unique genetic traits appear to play a role in the increased rates of hypertension (HTN), glucose dysregulation/diabetes (T2DM), and obesity in persons of African descent. Indeed, with increasing rates of westernization/urbanization and concomitant increases in obesity and T2DM, a similar predisposition to the cardiometabolic syndrome and cardiovascular disease (CVD) can be seen in Africans compared with persons of African descent, with CVD reaching epidemic proportions in many areas of Africa. In addition, the complex relationships of metabolic abnormalities that are unique to individuals of African descent have also been demonstrated in Africans. These include: (1) a dissociation of HTN to insulin resistance; (2) relative favorable lipid profile in the setting of increasing rates of CVD; (3) low levels of visceral adiposity in the setting of obesity and insulin resistance; and (4) a dissociation of insulin sensitivity and adiponectin when compared with Caucasians. Although not well understood, these unique relationships suggest that conventional parameters for CVD do not apply to Africans of persons of African descent.

Treatment of hypertension with thiazides: benefit or damage-effect of low- and high-dose thiazide diuretics on arterial elasticity and metabolic parameters in hypertensive patients with and without glucose intolerance.

Abstract: Thiazide diuretics may cause multiple metabolic abnormalities. The authors investigated the effects of varying doses of hydrochlorothiazide (HCTZ) on arterial elasticity and metabolic parameters in patients with hypertension (HTN), HTN and impaired fasting glucose (HTN+IFG), and HTN and type 2 diabetes mellitus (HTN+DM). The patients received low and high doses of HCTZ. Systolic and diastolic blood pressures declined significantly during the first 3 months in all patients, but no additional decrease was seen following the increase in HCTZ dose. In HTN, large artery elasticity index and small artery elasticity increased during the study. In HTN+IFG, large artery elasticity index increased without improvement in small artery elasticity index. In HTN+DM, both large artery elasticity index and small artery elasticity index did not improve during follow-up. Low-dose HCTZ improves arterial elasticity in hypertensive patients, but this effect is diminished with concomitant DM or IFG. The HCTZ dose increase worsened parameters of glucose metabolism and did not further decrease blood pressure or improve arterial elasticity.