Trastornos glucémicos y su asociación con la función pulmonar. Estudio transversal analítico / Glycemic disorders and their impact on lung function. Cross-sectional study

Antecedentes y objetivo: La diabetes mellitus puede afectar a los pulmones en diversas estructuras y funciones. Actualmente, se están realizando investigaciones para establecer la repercusión clínica de la hiperglucemia sobre la función pulmonar. El objetivo de este estudio es determinar si el estado glucémico (euglucémico, prediabetes o diabetes) se asocia con la disminución de los volúmenes pulmonares determinados mediante espirometría. Pacientes y métodos: Se trata de un estudio transversal analítico, realizado en el Hospital General Ticomán de la Ciudad de México. A los participantes se les determinó la concentración de glucosa y hemoglobina glucosilada (HbA1c), para establecer si eran portadores de un trastorno glucémico. A todos ellos se les realizó una espirometría forzada, obteniendo el volumen espiratorio al primer segundo (VEF1), la capacidad vital forzada (CVF), la relación VEF1/CVF, y el flujo espiratorio pico (FEP). Se categorizaron los pacientes en sujetos euglucémicos, prediabéticos y diabéticos según los criterios de la ADA. Se compararon los volúmenes pulmonares entre los grupos. Resultados: Se estudiaron un total de 55 sujetos, siendo 43 mujeres y 12 hombres. De esta muestra, 14 eran euglucémicos, 9 prediabéticos, y 32 diabéticos. Los individuos diabéticos presentan una disminución del %FEP comparados con los sujetos prediabéticos y los euglucémicos. Los valores de glucosa sérica en ayuno correlacionan con la disminución del %VEF1, VEF1/CVF y %FEP, mientras que la HbA1c solo se correlaciona con la disminución del %FEP. Conclusión: Los sujetos con diabetes presentan un %PEF menor que los sujetos euglucémicos y los prediabéticos, mientras que el %VEF1, %CVF y la relación VEF1/CVF no varían entre los diferentes estados glucémicos. El descontrol glucémico agudo se correlaciona con la disminución de más parámetros espirométricos que el descontrol crónico

Background and objective: Diabetes mellitus can affect the lungs, in its various structures and functions. Current research is being conducted to establish the clinical impact of hyperglycaemia on lung function. The objective of this study is to determine if the glycaemic state (euglycaemic, prediabetes or diabetes) is associated with a decrease in lung volume, determined by spirometry. Patients and methods: An analytical cross-sectional study was carried out at the Ticomán General Hospital in Mexico City. Glucose and glycosylated haemoglobin concentration were used as the parameters to determine if the subjects had a glycaemic disorder. They were further categorised into euglycaemic, prediabetic and diabetic subjects according to ADA criteria guidelines. The subjects underwent forced spirometry testing, obtaining expiratory volume at the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (FEP). The lung volumes between the groups were compared. Results: A total of 55 subjects were studied; 43 women, and 12 men; 14 euglycaemic, 9 prediabetic, and 32 with diabetes. Diabetic individuals presented a %FEP decrease compared to the prediabetic and euglycaemic subjects. The fasting serum glucose values correlated with decrease of %FEV1, FEV1/FVC and %FEP, while the HbA1c concentration only correlated with the decrease of %FEP. Conclusions: Subjects with diabetes have a lower %PEF than euglycaemic and prediabetic subjects, while the %FEV1, %FVC and the FEV1/FVC ratio do not vary between the different glycaemic states. Acute glycaemic non-control correlated with a decrease in more spirometric parameters than chronic glycaemic non-control

Glycemic disorders and their impact on lung function. Cross-sectional study. / Trastornos glucémicos y su asociación con la función pulmonar. Estudio transversal analítico.

