Resistant Hypertension in Diabetes Mellitus

Bayliss, George; Weinrauch, Larry A.; D’Elia, John A.

doi:10.1007/s11892-014-0516-y

Cited by 8 publications

(3 citation statements)

References 55 publications

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“…127 Moreover, in T2DM patients, masked hypertension is not infrequent and monitoring 24 h ambulatory BP may be a useful approach. 128 Reductions of BP were achieved by some exercise training protocols, mostly AET programmes, 11,12,41,42,52,56 but were accompanied by significant changes of the mean BMI, making the interpretation of BMI-independent effects difficult. In contrast, a trial in 140 T2DM patients did not find any changes in BP after six months of supervised combined AET/resistance training, while fitness and body composition were improved significantly.…”

Section: Exercise Training Targetsmentioning

confidence: 99%

Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

Kemps

Kränkel

Dörr

et al. 2019

Eur J Prev Cardiolog

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Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.

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Section: Exercise Training Targetsmentioning

confidence: 99%

Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

Kemps

Kränkel

Dörr

et al. 2019

Eur J Prev Cardiolog

View full text Add to dashboard Cite

show abstract

“…The risk of cardiovascular events is 4-fold higher in patients with both DM and hypertension, compared with the normotensive controls [19]. DM and hypertension share several pathophysiological mechanisms including inappropriate activation of the renin-angiotensin-aldosterone system, increased sympathetic nervous system activation, insulin resistance and hyperinsulinemia, oxidative stress, inflammation, impaired insulin-mediated vasodilatation, and abnormal renal processing of sodium [19,20]. On the other hand, some research has suggested a direct association between DM and primary hyperaldosteronim.…”

Section: Diabetes and Resistant Hypertensionmentioning

confidence: 99%

Resistant Hypertension in Diabetes Mellitus

Armario¹

2015

JED

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“…Hypertension is approximately twice as frequent in diabetes mellitus (DM) compared with non-DM patients 6) and RHTN is highly associated with DM, 7) but the etiology of hypertension and cardiovascular complications in DM patients is not fully understood. 8) It was reported that add-on treatment of an MR antagonist alleviated persistent albuminuria in DM patients with conventional antihypertensive treatment, 9) which suggests that aberrant MR activation could be also an underlying mechanism of hypertension in DM patients.…”

mentioning

confidence: 99%

High Glucose Stimulates Mineralocorticoid Receptor Transcriptional Activity Through the Protein Kinase C β Signaling

et al. 2017

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SummaryActivation of mineralocorticoid receptor (MR) is shown in resistant hypertension including diabetes mellitus. Although protein kinase C (PKC) signaling is involved in the pathogenesis of diabetic complications, an association between PKC and MR is not known. Activation of PKCα and PKCβ by TPA (12-OTetradecanoylphorbol 13-acetate) increased MR proteins and its transcriptional activities in HEK293-MR cells. In contrast, a high glucose condition resulted in PKCβ but not PKCα activation, which is associated with elevation of MR protein levels and MR transcriptional activities. Reduction of endogenous PKCβ by siRNA decreased those levels. Interestingly, high glucose did not affect MR mRNA levels, but rather decreased ubiquitination of MR proteins. In db/db mice kidneys, levels of phosphorylated PKCβ2, MR and Sgk-1 proteins were elevated, and the administration of PKC inhibitor reversed these changes compared to db/+ mice. These data suggest that high glucose stimulates PKCβ signaling, which leads to MR stabilization and its transcriptional activities.( 3) which have elucidated that add-on therapy of MR antagonist is beneficial for the improvement of prognosis in heart failure patients, we became aware in recent decades that aberrant MR activation could be crucially involved in cardiovascular morbidity and mortality. Indeed it is prevalently known that primary aldosteronism, in which aldosterone excess causes hypertension through MR activation, increases the risk of cardiovascular events such as myocardial infarction and arrhythmia by three-to five-fold over essential hypertension.4) Additionally, add-on treatment of an MR antagonist has also been demonstrated to be effective in resistant hypertension (RHTN), 5) suggesting that activation of MR would play a key role on the progression of RHTN. These clinical findings has been driving many researchers to focus on the molecular mechanism of aberrant MR activation in RHTN and its related organ damages, but a detailed mechanism remains largely unknown.Hypertension is approximately twice as frequent in diabetes mellitus (DM) compared with non-DM patients 6) and RHTN is highly associated with DM, 7) but the etiology of hypertension and cardiovascular complications in DM patients is not fully understood.8) It was reported that add-on treatment of an MR antagonist alleviated persistent albuminuria in DM patients with conventional antihypertensive treatment, 9) which suggests that aberrant MR activation could be also an underlying mechanism of hypertension in DM patients. We have recently proposed such MR antagonist-responsive hypertension as "MR-associated hypertension" 10) and investigated the molecular actions of MR, among which we identified several novel coregulators of MR. 11,12) DM is a major cause of macro-and microvascular complications. The molecular mechanisms for those vascular complications have been explained by several moFrom the

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Resistant Hypertension in Diabetes Mellitus

Cited by 8 publications

References 55 publications

Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

Resistant Hypertension in Diabetes Mellitus

High Glucose Stimulates Mineralocorticoid Receptor Transcriptional Activity Through the Protein Kinase C β Signaling

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