TYPE 2 DIABETES MELLITUS, HYPERTENSION AND CONCURRENT TYPE 2 DIABETES, AND HYPERTENSION

9 Feb
2010

hypertension

Clusters of multifaceted metabolic disorders including glucose intolerance, essential hyper tension, central obesity, dyslipidaemia and insulin resistance coined metabolic syndrome have been described among Caucasians. About 10 to 15% and 1 to 2% of Nigerians have hypertension and diabetes mellitus respectively. Both conditions coexist frequently in this population, the prevalence of hypertension among diabetics being 20-40%.

Several studies established a direct relationship between insulin resistance, enhanced sympathetic nervous activity, hypertension and type 2 diabetes. Increased sympathetic nervous activ­ity, transmembrane cation transport and renal sodium reabsorption probably contribute to the genesis of hypertension in metabolic syndrome. Insulin resistance causes deficiency of lipase resulting in altered lipid metabolism and dyslipidaemia. Increased influx of free fatty acids in the liver and production of tumor necrosis factor alpha (TNF-a) may play important roles in the mechanism of insulin resistance-related obesity. Recently, a defective gene (cd36), which encodes fatty acid translocase, was identified to underlie insulin resistance, defective fatty acid metabolism and hypertriglyceridaemia in spontaneously hypertensive rats. This may be an important pathogenic mechanism in human metabolic syndrome.

Dyslipidaemia in type 2 and hypertension are both quantitative and qualitative. Quantitative abnormalities include increased levels of total plasma cholesterol, triglyceride and low-density lipoprotein (LDL) cholesterol, and decreased level of high-density lipoprotein (HDL) cholesterol. Qualitative abnormalities include changes in the composition of LDL-cholesterol (small dense LDL-cholesterol, increased triglyceride content and increased electronegativity of LDL-cholesterol). These changes make LDL-cholesterol susceptible to oxidation and glycation, with consequential foam cell formation, endothelial dysfunction and atherosclerosis.

Information on plasma lipid concentrations and prevalence of dyslipidaemia among patients with type 2 diabetes and/or hypertension is, therefore, important. Several reports have confirmed that diabetes and hypertension are independently associated with dyslipidaemia among Nigerians. Data on lipid patterns among diabetic hypertensives is, however, scanty and limited to total plasma cholesterol. There also is no documentation of metabolic syndrome in this population, probably because of lack of facilities for insulin measurement. kamagra soft tablets

Given the association between type 2 diabetes and hypertension and dyslipidaemia, the role of lipid abnormalities as risk factors for atherosclerotic complications of diabetes and hypertension and the additive nature of these complications when both conditions occur concurrently, it may be proposed that putative increases in plasma lipid concentrations would occur in diabetic hypertensives.

The contrary may, however, be true, given the established role of hyperinsulinaemia as a central link in the genesis of diabetes, hypertension, and dyslipidaemia in metabolic syndrome.

The objective of this study is to compare the quantitative lipid abnormalities, atherogenic index and prevalence of dyslipidaemia among indigenous age and sex-matched Nigerians with type 2 diabetes mellitus, essential hypertension and concurrent diabetes, and hypertension with a view of providing evidence of metabolic syndrome, if any, in this population.

Clusters of multifaceted metabolic disorders including glucose intolerance, essential hyper tension, central obesity, dyslipidaemia and insulin resistance coined metabolic syndrome have been described among Caucasians. About 10 to 15% and 1 to 2% of Nigerians have hypertension and diabetes mellitus respectively. Both conditions coexist frequently in this population, the prevalence of hypertension among diabetics being 20-40%.

Several studies established a direct relationship between insulin resistance, enhanced sympathetic nervous activity, hypertension and type 2 diabetes. Increased sympathetic nervous activity, transmembrane cation transport and renal sodium reabsorption probably contribute to the genesis of hypertension in metabolic syndrome. Insulin resistance causes deficiency of lipoprotein lipase resulting in altered lipid metabolism and dyslipidaemia. Increased influx of free fatty acids in the liver and production of tumor necrosis factor alpha (TNF-a) may play important roles in the mechanism of insulin resistance-related obesity. Recently, a defective gene (cd36), which encodes fatty acid translocase, was identified to underlie insulin resistance, defective fatty acid metabolism and hypertriglyceridaemia in spontaneously hypertensive rats. This may be an important pathogenic mechanism in human metabolic syndrome.

Dyslipidaemia in type 2 diabetes and hypertension are both quantitative and qualitative. Quantitative abnormalities include increased levels of total plasma cholesterol, triglyceride and low-density lipoprotein (LDL) cholesterol, and decreased level of high-density canadian lipoprotein (HDL) cholesterol. Qualitative abnormalities include changes in the composition of LDL-cholesterol (small dense LDL-cholesterol, increased triglyceride content and increased electronegativity of LDL-cholesterol). These changes make LDL-cholesterol susceptible to oxidation and glycation, with consequential foam cell formation, endothelial dysfunction and atherosclerosis.

Information on plasma lipid concentrations and prevalence of dyslipidaemia among patients with type 2 diabetes and/or hypertension is, therefore, important. Several reports have confirmed that diabetes and hypertension are independently associated with dyslipidaemia among Nigerians. Data on lipid patterns among diabetic hypertensives is, however, scanty and limited to total plasma cholesterol. There also is no documentation of metabolic syndrome in this population, probably because of lack of facilities for insulin measurement. canadian pharmacy online

Given the association between type 2 diabetes and hypertension and dyslipidaemia, the role of lipid abnormalities as risk factors for atherosclerotic complications of diabetes and hypertension and the additive nature of these complications when both conditions occur concurrently, it may be proposed that putative increases in plasma lipid concentrations would occur in diabetic hypertensives.

The contrary may, however, be true, given the established role of hyperinsulinaemia as a central link in the genesis of diabetes, hypertension, and dyslipidaemia in metabolic syndrome.

The objective of this study is to compare the quantitative lipid abnormalities, atherogenic index and prevalence of dyslipidaemia among indigenous age and sex-matched Nigerians with type 2 diabetes mellitus, essential hypertension and concurrent diabetes, and hypertension with a view of providing evidence of metabolic syndrome, if any, in this population. kamagra jelly uk

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