Home is where the heart is, Friendship is a guest, a book, a fire, a hand clasp, a place where souls can rest

Home is where the heart is,

Friendship is a guest, a book, a fire,

a hand clasp, a place where souls

can rest

Nicotine Has Many Deleterious Effects on the CVS NICOTINE Kannel WB. J Hypertens 1990. McGill HC Jr. Am Heart J 1988. Robertson D. Am Heart J 1988.  Catecholamines  Vasopressin  Thromboxane B 2  Prostacyclin, NO  Blood pressure  Heart rate  Myocardial ischemia  Arrhythmia  HDL  Triglycerides  LDL  Fibrinogen  Platelet aggregation Hyperlipidemia Hypercoagulable state

ADVICE IS LIKE KISSING:IT COSTS NOTHING AND IT IS A PLEASANT THING TO DO -GEORGE BERNARD SHAW

MONEY WALKS-NOBODY TALKS!!!! It is said that for money you can have everything but you can buy food, not appetite you can buy books,not knowledge you can buy medicine,not health !!!

Insulin’s actions in normal humans and in obese hypertensives Normal Human Insulin Obesity or Hypertension Insulin Sympathetic Activation Vasodilation Increased Blood Pressure Decreased Blood Pressure No Increase in Blood Pressure Elevated Blood Pressure Potentiated Sympathetic Activation Attenuated Vasodilation Augmented Pressor Action Impaired Depressor Action Clinical Hypertension, 7th ed., Kaplan NM.

Diurnal blood pressure variation Am J Hypertens 2005; 18: 149-151.

What is morning BP surge? The morning BP surge (MBPS) is calculated as the mean systolic BP during the 2 h after waking minus the night time lowest BP (mean systolic BP during 1 h that included the lowest sleep BP) The Surge group MBPS > 45 mm Hg Non-Surge group MBPS < 45 mm Hg Am J Hypertens 2004;17:668-675.

The morning BP surge (MBPS) is calculated as the mean systolic BP during the 2 h after waking minus the night time lowest BP (mean systolic BP during 1 h that included the lowest sleep BP)

The Surge group MBPS > 45 mm Hg

Non-Surge group MBPS < 45 mm Hg

Classification of nocturnal dippers Percentage of nocturnal systolic BP reduction is calculated as (100 x {1-Sleep systolic BP/Awake systolic BP}) Patients are classified based on above value as Extreme dippers if nocturnal systolic BP reduction was ≥ 20% Dippers if decrease is ≥ 10% but <20% Non-dippers if decrease is ≥ 0% but <10% Risers if it is <0% Am J Hypertens 2005; 18: 1528-1533

Percentage of nocturnal systolic BP reduction is calculated as (100 x {1-Sleep systolic BP/Awake systolic BP})

Patients are classified based on above value as

Extreme dippers if nocturnal systolic BP reduction was ≥ 20%

Dippers if decrease is ≥ 10% but <20%

Non-dippers if decrease is ≥ 0% but <10%

Risers if it is <0%

Symp. Activity (alpha adrenergic activity) Baroreceptor sensitivity RAAS activity Plasma cortisol, catecholamine levels MBPS Thromboembolic tendency Platelet aggregation Hematocrit Fibrinogen, PAI-1 Blood viscosity Hypercoagulability Fibrinolytic activity Impaired endothelial function NO production atherosclerosis Shear stress on vascular wall Vascular tone Cardiovascular events MI Sudden cardiac death Ventricular fibrillation Ventricular tachyarrhythmia Stroke Target organ damage Hypertension 2005;45:485-86 AJH 2005; 18: 145-181

Laragh’s pearls Am J Hypertens 2001; 14: 491–503.

CAFÉ - an ASCOT substudy C onduit A rtery F unction E valuation

DIABETES–RELEVANT FEATURES OF ANTIHYPERTENSIVE CLASSES ( I ) Diuretics Drug class Metabolic control Other characteristics Worsening of dyslipidemia Worsening of glucose tolerance Hypokalemia Impotence  – blockers Worsening of dyslipidemia Worsening of insulin resistance Impairment of Insulin secretion Masking of hypoglycemic symptoms Lethargy and tiredness Home et al , 1997

Worsening of dyslipidemia

Worsening of glucose tolerance

Hypokalemia

Impotence

Worsening of dyslipidemia

Worsening of insulin resistance

Impairment of Insulin secretion

Masking of hypoglycemic symptoms

Lethargy and tiredness

DIABETES–RELEVANT FEATURES OF ANTIHYPERTENSIVE CLASSES ( II ) Drug class Metabolic control Other characteristics ACE inhibitors Probably neutral Reduced progression of nephropathy Risk of renal deterioration Reversible cough Selective  – blockers Improved lipid profile Improved insulin sensitivity Improved sexual function Calcium channel blockers Netural Peripheral edema Increased mortality (Short acting) Home et al , 1997

ACE inhibitors

Probably neutral

Reduced progression of nephropathy

Risk of renal deterioration

Reversible cough

Selective  – blockers

Improved lipid profile

Improved insulin sensitivity

Improved sexual function

Calcium channel blockers

Netural

Peripheral edema

Increased mortality (Short acting)

EFFECT OF ANTIHYPERTENSIVE DRUGS ON INSULIN SENSITIVITY INDEX Lithell, 1991 % Hyperinsulinemic-euglycemic clamp method

No TGL  HDL  Anti Oxide α β γ Adiponectin 

Why should  1 blockers improve insulin sensitivity?  1 blockade:  Anti-lipolytic (inhibits peripheral lipolysis)  Stimulates lipoprotein lipase-mediated clearance of TGs   in release of non-esterified (free) fatty acids  improves muscle blood flow   capillary recruitment (  LPL receptors)  Prolongs transit time for blood over muscle bed  in insulin hypersecretion:   in hyperinsulinemia   mobilization of intracellular calcium (insulin secretagogue)   counter-insulin hormones CRF, cortisol, catecholamines   glycogenolysis and gluconeogenesis   in hyperglycemia Andersson PE . Am J Hypertens 1996; 9: 323-333.