Circadian Blood Pressure Variability in Normo and Hypertensive Diabetic Patients

Background: Diabetic patients have a higher prevalence of non-dipping pattern in blood pressure (BP) than general population. Non-dipping arterial pressure pattern is associated with increased cardiovascular risk. The objective of this study was to investigate the association between the clinical and paraclinical characteristics of the diabetic patients with circadian BP variability.Materials and Methods: This cross-sectional study included 114 diabetic patients (more than 18 years old) recruited by consecutive sampling. The patients were divided into two groups according to the results of systolic blood pressure dipping from day to night.Results: Mean age was 58.3±9.6 years; and 63% of the study population was male. Also, 80.7%, 78.1%, and 78.9% of the patients had non-dipper patterns in systolic, diastolic, and mean BP respectively. The dipping pattern did not have any significant association with baseline or clinical characteristics of the patients (p>0.05).Conclusion: The characteristics of the patients do not assist finding diabetic persons who are more likely to have non-dipping arterial pressure pattern. As such, ABPM is an essential tool for proper risk stratification in diabetic patients

Intracardiac Shunts and Role of Tissue Doppler Imaging in Diagnosis and Discrimination

Background: We sought to assess right ventricular (RV) systolic and diastolic functions via tissue Doppler imaging (TDI) in order to discriminate right-to-left (bidirectional) from left-to-right intracardiac shunts. Methods: A tissue Doppler velocity study via Doppler echocardiography was performed in 20 patients with left-to-right shunt (without evidence of significant pulmonary hypertension) and 20 patients with right-to-left shunt or bidirectional shunt (with significant pulmonary hypertension) or Eisenmenger΄s complex and 20 healthy subjects as the control group. RV myocardial performance index (MPI), S wave velocity, E wave velocity, isovolumic relaxation time (IVRT), and isovolumic contraction time (IVCT) from the lateral tricuspid annulus were measured using TDI. Results: In the patients with left-to-right shunt, the tissue Doppler parameters showed higher S-wave, peak systolic(Sa)/early contraction(Ea) , Sa/IVRT, and Sa/IVCT values; and in the patients with right-to-left or bidirectional shunt tissue, the Doppler parameters showed higher MPI and MPI/Sa value with a high specificity and sensitivity.Conclusion: We conclude that an evaluation of MPI, S wave, E wave, IVRT, and IVCT via tissue Doppler echocardiography is a useful index for the discrimination of right-to-left from left-to-right and bidirectional intracardiac shunts

The effects of different doses of atorvastatin on serum lipid profile, glycemic control, and liver enzymes in patients with ischemic cerebrovascular accident

BACKGROUND: Despite established effects of atorvastatin on level of serum lipid profile in patients with different underlying clinical conditions, the effects of this drug on other serum biomarkers remain uncertain. We examined the effects of atorvastatin therapy on lipid profile, glycemic control, and liver enzymes in patients with ischemic cerebrovascular accident without any history or clinical evidences of diabetes, heart failure, renal failure, or hepatic disease. METHODS: In a randomized double-blinded controlled trial, 140 hospitalized patients with an ischemic cerebrovascular accident were included and randomly assigned to receive either atorvastatin 40 mg (n = 70) or atorvastatin 20 mg daily (n = 70) for 3 months. The levels of biomarkers were measured at the time of administrating drugs as well as at the time of completing the treatment. RESULTS: A significant reduction was revealed in serum triglyceride, total cholesterol, low-density lipoprotein, non-high-density lipoprotein (HDL) cholesterol, and also aspartate aminotransferase levels as well as a significant increase in serum HDL level following administration of atorvastatin in both case and control groups who received the atorvastatin 40 mg/day and 20 mg/day, respectively (all P &lt; 0.050). Although a significant increase in fasting blood sugar and hemoglobin A1c was observed in the case group received atorvastatin 40 mg/day (both P &lt; 0.001), but this elevation was not occurred in another group treated with lower dose of the drug (both P &gt; 0.050). CONCLUSION: Daily administration of 20 mg and 40 mg doses of atorvastatin for 3 months provides improvement in serum lipid profiles; however, because of interfering effect of high-dose atorvastatin on glycemic control status, the use of the former dose may be preferred. This is very important in these patients because the positive effects of high-dose atorvastatin in stroke patients are not confirmed. &nbsp;&nbsp;</div