BACKGROUND AND OBJECTIVE: Diabetes mellitus can affect the lungs, in its various structures and functions. Current research is being conducted to establish the clinical impact of hyperglycaemia on lung function. The objective of this study is to determine if the glycaemic state (euglycaemic, prediabetes or diabetes) is associated with a decrease in lung volume, determined by spirometry. PATIENTS AND METHODS: An analytical cross-sectional study was carried out at the Ticomán General Hospital in Mexico City. Glucose and glycosylated haemoglobin concentration were used as the parameters to determine if the subjects had a glycaemic disorder. They were further categorised into euglycaemic, prediabetic and diabetic subjects according to ADA criteria guidelines. The subjects underwent forced spirometry testing, obtaining expiratory volume at the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (FEP). The lung volumes between the groups were compared. RESULTS: A total of 55 subjects were studied; 43 women, and 12 men; 14 euglycaemic, 9 prediabetic, and 32 with diabetes. Diabetic individuals presented a %FEP decrease compared to the prediabetic and euglycaemic subjects. The fasting serum glucose values correlated with decrease of %FEV1, FEV1/FVC and %FEP, while the HbA1c concentration only correlated with the decrease of %FEP. CONCLUSIONS: Subjects with diabetes have a lower %PEF than euglycaemic and prediabetic subjects, while the %FEV1, %FVC and the FEV1/FVC ratio do not vary between the different glycaemic states. Acute glycaemic non-control correlated with a decrease in more spirometric parameters than chronic glycaemic non-control.

[Effect of the components of the metabolic syndrome on pulmonary function. The unexpected role of high-density lipoprotein cholesterol]. / Efecto de los componentes del síndrome metabólico en la función pulmonar. El inesperado papel del colesterol ligado a lipoproteínas de alta densidad.

BACKGROUND: Metabolic syndrome is a condition that predisposes to cardiovascular disease and diabetes mellitus. In addition, it can have effects over neoplastic pathologies, liver and pulmonary function. Our objective is to analyze the effect of the metabolic syndrome and its components on pulmonary function. METHOD: 110 subjects from Mexico City were evaluated and anthropometric measurements, glucose determination, triglycerides and high-density lipoprotein (HDL) cholesterol were made. They underwent a simple spirometry. Diagnosis of metabolic syndrome was made following the NCEP-ATPIII criteria. RESULTS: Of 110 individuals, 90 (82%) were women and 20 men (18%); 71 subjects (65%) presented metabolic syndrome. Subjects with central obesity had a forced vital capacity (FVC) lower than subjects without central obesity (2.72 vs. 3.11 liters; p < 0.05). Those with low HDL had better spirometric results than subjects with normal HDL (FEV1 2.36 vs. 1.85 liters; p < 0.05), FVC (2.95 vs. 2.45 liters; p < 0.05) and FEV1/FVC ratio (0.78 vs.74; p < 0.05). Hypertensive subjects presented lower volumes in FEV1 (1.91 vs. 2.38; p < 0.05) and FVC (2.49 vs. 2.99; p < 0.05). CONCLUSION: There is no difference between the spirometry volumes of patients with metabolic syndrome versus the metabolically healthy subjects. The only factors associated with a decrease in FEV1 and FVC are central obesity and arterial hypertension. An unexpected finding was the negative correlation between HDL levels and lung function.

ANTECEDENTES: El síndrome metabólico es un estado que predispone a enfermedad cardiovascular y diabetes mellitus. Además, puede repercutir en la función hepática, en patologías neoplásicas y en la función pulmonar. Nuestro objetivo es analizar el efecto del síndrome metabólico y sus componentes sobre la función pulmonar. MÉTODO: Se evaluaron 110 sujetos de la Ciudad de México a quienes se realizaron mediciones antropométricas, determinación de glucosa, triglicéridos y colesterol ligado a lipoproteínas de alta densidad (HDL). Se les practicó una espirometría simple. Se realizó el diagnóstico de síndrome metabólico siguiendo los criterios NCEP-ATPIII. RESULTADOS: De 110 individuos, 90 (82%) fueron mujeres y 20 hombres (18%), y 71 (65%) presentaron síndrome metabólico. Los sujetos con obesidad central tuvieron una capacidad vital forzada (CVF) menor que aquellos sin obesidad central (2.72 vs. 3.11 l; p < 0.05). Los que presentaron colesterol HDL bajo tuvieron mejores resultados espirométricos que los sujetos con colesterol HDL normal (volumen espiratorio forzado en el primer segundo [VEF1] 2.36 vs. 1.85 l; p < 0.05), mejor CVF (2.95 vs. 2.45 l; p < 0.05) y mejor relación VEF1/CVF (78 vs. 74; p < 0.05). Los sujetos hipertensos presentaron menores volúmenes en VEF1 (1.91 vs. 2.38; p < 0.05) y CVF (2.49 vs. 2.99; p < 0.05). CONCLUSIÓN: No existe diferencia en los volúmenes espirométricos de pacientes con síndrome metabólico al compararlos con sujetos metabólicamente sanos. Solo la obesidad central y la hipertensión arterial se asocian con disminución del VEF1 y la CVF. Un hallazgo inesperado es la correlación negativa entre los valores de colesterol HDL y la función pulmonar.

