OBJECTIVES: The ELITE study (German acronym for "Nutrition, lifestyle and individual information for prevention of heart attack, stroke and dementia") prospectively collects data on hypertension, cardiovascular risk factors (RF), dietary habits, physical activity, cognitive function, and quality of life in North-West Germany, which will then be improved through targeted individual information. The aim of the study is to improve the health of the participants in the long term and to identify reasons for a lack of implementation of prevention measures. METHODS: Of 4,602 included subjects, 3,868 could be studied so far at one-year follow-up. Blood pressure (BP) was measured according to the guidelines at admission and blood pressure history, premedication, sports behaviour and BMI were recorded by means of questionnaires and compared with the data collected in the follow-up examination after one year. RESULTS: The participants were evaluated in 4 groups (G): G1 - normotensive patients (n = 1,558), G2 - controlled hypertensive patients (n = 502), G3 - untreated uncontrolled hypertensive patients (n = 1,080), G4 - treated uncontrolled hypertensive patients (n = 728). In G1 blood pressure (RR) remained unchanged from 126.3/77.8 to 127.8/78.5, in G2 there was a significant (p < 0.001) RR increase from 128.1/77.0 to 134.9/79.8. In G3 and G4 RR decreased significantly (p < 0.001) from 149.9/90.0 to 143.5/86.9 and from 153.1/87.5 to 146.2 84.1 mmHg, respectively. In G3 and G4, RR decreased in 56.1% and 56.3% of subjects and increased in 18% and 21%, respectively. In contrast, RR increase was found more frequently in G1 and G2 (34.3% and 51%, respectively), and RR decrease less frequently (25.4 and 20.7%, respectively). The main reasons for RR decrease were weight loss, more exercise, and more antihypertensives. Frequently, improved compliance and dietary changes were given as reasons. As expected, the opposite often led to RR increase. CONCLUSION: 56% of the hypertensive participants succeeded in lowering their blood pressure, whereas there was a significant increase in blood pressure, especially in those who were well controlled with antihypertensives. This underlines the need to further motivate normotensive patients to maintain their normotension. The results show that the combination of individual written education and lifestyle interventions are an effective tool for the public health sector to combat hypertension. In our participants, lifestyle interventions have a significant impact on BP change. It should be noted critically that there are still too many patients who have not been reached.
Chronic venous disease and diabetes mellitus are highly prevalent and debilitating conditions affecting millions of individuals globally. Although these conditions are typically considered as separate entities, they often co-exist which may be important in both understanding their pathophysiology and determining the best treatment strategy. Diabetes mellitus is twice as common in patients with chronic venous disease compared with the general population. Notably, a large proportion of patients with diabetes mellitus present with venous disorders, although this is often overlooked. The etiology of chronic venous disease is multifactorial, involving hemodynamic, genetic, and environmental factors which result in changes to the venous endothelium and structural wall as well as inflammation. Inflammation, endothelial dysfunction and hyperfiltration or leakage, are commonly observed in diabetes mellitus and cause various diabetic microvascular complications. Both diseases are also influenced by the increased expression of adhesion molecules, chemokines, and cytokines, and are characterized by the presence of vessel hypertension. Consequently, despite differences in etiology, the pathophysiology of both chronic venous disease and diabetic microangiopathy appears to be driven by endothelial dysfunction and inflammation. Treatment strategies should take the co-existence of chronic venous disease and diabetic microangiopathy into account. Compression therapy is recommended in inflammatory conditions that have an edema component as seen in both chronic venous disease and diabetes mellitus. Lifestyle changes like weight loss and exercise, will improve metabolic state and lower inflammation and should be promoted in these patients. Additionally, both patient populations may benefit from venoactive drugs.
