No abstract

Aim: To assess the effect of hepatitis C virus (HCV) eradication on type 2 diabetes mellitus (T2DM) incidence. Methods: A prospective multicentre case-control study was performed, which included 2426 patients with HCV, 42% of whom had liver fibrosis stage F0-F2 and 58% of whom had liver fibrosis stage F3-F4. The study population consisted of a control group including 1099 untreated patients and 1327 cases treated with directacting antivirals (DAAs). T2DM incidence was assessed during a median (interquartile range) follow-up period of 30 (28-42) months. Risk factors for T2DM were assessed using a Cox regression model (relative risk [RR], hazard ratio [HR], Kaplan-Meier analysis). Insulin sensitivity was evaluated by homeostatic model assessment (HOMA) and changes by repeated-measures ANOVA. Factors independently associated with T2DM were assessed by multivariate analysis. Results: The absolute incidence of T2DM for controls and cases was 28 and 7/1000 person-years, respectively (P = 0.001). In cases compared to controls, HCV clearance reduced the RR and HR of T2DM by 81% and 75% to 93%, respectively (P = 0.001). It was calculated that, for every 15 patients who obtained HCV clearance, one case of T2DM was saved. HCV clearance was associated with significant reductions in HOMA-insulin resistance and HOMA-β-cell function and an increase in HOMAinsulin sensitivity, as assessed in 384 patients before and after HCV clearance. At

No abstract

The authors investigated the efficacy of a lifestyle educational program, organized in small group meetings, in improving the outcome of a nonpharmacologic intervention. One hundred and eighty-eight hypertensive patients with stable blood pressure (BP) levels and drug therapy in the previous 6 months were randomly divided into educational care (EC) and usual care (UC) groups. They were followed at 3-month intervals up to 2 years. In addition to the visits in an outpatient clinic, patients in the EC program participated in small group meetings in order to improve their knowledge of the disease and reinforce their motivation for treatment. At baseline, EC and UC groups were similar for age, sex, body mass index (BMI), blood pressure (BP) levels, and pharmacologic treatment. Patients in the EC group had significantly reduced total energy, total and saturated fats, and sodium intake. Physical activity was significantly increased in the EC group as well. At the end of the 1-year follow-up, BMI (P<.001), visceral fat (P<.001), and BP (P<.001) were significantly lower in the EC group compared with the UC group. Pharmacologic treatment during the study was similar for all classes of drugs apart from diuretics whose dose was higher in the UC group at the end of the study. J Clin Hypertens (Greenwich). 2012;14:767-772. Ó2012 Wiley Periodicals, Inc.The association between arterial hypertension and other metabolic diseases has been frequently observed in the literature by several investigators and by ourselves in both clinical studies in the outpatient clinic and in observational studies in large population samples.1-4 Overweight status particularly seems to influence the development of hypertension but impairment in blood lipids and glucose are also involved, as seen in the metabolic syndrome.5 Accordingly, guidelines for optimal treatment of arterial hypertension indicate that nonpharmacologic intervention is the first approach in patients with low global cardiovascular risk and is associated with drug therapy in patients with moderate to high global risk. 6Despite the interest to prevent the vascular complications of hypertension, the goal of normal blood pressure (BP) levels is achieved in only <25% patients with hypertension worldwide. Reasons for this disappointing result vary, including low dosage of antihypertensive drugs, patients not taking prescribed pills, resistant hypertension, and poor compliance to prescribed nonpharmacologic measures. We have described the difficulties found by our patients in continuing a dietary approach to improve BP over a long period of time despite achieving significant improvement in BP and body weight (BW) control, associating lifestyle changes with pharmacologic treatment. The aim of the present study was to evaluate whether an educational program dedicated to nonpharmacologic measures to treat hypertension, including small group meetings with doctors and dieticians in addition to usual controls in the outpatient clinic would be useful in achieving better and long-lasting results i...

High blood pressure (BP) is one of the crucial determinants of the metabolic syndrome (MS). The extent to which MS, diagnosed according to the criteria of the International Federation of Diabetes, impacts on cardiovascular organ damage, independently of BP, is debated. Three hundred and forty hypertensive patients and 100 normotensive controls underwent the following procedures: (1) physical examination and resting BP measurements, (2) 24 h ambulatory BP monitoring, (3) laboratory routine examination, (4) echocardiography, (5) carotid ultrasonography and (6) ankle-brachial BP index. The syndrome was found in 104 of the 340 hypertensive patients (30.6). In comparison to those without MS, those with MS had significantly higher prevalence of left ventricular (LV) hypertrophy by mass/height 2.7 criteria (46 vs 42%, Po0.01) but not by LV mass/body surface criteria (30 vs 31%); the ratio between early-to-late peak velocities of the LV filling waves (E/A) was higher (E/ A ¼ 0.9970.14 vs 0.8970.15, Po0.01) and left atrium was larger (3.870.3 vs 3.570.5 cm, Po0.01). Both hypertensive groups had significantly greater LVM and carotid intima-media thickness than normotensives, without between-group-difference. In this hypertension outpatient clinic almost one-third hypertensive patients have MS. They show a deterioration in structure and function of the heart in comparison to hypertensive patients without MS, but no difference was detected in the carotid and peripheral arterial circulation.