Impact of trandolapril therapy and its combination with a calcium channel blocker on plasma adiponectin levels in patients with type 2 diabetes and hypertension.

INTRODUCTION: Adiponectin is secreted from adipose tissue and exhibits a protective effect against cardiovascular disease; plasma adiponectin concentrations are decreased in type 2 diabetic and in hypertensive patients. OBJECTIVE: The aim of this study was to compare the effect of trandolapril (T) and its fixed-dose combination with verapamil (FDTV) on adiponectin levels in hypertensive type 2 diabetic patients. METHODS: A total of 40 type 2 diabetic patients with never-treated hypertension were randomly assigned to two groups. One group received FDTV 180 mg + T 2 mg, once a day; the other group received T 2 mg once a day, administered for 3 months in both groups. Adiponectin was measured by enzyme-linked immunosorbent assay (ELISA) at the beginning and end of the study. Patients were evaluated monthly for blood pressure, fasting serum glucose and adverse events. Statistical analysis was performed with analysis of variance (ANOVA). RESULTS: All patients experienced a significant reduction of blood pressure. Both therapeutics regimens increased the levels of adiponectin, However, FDTV produces a higher increase in the levels of the hormone (8.15 ± 4.6 to 10.96 ± 5.6 µg/ml) when compared with the T treatment (7.64 ± 3.8 to 8.92 ± 4.4 µg/ml), p < 0.05. None of the patients suffered adverse events. CONCLUSION: Our results show that the addition of FDTV to T produced a greater increase on adiponectin levels than trandolapril alone.

Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors.

Recent guidelines for the management of hypertension recommend target blood pressures <140/90 mmHg in hypertensive patients, or <130/80 mmHg in subjects with diabetes, chronic kidney disease, or coronary artery disease. Despite the availability and efficacy of antihypertensive drugs, most hypertensive patients do not reach the recommended treatment targets with monotherapy, making combination therapy necessary to achieve the therapeutic goal. Combination therapy with 2 or more agents is the most effective method for achieving strict blood pressure goals. Fixed-dose combination simplifies treatment, reduces costs, and improves adherence. There are many drug choices for combination therapy, but few data are available about the efficacy and safety of some specific combinations. Combination therapy of calcium antagonists and inhibitors of the renin-angiotensin-aldosterone system (RAAS) are efficacious and safe, and have been considered rational by both the JNC 7 and the 2007 European Society of Hypertension - European Society of Cardiology guidelines for the management of arterial hypertension. The aim of this review is to discuss some relevant issues about the use of combinations with calcium channel blockers and RAAS inhibitors in the treatment of hypertension.

Manejo de las emergencias hipertensivas en el ancino con dinitrato de isosorbide en nebulizador / The management of hypertensive emergencies in the elderly patient with isosorbide dinitrate aerosol

En este estudio se valoró la eficacia y seguridad del Dinitrato de isosorbide en nebulizador administrado por la mucosa oral, en 20 pacientes ancianos que se presentaron en el hospital con emergencia hipertensiva (Presión arterial media >140 mm Hg y evidencia de daño a órgano blanco). Los pacientes recibieron una aplicación de 1.25 mg del medicamento a su ingreso, y una segunda dosis del fármaco a los 15 minutos si la presión arterial media no presentaba una reducción >15 por ciento. Tres sujetos (15 por ciento) respondieron con una aplicación y 17 (85 por ciento) requirieron una segunda dosis, los 20 pacientes tuvieron una disminución significativa de las cifras de presión arterial (193+-9/123+-5.4 a 154+7.1/92.5 +-6.2 mm Hg p<0.005), así como de la presión arterial media (146.8+-8 a 113+-5 mm Hg 23 por ciento, p<0.005) en un máximo de 30 minutos1 sin presentar fenómenos secundarios, hipertensión de rebote ni hipotensión grave, manteniéndose dicho control durante 3 horas. También se apreció en los pacientes una reducción del 13.5 por ciento en la frecuencia cardíaca (p<0.005). Los resultados sugieren que el dinitrato de isosorbide en nebulizador, es una alternativa eficaz y segura en el tratamiento de pacientes ancianos con una emergencia hipertensiva.