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Nephropathy and neuropathy
Abbreviations: A2, angiotensin II; ACEI, ACE inhibitor; ADA, American Diabetes Association; AER, albumin excretion rate; ANP, atrial natriuretic peptide; ARB, angiotensin II receptor blocker; ARI, aldose reductase inhibitor; bid, twice a day; CCB, calcium-channel blocker; CHD, coronary heart disease; CVD, cardiovascular disease; ED, erectile dysfunction; ETT, exercise tolerance testing; GFR, glomerular filtration rate; IAPP, islet amyloid polypeptide; I/D, insertion/deletion; MAPK, mitogen-activated protein kinase; MI, myocardial infarction; MNCV, motor nerve conduction velocity; NBE nerve blood flow; PDGF, platelet-derived growth factor; PKC, protein kinase C; rhNGF, recombinant human nerve growth factor; TGF, transforming growth factor; tid, three times a day; UKPDS, U.K. Prospective Diabetes Study.
A table elsewhere in this issue shows conventional and Systeme International (SI) units and conversion factors for many substances.
This is the sixth of eight reports on the American Diabetes Association (ADA) Annual Meeting and Scientific Sessions held in San Diego, California, in June 1999. It covers topics related to the assessment and treatment of diabetic nephropathy and neuropathy, focusing in particular on recent studies of diabetes-related hypertension, lower-extremity ulceration, peripheral neuropathy and erectile dysfunction.
Hypertension
Lennart Hansson, Uppsala, Sweden, gave an update on the outcome of hypertension treatment in diabetes. The frequency of cardiovascular disease (CVD) is two to three times higher among patients with diabetes versus patients without diabetes (1), and data compiled by the World Health Organization show that CVD is a major cause of death (2). According to the Multiple Risk Factor Intervention Trial study, the frequency of CVD-related mortalities was three- to fourfold higher among patients with diabetes, regardless of their blood pressure levels; in particular, diabetic patients with low blood pressure levels appeared to be at an increased risk for hypertension (3). Normal blood pressure measurements are considered to be < 130/85 mmHg, and optimal blood pressure measurements are considered to be <120/80 mmHg. In total, there are ~50 million people in the U.S. who are hypertensive. Blood pressure levels are well controlled in only 27% of U.S. patients. Effective control of blood pressure levels is less frequent in Western Europe (only an estimated 6% of U.K. patients have good blood pressure control), and effective hypertension control in the developing world is even less frequent than that in Western Europe (4)....