- MeSH
- chronická nemoc MeSH
- diabetes mellitus * MeSH
- diabetické angiopatie * diagnóza epidemiologie etiologie MeSH
- hypertenze * MeSH
- lidé MeSH
- vény MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The differential diagnosis of thrombotic microangiopathy (TMA) is complex however the rapid diagnosis of the underlying condition is vital to inform urgent treatment decisions. A survey was devised with the objective of understanding current practices across Europe and the Middle East, and of challenges when diagnosing the cause of TMA. METHODS: Over 450 clinicians, from 16 countries were invited to complete an online survey. RESULTS: Of 254 respondents, the majority were nephrologists, had >10 years' experience in their specialty, and had diagnosed a patient with TMA. The triad of thrombocytopenia, haemolytic anaemia and acute kidney injury are the main diagnostic criteria used. Responses indicate that a differential diagnosis of TMA is usually made within 1-2 (53%) or 3-4 days (26%) of presentation. Similarly, therapy is usually initiated within the first 4 days (74%), however 13% report treatment initiation >1-week post-presentation. Extrarenal symptoms and a panoply of other conditions are considered when assessing the differential diagnosis of TMA. While 70 and 78% of respondents stated they always request complement protein levels and ADAMTS13 activity, respectively. Diagnostic considerations of paediatric and adult nephrologists varied. A greater proportion of paediatric than adult nephrologists consider extrarenal manifestations clinically related to a diagnosis of TMA; pulmonary (45% vs. 18%), gastrointestinal (67% vs. 50%), CNS (96% vs. 84%) and cardiovascular (54% vs. 42%), respectively. Variability in the availability of guidelines and extent of family history taken was also evident. CONCLUSIONS: This survey reveals the variability of current practices and the need for increased urgency among physicians in the differential diagnosis of TMA, despite their experience. Above all, the survey highlights the need for international clinical guidelines to provide systematically developed recommendations for understanding the relevance of complement protein levels, complement abnormalities and ADAMTS13 testing, in making a differential diagnosis of TMA. Such clinical guidelines would enable physicians to make a more rapid and informed diagnosis of TMA, therefore initiate effective treatment earlier, with a consequent improvement in patient outcomes.
- MeSH
- biologické markery krev MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- nefrologie metody normy MeSH
- nefrologové * normy MeSH
- průzkumy a dotazníky * normy MeSH
- trombotické mikroangiopatie krev diagnóza epidemiologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa epidemiologie MeSH
- Střední východ epidemiologie MeSH
Background: Emapticap pegol (NOX-E36) is a Spiegelmer® that specifically binds and inhibits the pro-inflammatory chemokine C-C motif-ligand 2 (CCL2) (also called monocyte-chemotactic protein 1). The objective of this exploratory study was to evaluate the safety and tolerability as well as the renoprotective and anti-diabetic potential of emapticap in type 2 diabetic patients with albuminuria. Methods: A randomized, double-blind, placebo-controlled Phase IIa study was initiated in 75 albuminuric type 2 diabetics. Emapticap at 0.5 mg/kg and placebo were administered subcutaneously twice weekly for 12 weeks to 50 and 25 patients, respectively, followed by a treatment-free phase of 12 weeks. Results: Twice weekly subcutaneous treatment with emapticap over 3 months was generally safe and well tolerated and reduced the urinary albumin/creatinine ratio (ACR) from baseline to Week 12 by 29% (P < 0.05); versus placebo a non-significant ACR reduction of 15% was observed (P = 0.221). The maximum difference, 26% (P = 0.064) between emapticap and placebo, was seen 8 weeks after discontinuation of treatment. At Week 12, the HbA1c changed by −0.31% in the emapticap versus +0.05% in the placebo group (P = 0.146). The maximum difference for HbA1c was observed 4 weeks after the last dose with −0.35% for emapticap versus +0.12% for placebo (P = 0.026). No relevant change in blood pressure or estimated glomerular filtration rate was seen between the treatment groups throughout the study. A post hoc analysis with exclusion of patients with major protocol violations, dual RAS blockade or haematuria increased the ACR difference between the two treatment arms to 32% at Week 12 (P = 0.014) and 39% at Week 20 (P = 0.010). Conclusions: Inhibition of the CCL2/CCL2 receptor axis with emapticap pegol was generally safe and well tolerated. Beneficial effects on ACR and HbA1c were observed in this exploratory study, which were maintained after cessation of treatment. Taken together, emapticap may have disease-modifying effects that warrant further investigation in adequately powered confirmatory studies.
- MeSH
- albuminurie farmakoterapie etiologie metabolismus MeSH
- aptamery nukleotidové terapeutické užití MeSH
- chemokin CCL2 antagonisté a inhibitory MeSH
- diabetes mellitus 2. typu komplikace patofyziologie MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- hodnoty glomerulární filtrace MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza MeSH
- senioři MeSH
- vyšetření funkce ledvin MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 individuals, including 522 with follow-up data, using proteome analysis. We validated that a previously established multipeptide urinary biomarker classifier performed significantly better in detecting and predicting progression of CKD than the current clinical standard, urinary albumin. The classifier was also more sensitive for identifying patients with rapidly progressing CKD. Compared with the combination of baseline eGFR and albuminuria (area under the curve [AUC]=0.758), the addition of the multipeptide biomarker classifier significantly improved CKD risk prediction (AUC=0.831) as assessed by the net reclassification index (0.303±-0.065; P<0.001) and integrated discrimination improvement (0.058±0.014; P<0.001). Correlation of individual urinary peptides with CKD stage and progression showed that the peptides that associated with CKD, irrespective of CKD stage or CKD progression, were either fragments of the major circulating proteins, suggesting failure of the glomerular filtration barrier sieving properties, or different collagen fragments, suggesting accumulation of intrarenal extracellular matrix. Furthermore, protein fragments associated with progression of CKD originated mostly from proteins related to inflammation and tissue repair. Results of this study suggest that urinary proteome analysis might significantly improve the current state of the art of CKD detection and outcome prediction and that identification of the urinary peptides allows insight into various ongoing pathophysiologic processes in CKD.
