Treating Diabetes and Hypertension

 

Diabetes and hypertension causes various micro- and macrovascular complications leading to changes in blood pressure (BP). A BP of < 130/80 mm Hg has been the recommendation for patients with both diabetes and hypertension.

However the  Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure-lowering trial and results from the International Verapamil SR-Trandolapril Study (INVEST) study have questioned this. The new recommendations suggest that different antihypertensive combinations may offer specific cardio-, vasculo-, and renoprotective advantages that not only treat the hypertension but also prevent complications of high BP.

Angiotensin converting enzyme (ACE) inhibitor plus diuretic combination therapy improves BP, counterbalances renin-angiotensin system activation due to diuretic therapy and reduces the risk of electrolyte alterations.

ACE inhibitor plus calcium channel blocker reduces proteinuria, the rate of decline in glomerular filtration rate (GUARD trial). Moreover, the ACCOMPLISH trial results led to the conclusion that ACE inhibitor/calcium channel blocker combo helps cardiovascular outcomes in high-risk patients.

 

References:

Curr Atheroscler Rep.Optimal Therapy in Hypertensive Subjects with Diabetes Mellitus.Reboldi G, Gentile G, Angeli F, Verdecchia P.

Vasc Health Risk Manag. Choice of ACE inhibitor combinations in hypertensive patients with type 2 diabetes: update after recent clinical trials. Reboldi G, Gentile G, Angeli F, Verdecchia P.

Age related changes to kidneys

The aging kidney is characterized by:

1. Loss of renal mass
2. Arterial sclerosis
3. Arteriolar hyalinosis
4. An increased number of sclerotic glomeruli
5. Loss of tubules
6. Interstitial fibrosis.

Genetics, hemodynamic factors, diabetes and hypertension all affect changes in the kidney function

Reference:

J Nephrol. The aging kidney: structural changes.Pannarale G, Carbone R, Del Mastro G, Gallo C, Gattullo V, Natalicchio L, Navarra A, Tedesco A.

New treatments for Chronic kidney disease (CKD)

 

Erythropoiesis stimulating agents (ESAs) fix anemia in patients with chronic kidney disease (CKD). Recombinant human erythropoietin (EPO) is one example. Peginesatide , inhibitors of hypoxia-inducible transcription factor, gene therapy, EPO fusion proteins, drugs that inhibit GATA and hematopoietic cell phosphatase are experimental therapies being tested. Anemia management using both iron and/or ESAs is a successful strategy used by clinicians. Intravenous (IV) iron such as Ferumoxytol (Feraheme) and ferric carboxymaltose (Ferinject)do not require a test dose, and a much higher dose of iron can be delivered as a single administration.

Reference:

Curr Opin Investig Drugs. Chronic kidney disease-associated anemia: new remedies. Del Vecchio L, Cavalli A, Tucci B, Locatelli F.

How to enhance antioxidant intake and nutrition?

Different foods contain antioxidant compounds and sometimes eating several foods at once may enhance the amount of antioxidants your body gets.

• Fruits (raspberry, blackberry, and apple)
• Vegetables (broccoli, tomato, mushroom, and purple cauliflower)
• Legumes (soybean, adzuki bean, red kidney bean, and black bean)

Scientists studied how total phenolic content, ferric reducing antioxidant power, 2,2-diphenyl-1-picrylhydrazyl, radical scavenging capacity, and oxygen radical absorbance capacity across food categories changed when the foods were eaten together.

The study found that combining specific foods across categories (e.g., fruit and vegetables) was more likely to result in additive antioxidant capacity

So your daily food antioxidant intake may be enhanced by mixing the right categories of food.

 

Reference:

J Agric Food Chem. Synergistic, Additive, and Antagonistic Effects of Food Mixtures on Total Antioxidant Capacities. Wang S, Meckling KA, Marcone MF, Kakuda Y, Tsao R.

