Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.

OBJECTIVE -To determine the prevalence and factors associated with diabetic retinopathy in the Australian population and to estimate the time difference between disease onset and clinical diagnosis of type 2 diabetes.RESEARCH DESIGN AND METHODS -The Australian Diabetes, Obesity and Lifestyle study (AusDiab) included 11,247 adults aged Ն25 years in 42 randomly selected areas of Australia. Retinopathy was assessed in participants identified as having diabetes (based on self-report and oral glucose tolerance test), impaired fasting glucose, and impaired glucose tolerance and in a random sample with normal glucose tolerance. Data were available for 2,177 participants.RESULTS -Overall, 15.3% of those with diabetes had retinopathy. The prevalence of retinopathy was 21.9% in those with known type 2 diabetes (KDM) and 6.2% in those newly diagnosed (NDM). The prevalence of proliferative diabetic retinopathy (PDR) was 2.1% in those with KDM. No cases of PDR were found in those with NDM. Untreated vision threatening retinopathy (presence of PDR or macular edema) was present in 1.2% (n ϭ 4). Factors associated with retinopathy were duration of diabetes, HbA 1c , and systolic blood pressure. Using linear extrapolation of the prevalence of retinopathy with diabetes duration, the onset of diabetes in this population was approximately the time of diagnosis.CONCLUSIONS -This is one of the first national studies of diabetic retinopathy in a developed country. The prevalence of retinopathy was similar to that in other population-based studies. Vision threatening retinopathy was relatively rare; however, four untreated cases were identified. Regular screening for diabetic retinopathy and more aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy. Diabetes Care 26:1731-1737, 2003D iabetic retinopathy is a common complication of diabetes and despite the availability of effective treatment, it remains one of the leading causes of visual loss (1-5). Internationally there have been many studies assessing the prevalence of retinopathy, though few have looked at both those with previously and newly diagnosed diabetes (6 -8), and only one from a developed country has used a nationally representative population (9). Several factors have consistently been identified by both cross-sectional and prospective studies as risk factors in the development of diabetic retinopathy: duration of diabetes, systolic blood pressure (SBP), glycemic control, and urinary albumin (7,10). Other factors, including BMI, smoking, serum lipids, and Cpeptide, have shown varying results (7, 10 -13).By the time of clinical diagnosis of type 2 diabetes, some individuals already show evidence of diabetic retinopathy (7,14 -16), indicating that diabetes may have been present for several years. Extrapolating the relationship between duration of diabetes and prevalence of retinopathy back to a prevalence of zero, previous studies have estimated that the actual onset of diabetes is up to 12 years befor...

PurposeAge-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future.DesignMeta-analysis of prevalence data.ParticipantsA total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe.MethodsAMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV).Main Outcome MeasuresPrevalence of early and late AMD, BCVA, and number of AMD cases.ResultsPrevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95% CI 13.6%–21.5%) in those aged ≥85 years; for late AMD these figures were 0.1% (95% CI 0.04%–0.3%) and 9.8% (95% CI 6.3%–13.3%), respectively. We observed a decreasing prevalence of late AMD after 2006, which became most prominent after age 70. Prevalences were similar for gender across all age groups except for late AMD in the oldest age category, and a trend was found showing a higher prevalence of CNV in Northern Europe. After 2006, fewer eyes and fewer ≥80-year-old subjects with CNV were visually impaired (P = 0.016). Projections of AMD showed an almost doubling of affected persons despite a decreasing prevalence. By 2040, the number of individuals in Europe with early AMD will range between 14.9 and 21.5 million, and for late AMD between 3.9 and 4.8 million.ConclusionWe observed a decreasing prevalence of AMD and an improvement in visual acuity in CNV occuring over the past 2 decades in Europe. Healthier lifestyles and implementation of anti–vascular endothelial growth factor treatment are the most likely explanations. Nevertheless, the numbers of affected subjects will increase considerably in the next 2 decades. AMD continues to remain a significant public health problem among Europeans.

OBJECTIVE -This national, population-based study reports diabetes incidence based on oral glucose tolerance tests (OGTTs) and identifies risk factors for diabetes in Australians.RESEARCH DESIGN AND METHODS -The Australian Diabetes, Obesity and Lifestyle Study followed-up 5,842 participants over 5 years. Normal glycemia, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes were defined using World Health Organization criteria.RESULTS -Age-standardized annual incidence of diabetes for men and women was 0.8% (95% CI 0.6 -0.9) and 0.7% (0.5-0.8), respectively. The annual incidence was 0.2% (0.2-0.3), 2.6% (1.8 -3.4), and 3.5% (2.9 -4.2) among those with normal glycemia, IFG, and IGT, respectively, at baseline. Among those with IFG, the incidence was significantly higher in women (4.0 vs. 2.0%), while among those with IGT, it was significantly higher in men (4.4 04 -3.31]) were associated with incident diabetes. In age-and sexadjusted models, A1C was a predictor of diabetes in the whole population, in those with normal glycemia, and in those with IGT or IFG.CONCLUSIONS -Diabetes incidence is 10 -20 times greater in those with IGT or IFG than those with normal glycemia. Measures of glycemia, A1C, metabolic syndrome components, education level, smoking, and physical inactivity are risk factors for diabetes. Diabetes Care 31:267-272, 2008

The world is currently grappling with a dual pandemic of diabetes and coronavirus disease 2019 . Several articles published in the recent issues of Diabetes, Obesity and Metabolism and elsewhere have raised concerns about a bi-directional relationship between these two health conditions. [1][2][3][4][5][6][7][8] It is now undoubtedly proven that diabetes is associated with a poor prognosis of COVID-19. 6,[9][10][11][12][13] On the other hand, COVID-19 patients with diabetes frequently experience uncontrolled hyperglycaemia and episodes of acute hyperglycaemic crisis, requiring exceptionally high doses of insulin. 1,2,5,7,9,14 More intriguingly, recent reports show that newly diagnosed diabetes is commonly observed in COVID-19 patients. 2,3,5,15 However, this has not been systematically studied before. Therefore, we performed a systematic review and meta-analysis to examine the proportion of newly diagnosed diabetes in COVID-19 patients. This study was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 16 and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) 17 guidelines (see Figure S1 and Table S1 for checklists), and is registered with PROSPERO (registration no. CRD42020200432). Two authors (TS and YC) independently searched PubMed, MEDLINE, Embase and Scopus databases and preprint servers (medRxiv and Research Square) until 2 November 2020.We considered observational studies providing data on the number or proportion of COVID-19 patients (laboratory confirmed or clinically diagnosed) with newly diagnosed diabetes. We excluded observational studies that were conducted only among patients with diabetes, case reports, case series, letters, editorials, commentaries and review articles. Newly diagnosed diabetes was defined as new-onset diabetes