- MeSH
- biologické markery moč MeSH
- chronická renální insuficience moč MeSH
- dospělí MeSH
- hodnoty glomerulární filtrace MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- peptidy moč MeSH
- progrese nemoci MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
Antihypertenzní léčba po cévní mozkové příhodě snižuje výskyt recidiv. Příliš nízké hodnoty krevního tlaku (< 120/70 mm Hg) však mohou být u rizikových pacientů spojeny se vzestupem incidence kardiovaskulárních příhod. Prahová hodnota krevního tlaku ve smyslu J‑křivky dosud nebyla s definitivní platností prokázána. U pacientů po cévní mozkové příhodě by před zahájením nebo změnou antihypertenzní léčby mělo být provedeno 24hodinové monitorování krevního tlaku. Antihypertenziva jsou indikována při hodnotách krevního tlaku ≥ 140/90 mm Hg, je‑li arteriální hypertenze potvrzena dlouhodobým monitorováním. V rozmezí hodnot 130–140/89–90 je antihypertenzní léčba indikována pouze u rizikových pacientů, pokud neexistují kontraindikace, přičemž dlouhodobá registrace krevního tlaku je v každém případě vhodná. Také po cévní mozkové příhodě platí všeobecná terapeutická doporučení pro pacienty s arteriální hypertenzí, mj. restrikce příjmu sodíku pod 6 g denně a zvýšení příjmu kalia ve stravě bohaté na zeleninu a ovoce.
Eine antihypertensive Therapie nach Schlaganfall reduziert Rezidive. Sehr niedrige Blutdruckwerte (< 120/70) können zu einem Anstieg von kardiovaskulären Ereignissen und auch Schlaganfällen bei bestimmten Risikopatienten führen. Ein definitiver unterer Schwellenwert im Sinne einer „J‑Kurve“ kann bislang nicht belegt werden. Vor Therapiebeginn bzw. ‑umstellung sollte bei vorbehandelten Patienten eine Langzeitblutdruckmessung erfolgen. Bei Blutdruck > 140/90 mm Hg (Bestätigung durch Langzeitblutdruckmessung empfohlen) sollte eine antihypertensive Therapie erfolgen. Bei Werten von 130–140/89–90 mmHg ist eine Therapie nur indiziert bei Hochrisikopatienten und fehlenden Kontraindikationen für eine antihypertensive Therapie (Langzeitblutdruckmessung in jedem Fall empfehlenswert). Auch nach Schlaganfall gilt die Empfehlung zur Beachtung der Allgemeinmaßnahmen zur Hochdrucktherapie: dies gilt u. a. für eine Natrium‑Restriktion < 6 g täglich und die Empfehlung zu einer Kalium‑reichen Ernährung (mit ausreichend Salat, Gemüse und Obst).
- MeSH
- ambulantní monitorování krevního tlaku MeSH
- antihypertenziva aplikace a dávkování kontraindikace terapeutické užití MeSH
- blokátory kalciových kanálů aplikace a dávkování terapeutické užití MeSH
- blokátory receptorů AT1 pro angiotensin II aplikace a dávkování terapeutické užití MeSH
- cévní mozková příhoda * komplikace krev patologie prevence a kontrola MeSH
- hypertenze * diagnóza farmakoterapie prevence a kontrola MeSH
- inhibitory ACE aplikace a dávkování terapeutické užití MeSH
- klinické zkoušky jako téma MeSH
- kombinovaná farmakoterapie využití MeSH
- kongresy jako téma MeSH
- lidé MeSH
- měření krevního tlaku metody normy MeSH
- sekundární prevence metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- systola účinky léků MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
Diabetic medicine, ISSN 0742-3071 Supplement Vol. 14. 3
S80 s. ; 30 cm
