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      HYPERTENSION IN DIABETICS REGISTERED IN PRIMARY HEALTH CARE CENTERS IN MAKKAH DISTRICT, SAUDI ARABIA

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          Abstract

          Background:

          Hypertension in diabetes is a common and important problem, which aggravates diabetic macro- and microvascular complications. Since both diabetes and hypertension are common diseases, their follow up in primary health care centers should emphasize the early detection of hypertension in diabetes. This study aims at studying the magnitude of hypertension in diabetic subjects registered in primary health care centers.

          Methods:

          A sample of 1039 diabetic subjects registered at the primary health care in urban and rural Makkah region were interviewed. Information gathered included demographic and diabetes-related variables. Blood pressure and body mass index were determined for 1020 subjects.

          Results:

          Diabetic subjects who had high blood pressure readings amounted to 560 (54.9%), of whom with stage 1, 2, and 3 hypertension formed 25.5%, 7.0% and 2.5%, respectively. Subjects with undetected high blood pressure amounted to 225 (22.1%). There was significant association of high blood pressure with age, male gender, body mass index and low education.

          Conclusion:

          The problem of hypertension in diabetes could be sizeable. Many patients may remain undetected. A diligent search for diabetic subjects with elevated blood pressure should be made through an efficient system of follow up in the PHCC centers.

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          Most cited references16

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          Hypertension and associated metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system.

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            Health care and health status and outcomes for patients with type 2 diabetes.

            M Harris (2000)
            To evaluate access and utilization of medical care, and health status and outcomes that would be influenced by recent medical care, in a representative sample of patients with type 2 diabetes. A national sample of 733 adults with type 2 diabetes was studied from 1991 to 1994 in the Third National Health and Nutrition Examination Survey. Structured questionnaires and clinical and laboratory assessments were used to determine the frequencies of physician visits, health insurance coverage, screening for diabetes complications, treatment for hyperglycemia, hypertension, and dyslipidemia; and the proportion of patients who met treatment goals and established criteria for health outcome measures including hyperglycemia, albuminuria, obesity, hypertension, and dyslipidemia. Almost all patients had 1 source of primary care (95%), 2 or more physician visits during the past year (88%), and health insurance coverage (91%). Most (76%) were treated with insulin or oral agents for their diabetes, and 45% of those patients taking insulin monitored their blood glucose at least once per day The patients were frequently screened for retinopathy (52%), hypertension (88%), and dyslipidemia (84%). Of those patients with hypertension, 83% were diagnosed and treated with antihypertensive agents and only 17% were undiagnosed or untreated; most of the patients known to have dyslipidemia were treated with medication or diet (89%). Health status and outcomes were less than optimal: 58% had HbA1c >7.0, 45% had BMI >30, 28% had microalbuminuria, and 8% had clinical proteinuria. Of those patients known to have hypertension and dyslipidemia, 60% were not controlled to accepted levels. In addition, 22% of patients smoked cigarettes, 26% had to be hospitalized during the previous year, and 42% assessed their health status as fair or poor. Rates of health care access and utilization, screening for diabetes complications, and treatment of hyperglycemia, hypertension, and dyslipidemia in type 2 diabetes are high; however, health status and outcomes are unsatisfactory. There are likely to be multiple reasons for this discordance, including intractability of diabetes to current therapies, patient self-care practices, physician medical care practices, and characteristics of U.S. health care systems.
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              Etiology of the metabolic syndrome: potential role of insulin resistance, leptin resistance, and other players.

              Obesity and Type 2 diabetes are now major public health issues in developed nations and have reached epidemic proportions in many developing nations, as well as disadvantaged groups in developed countries, e.g., Mexican-Americans, African-Americans, and Australian Aborigines. These groups all show hyperinsulinemia and insulin resistance, which have been demonstrated to be future predictors of Type 2 diabetes and have also been suggested as key factors in the etiology of the Metabolic Syndrome. It is now increasingly recognized that Type 2 diabetes is part of a cluster of cardiovascular disease (CVD) risk factors comprising the Metabolic Syndrome. This group is at very high risk of atherosclerosis because each of the risk factors in the Metabolic Syndrome cluster in its own right is an important CVD risk factor. They also contribute cumulatively to atherosclerosis. A key strategy in reducing macrovascular disease lies in the better understanding of the Metabolic Syndrome--glucose intolerance, hypertension, hyperlipidemia, and central obesity. Although it has been suggested that hyperinsulinemia/insulin resistance is the central etiological factor for the Metabolic Syndrome, epidemiological data do not support the idea that this can account for all of the cluster abnormalities. We have animal and human data suggesting that hyperleptinemia rather than, or synergistically with, hyperinsulinemia may play a central role in the genesis of the CVD risk factor cluster that constitutes the syndrome. Studies in Psammomys obesus (the Israeli sand rat) suggest hyperinsulinemia/insulin resistance is an early metabolic lesion in the development of obesity and Type 2 diabetes. This animal also develops other features of the Metabolic Syndrome, making it an excellent model to investigate etiology. Psammomys, when placed on an ad libitum laboratory diet, develops hyperinsulinemia, insulin resistance, impaired glucose tolerance, diabetes, and dyslipidemia. It also develops hyperleptinemia and leptin insensitivity, and hyperleptinemia is correlated with insulin resistance independent of changes in body weight. It is likely that a similar sequence occurs in the transition from the prediabetic state to Type 2 diabetes in humans. More recently, other potential players in the etiology of the Metabolic Syndrome have been suggested including endothelial dysfunction and acetylation-stimulating protein (ASP). It has been suggested that endothelial dysfunction may be an antecedent for both Type 2 diabetes and the Metabolic Syndrome. In addition, ASP is a serious new candidate for an important role in insulin resistance. The ASP pathway plays a critical role in fatty acid metabolism and storage, and it has been suggested that ineffective storage of fatty acids by adipocytes due to a defect in the ASP pathway may lead to insulin resistance and Type 2 diabetes.
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                Author and article information

                Journal
                J Family Community Med
                J Family Community Med
                JFCM
                Journal of Family & Community Medicine
                Medknow Publications & Media Pvt Ltd (India )
                1319-1683
                2229-340X
                Sep-Dec 2000
                : 7
                : 3
                : 23-28
                Affiliations
                [1] Department of Family and Community Medicine, College of Medicine, King Faisal University, Dammam, Saudi Arabia
                Author notes
                Correspondence to: Dr. Ahmed G. Elzubier, P.O. Box 40187, Al-Khobar 31952, Saudi Arabia
                Article
                JFCM-7-23
                3437077
                23008627
                cb501244-4b42-416a-8fb6-dca6cb697c74
                Copyright: © Journal of Family and Community Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Health & Social care
                diabetes mellitus,hypertension,primary health care centers
                Health & Social care
                diabetes mellitus, hypertension, primary health care centers

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