Background: Renin-angiotensin system antagonists are the mainstays of blood pressure (BP) lowering strategies in people with diabetes. Perindopril a long half-life Angiotensin Converting Enzyme (ACE) inhibitor offers the advantage of a single daily dose, usually empirically taken in the morning. We therefore aimed to assess the influence of time of administration on the effect of Perindopril on circadian BP in type 2 diabetes (T2D) individuals with previously untreated stage 1 hypertension. Methods: Twenty T2D patients (9 being women) with a mean age of 58.7 years, newly diagnosed with stage 1 hypertension, were randomly allocated to receive perindopril 10 mg/day as monotherapy either in the morning or in the evening for 28 days, with crossover without washout period on day 29 th and additional 28 days follow-up. A 24hour ambulatory BP monitoring (ABPM) was performed at baseline, days 28 and 56. This study was retrospectively registered having a trial registration: ClinicalTrials.gov Identifier: NCT03393715. January 8, 2018. Results: Median diagnosed duration of diabetes was 2.0 years. At baseline, mean 24-hour systolic and diastolic BP were 137.0 mmHg and 84.5 mmHg, and mean albumin/ creatinine ratio (ACR) was 132.6 mg/g. There was no difference in the 24-hour systolic blood pressure pattern between the patients on morning perindopril and patients on evening perindopril (p = 0.61). The chronotherapeutic scheme did not influence neither ACR (p = 0.58) nor uric acid level (p = 0.32). However, the administration of 10 mg Perindopril lowered the ACR in both treatment allocation sequences; with an overall treatment effect of-41.7 (95% CI:-92.6 to 9.2) mg/g. Conclusions: The morning administration of perindopril did not prove to be superior to night time regimen for BP control in this group of sub-Saharan type 2 diabetes patients with stage 1 hypertension. However, the administration of perindopril seems to lower the ACR which is suggestive of the reno-protective effect of ACE inhibitors in patients presenting with hypertension and type 2 diabetes.

Introduction: Macroprolactin (MacroPRL), a variant of human prolactin, may interfere with hormonal assay and falsely increase serum prolactin levels. Therefore, failure to identify macroprolactinemia can lead to inappropriate investigations and treatment in women already susceptible to anxiety and stress. We aimed to identify macroprolactinemia among women of childbearing age with hyperprolactinemia. Materials and methods:We conducted a cross-sectional study in a tertiary care setting at the endocrine unit. Study participants were recruited from both endocrine and gynecological outpatient consultation services. They were women of childbearing age (18 to 49 years) consulting for signs and symptoms of gonadal dysfunction or hyperprolactinemia (PRL > 25 ng/ml). Total prolactin was measured using a Human direct ELISA method. Polyethylene glycol 6000 (PEG 6000) precipitation was used to detect macroprolactin. Results:We enrolled 33 women with a mean age of 31 ± 7 years (range 21-48). Twenty-seven (81.8%) participants were symptomatic, and the majority, 23/27 (69.7%) reported having galactorrhea, and 21 (63.4%) women reported having an irregular menstrual cycle. The median pre-precipitation prolactinemia reduced significantly after PEG precipitation from 61.2 (IQR: 33.2-115.9) ng/ml to 33.8 (IQR: 17.9-70.5) ng/ml, p < 0.001. After PEG precipitation 5 participants had a serum prolactin recovery rate below 60%, and therefore a prevalence of macroprolactinemia at 15.2%. Four out of five (80%) women with macroprolactinemia presented with symptoms which were (Amenorrhea, oligomenorrhea and galactorrhea). Conclusion:PEG 6000 permitted the detection of macroprolactinemia in women of childbearing age with hyperprolactinemia who otherwise would have been subjected to unnecessary medical investigations and treatment. Also, most of those with macroprolactin were symptomatic contrary to previous postulates.