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Hypertensive subjects with type-2 diabetes, the sympathetic nervous system, and treatment implications
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Coats, Andrew J. S. and Cruickshank, John M. (2014) Hypertensive subjects with type-2 diabetes, the sympathetic nervous system, and treatment implications. International Journal of Cardiology, Volume 174 (Number 3). pp. 702-709. doi:10.1016/j.ijcard.2014.04.204 ISSN 0167-5273.
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Official URL: http://dx.doi.org/10.1016/j.ijcard.2014.04.204
Abstract
Central obesity is closely linked to hypertension and type-2 diabetes (DM2) in young/middle-age. In the elderly, systolic hypertension is a reflection of aging/stiff arteries. Diastolic (± systolic) hypertension in young/middle-age is accompanied by increased sympathetic nerve activity, particularly in the presence of the metabolic syndrome or DM2. High beta-receptor density (Bmax) and cyclic AMP (cAMP) levels in human lymphocytes, independent of blood pressure, are associated with a high risk of myocardial infarction (not stroke-risk, which is dependent on blood pressure). This has treatment implications in the young/middle-aged hypertensive subject. Antihypertensive agents that increase sympathetic nerve activity e.g. dihydropyridine calcium blockers, angiotensin receptor blockers, and thiazide-type diuretics, do not reduce (and may increase) the risk of myocardial infarction. Beta-1 blockade, effective in reversing and stabilising coronary atheromataous plaque, and with possible anti-tumor properties, is superior to ACE-inhibition, and is the treatment of choice in young/middle-aged hypertension with DM2.
Item Type: | Journal Article | ||||
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Divisions: | Administration > University Executive Office | ||||
Journal or Publication Title: | International Journal of Cardiology | ||||
Publisher: | Elsevier Ireland Ltd. | ||||
ISSN: | 0167-5273 | ||||
Official Date: | July 2014 | ||||
Dates: |
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Volume: | Volume 174 | ||||
Number: | Number 3 | ||||
Page Range: | pp. 702-709 | ||||
DOI: | 10.1016/j.ijcard.2014.04.204 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access |
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