Effects of metabolic syndrome on kidney function

Abdominal obesity leads to a prothrombotic condition thereby increasing the risk of cardiovascular disease. This is very commonly seen in patients who have metabolic syndrome. Recently, research has shown that body mass index increases, insulin resistance and increased fasting insulin levels may cause chronic kidney disease.

So what are the risk factors for patients who have metabolic syndrome in terms of their kidney health?

1. The combination of dysglycemia and high blood pressure caused in metabolic syndrome predisposes patients to kidney problems.
2. Patients with atherosclerotic renal artery stenosis who underwent hemodialysis had worsening kidney function.
3. Moreover, patients with metabolic syndrome have worse outcomes  for dialysis access procedures.

Reference:

Vykoukal D, Davies MG.Metabolic syndrome and outcomes after renal intervention.Cardiol Res Pract. 2010

Receiving the shingles vaccine is associated with lowering the risk of getting the disease

receiving the shingles vaccine is associated with lowering the risk of getting the disease

Medical App Review - Ultrasound - iPhone / iPad App Demo

Alternative Medicine: preventing and treating the common cold by natual home remedies

Preventing colds or relieving cold symptoms by alternative medicine may be beneficial. Scientific evidence to date does not support recommending any of these therapies for general use against colds. People should check with their health care provider before using any therapy.Here are some other examples:

• Andrographis (Andrographis paniculata)
• Astragalus (Astragalus membranaceus)
• Bee propolis
• Chinese herbal medicine
• Elderberry (Sambucus nigra)
• Garlic (Allium sativum)
• Goldenseal (Hydrastis canadensis)
• Green tea
• Guided imagery
• Honey
• Homeopathic remedies
• Hydrotherapy
• Nasal irrigation
• North American ginseng (Panax quinquefolius)
• Peppermint (Mentha x piperita)
• Probiotics
• Selenium
• South African geranium or Umckaloabo (Pelargonium sidoides)
• Stress management
• Vitamin E
  

 

 

References

1. Arroll B. Non-antibiotic treatments for upper-respiratory tract infections (common cold). Respiratory Medicine. 2005;99:1477–1484.
2. Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea: a randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine. 2002;137(12):939–946.
3. Bukutu C, Le C, Vohra S. Complementary, holistic, and integrative medicine: the common cold. Pediatrics in Review. 2008;29(12):e66–e71.
4. Caruso TJ, Prober CG, Gwaltney JM Jr. Treatment of naturally acquired common colds with zinc: a structured review. Clinical Infectious Diseases. 2007;45:569–574.
5. Eisenberg D, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998 Nov 11;280(18):1569-75.
6. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb;11(1):42-9.
7. D’Arcy PF. Mechanisms of drug interactions. Drug interactions with herbal and other non-orthodox remedies. Berlin: Springer-Verlag; 1996. p 327-52.

How Coffee Protects Against Diabetes

Coffee helps increase the circulating amount of a protein called sex hormone–binding globulin (SHBG). This protein, according to research studies, has shown to be involved in the development of type 2 diabetes and it is also responsible for the testosterone and estrogen in the human body. Previous research has shown that coffee consumption prevents high-blood sugar and also improved insulin sensitivity. Consumption of decaffeinated coffee was not significantly associated with SHBG levels, nor diabetes risk. Coffee contains magnesium which is known to help with carbohydrate metabolism. Some studies have shown that antioxidants known as lignans or chlorogenic acids may be involved in helping to reduce diabetes.

Reference:

http://newsroom.ucla.edu/portal/ucla/why-coffee-protects-against-diabetes-190743.aspx

Arch Intern Med. 2006;166:1311-1316

Rachel Huxley; Crystal Man Ying Lee; Federica Barzi; Leif Timmermeister; Sebastien Czernichow; Vlado Perkovic; Diederick E. Grobbee; David Batty; Mark Woodward. Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus: A Systematic Review With Meta-analysis. Arch Intern Med, 2009;

Consumer Driven Health Plans

Consumer Driven Health Plans