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- December 1, 2008 |
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Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists.
CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"Pharmacological Intervention in CVD Risk Factors - Components of the Metabolic Syndrome: Hypertension"Prof. Stefano Del Prato (biography)
English - 2005-04-15 - 33 minutes
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Summary :
Insulin resistance occurs in many hypertensive patients. Moreover, increased blood pressure levels have been included in the ATP III diagnostic criteria for the Metabolic Syndrome, a condition that is believed to recognize insulin resistance as the background pathogenetic factor. Based on these assumptions, it has been suggested that 1. treatment of hypertension should not aggravate insulin resistance and 2. relief of insulin resistance might impact on arterial blood pressure. Diet, physical exercise, and modest reduction of body weight can effectively improve insulin sensitivity as well as reduce blood pressure. Similarly, drug-induced reduction of body weight and waist circumference is associated with improvement of blood pressure values. More discrepant are the results obtained with insulin sensitizing drugs. In lean essential hypertensive non-diabetic individuals metformin administration can reduce insulin resistance without eliciting any significant effect on arterial blood pressure, although metformin treatment in obese Type 2 diabetic individuals was associated with significant reduction in blood pressure. Similarly, clinical trials have indicated that treatment of Type 2 diabetic patients with PPAR-g agonists can lead to modest though significant reduction of systolic blood pressure. Current approach, however, requires aggressive treatment of hypertension in patients with Metabolic Syndrome, particularly in the presence of microalbuminuria, a recognized risk factor for cardiovascular disease and diabetic nephropathy. Blockade of the renin-angiotensin system (RAS) by ACE-inhibitors and antagonists of angiotensin receptors (ARB) have been shown to prevent cardiovascular events and kidney disease in insulin resistant Type 2 diabetic patients. Moreover, RAS blockade can improve insulin sensitivity, increase skeletal muscle blood flow, decrease hepatic insulin clearance, exert positive effects on abdominal fat, exert anti-inflammatory and protective effects on oxidative stress, thus acting on many of the alterations characterizing the Metabolic Syndrome. These effects may also account for the reduction of conversion to diabetes in individuals treated with the RAS blockade.
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The importance of hypertension in the definition of the metabolic syndrome
• Improving insulin sensitivity to reduce blood pressure
• Treating hypertension without worsening insulin resistance
Bibliographic references :
Pedrinelli, Roberto; Dell'Omo, Giulia; Penno, Giuseppe; Di Bello, Vitantonio; Giorgi, Davide; Pellegrini, Giovanni; Del Prato, Stefano; Mariani, MarioMicroalbuminuria, a parameter independent of metabolic influences in hypertensive men. Journal of Hypertension. 21(6):1163-1169, June 2003.
Giuseppe Schillaci, Matteo Pirro, Gaetano Vaudo, Fabio Gemelli, Simona Marchesi, Carlo Porcellati and Elmo MannarinoPrognostic value of the metabolic syndrome in essential hypertension Journal of the American College of Cardiology Volume 43, Issue 10 , 19 May 2004, Pages 1817-1822
Jaakko Tuomilehto, M.D., Ph.D., Jaana Lindstrom, M.S., Johan G. Eriksson, M.D., Ph.D., Timo T. Valle, M.D., Helena Hamalainen, M.D., Ph.D., Pirjo Ilanne-Parikka, M.D., Sirkka Keinanen-Kiukaanniemi, M.D., Ph.D., Mauri Laakso, M.D., Anne Louheranta, M.S., Merja Rastas, M.S., Virpi Salminen, M.S., Sirkka Aunola, Ph.D., Zygimantas Cepaitis, Dipl.Eng., Vladislav Moltchanov, Ph.D., Martti Hakumaki, M.D., Ph.D., Marjo Mannelin, M.S., Vesa Martikkala, M.S., Jouko Sundvall, M.S., Matti Uusitupa, M.D., Ph.D., for the Finnish Diabetes Prevention Study Group Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance NEJM Volume 344:1343-1350
Andrea Natali, Stephanie Baldeweg, Elena Toschi, Brunella Capaldo, Daniele Barbaro, Amalia Gastaldelli, John S. Yudkin, and Ele FerranniniVascular Effects of Improving Metabolic Control With Metformin or Rosiglitazone in Type 2 DiabetesDiabetes Care 27: 1349-1357
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