Oral glucose tolerance testing in an outpatient heart failure clinic reveals a high proportion of undiagnosed diabetic patients with an adverse prognosis

Egstrup, Michael; Schou, Morten; Gustafsson, Ida; Kistorp, Caroline; Hildebrandt, Per; Tuxen, Christian

doi:10.1093/eurjhf/hfq216

Cited by 42 publications

(48 citation statements)

References 35 publications

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“…Diabetics have an increased risk of developing heart failure [7], and CHF is an independent risk factor for the development of DM [8,9]. Cardiac functions are also associated with impairment of glucose metabolism [10].…”

Section: Discussionmentioning

confidence: 99%

The relationship between glycemic control and BNP levels in diabetic patients

Dal¹,

Ata

Yavuz

et al. 2014

Cardiol J

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Section: Discussionmentioning

confidence: 99%

The relationship between glycemic control and BNP levels in diabetic patients

Dal¹,

Ata

Yavuz

et al. 2014

Cardiol J

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“…109 Systematic assessment with oral glucose tolerance testing in patients with HF without a previous diagnosis of diabetes mellitus may also identify a large proportion (18%) of patients with newly diagnosed diabetes mellitus. 110 The presence of diabetes mellitus in patients with HF is associated with increased morbidity and mortality. 104,[111][112][113][114][115][116] In the CHARM Program (Candesartan Heart Failure Assessment of Reduction), rates of HF hospitalization in patients with diabetes mellitus were approximately twice the rates of those without diabetes mellitus.…”

Section: Association Of Diabetes Mellitus With the Development Of Incmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

371

220

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CLINICAL STATEMENTS AND GUIDELINESfailed to show a significant reduction of SBP in patients with resistant hypertension. 81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HFSeveral classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine calcium channel blockers such as diltiazem and verapamil should be avoided. 8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation), 82 as was felodipine. 73 In the current 2013 HF guidelines, most calcium channelblocking drugs except amlodipine are not recommended. 8Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associated with increased mortality in patients with HF; thus, centrally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF. 83In the ALLHAT trial, the α-blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treatment. 45 Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of α-blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEFMost patients with HF and preserved LVEF (HFpEF), especially elderly women, have hypertension. A significant proportion of these patients also have evidence of LV hypertrophy, and some may have atrial dilatation, cardiac enlargement, and wall motion abnormalities without LV systolic dysfunction. Patients with HFpEF may respond particularly well to the treatment of hypertension with regression of hypertrophy 84 and improvement in filling pressures. 84,85 Most patients with HFpEF require treatment with cardiac medications for the comorbidities of hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation. The 2013 HF guidelines suggest that the use of β-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control BP in patients with HFpEF. 8 The use of ARBs might also be considered to decrease hospitalizations for patients with HFpEF. recommendations Harmonized With Existing Guidelines for the recognition and Treatment of pa...

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“…Patients with diabetes have a 2.5-fold increased risk of developing heart failure [1]. On the other hand, heart failure is an independent risk factor for the development of diabetes [2][3][4]. Changes in heart function are associated with alterations in glucose metabolism [5,6] and whole-body insulin resistance is prevalent in chronic heart failure patients [7].…”

Section: Introductionmentioning

confidence: 99%

B-type natriuretic peptide (BNP) affects the initial response to intravenous glucose: a randomised placebo-controlled cross-over study in healthy men

et al. 2011

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Aims/hypothesis B-type natriuretic peptide (BNP) is a hormone released from cardiomyocytes in response to cell stretching and elevated in heart failure. Recent observations indicate a distinct connection between chronic heart failure and diabetes mellitus. This study investigated the role of BNP on glucose metabolism. Methods Ten healthy volunteers (25±1 years; BMI 23± 1 kg/m 2 ; fasting glucose 4.6±0.1 mmol/l) were recruited to a participant-blinded investigator-open placebo-controlled cross-over study, performed at a university medical centre. They were randomly assigned (sequentially numbered opaque sealed envelopes) to receive either placebo or 3 pmol kg −1 min −1 BNP-32 intravenously during 4 h on study day 1 or 2. One hour after beginning the BNP/placebo infusion, a 3 h intravenous glucose tolerance test (0.33 g/kg glucose + 0.03 U/kg insulin at 20 min) was performed. Plasma glucose, insulin and C-peptide were frequently measured.Results Ten volunteers per group were analysed. BNP increased the initial glucose distribution volume (13±1% body weight vs 11±1%, p<0.002), leading to an overall reduction in glucose concentration (p<0.001), particularly during the initial 20 min of the test (p=0.001), accompanied by a reduction in the initial C-peptide levels (1.42± 0.13 vs 1.62±0.10 nmol/l, p=0.015). BNP had no impact on beta cell function, insulin clearance or insulin sensitivity and induced no adverse effects. Conclusions/interpretation Intravenous administration of BNP increases glucose initial distribution volume and lowers plasma glucose concentrations following a glucose load, without affecting beta cell function or insulin sensitivity. These data support the theory that BNP has no diabetogenic properties, but improves metabolic status in men, and suggest new questions regarding BNP-induced differences in glucose availability and signalling in various organs/tissues. Trial registration: ClinicalTrials.gov: NCT01324739 Funding: The study was funded by Jubilée Fonds of the Austrian National Bank (OeNB-Fonds).

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Oral glucose tolerance testing in an outpatient heart failure clinic reveals a high proportion of undiagnosed diabetic patients with an adverse prognosis

Cited by 42 publications

References 35 publications

The relationship between glycemic control and BNP levels in diabetic patients

The relationship between glycemic control and BNP levels in diabetic patients

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

B-type natriuretic peptide (BNP) affects the initial response to intravenous glucose: a randomised placebo-controlled cross-over study in healthy men

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