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Hypertension, defined as a sustained blood pressure ≥140/90 mmHg, is common among patients with either type 1 or type 2 diabetes. Hypertension is a major risk factor for both ASCVD and microvascular complications. Moreover, numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications. Please refer to the American Diabetes Association (ADA) position statement “Diabetes and Hypertension” for a detailed review of the epidemiology, diagnosis, and treatment of hypertension ( 5 ).


Blood pressure should be measured by a trained individual and should follow the guidelines established for the general population: measurement in the seated position, with feet on the floor and arm supported at heart level, after 5 min of rest. Cuff size should be appropriate for the upper-arm circumference. Elevated values should be confirmed on a separate day. Postural changes in blood pressure and pulse may be evidence of autonomic neuropathy and therefore require adjustment of blood pressure targets. Orthostatic blood pressure measurements should be checked on initial visit and as indicated.

Home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring may provide evidence of white coat hypertension, masked hypertension, or other discrepancies between office and “true” blood pressure ( 5 ). In addition to confirming or refuting a diagnosis of hypertension, home blood pressure assessment may be useful to monitor antihypertensive treatment. Studies of individuals without diabetes found that home measurements may better correlate with ASCVD risk than office measurements ( 6 , 7 ). Moreover, home blood pressures may improve patient medication adherence and thus help reduce cardiovascular risk ( 8 ).

Blood pressure should be measured at every routine clinical visit. Patients found to have elevated blood pressure (≥140/90) should have blood pressure confirmed using multiple readings, including measurments on a separate day, to diagnose hypertension. B

All hypertensive patients with diabetes should monitor their blood pressure at home. B


Randomized clinical trials have demonstrated unequivocally that treatment of hypertension to blood pressure <140/90 mmHg reduces cardiovascular events as well as microvascular complications ( 9 15 ). Therefore, patients with type 1 or type 2 diabetes who have hypertension should, at a minimum, be treated to blood pressure targets of <140/90 mmHg. Intensification of antihypertensive therapy to target blood pressures lower than <140/90 mmHg (e.g., <130/80 or <120/80 mmHg) may be beneficial for selected patients with diabetes such as those with a high risk of cardiovascular disease. Such intensive blood pressure control has been evaluated in large randomized clinical trials and meta-analyses of clinical trials.

Most patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg. A

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Hertzel C. Gerstein
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Circulation. 2009; 119: 773-775
Hertzel C. Gerstein

Diabetes is a metabolic disorder that is diagnosed when the fasting and/or postload glucose level rises above well-established thresholds. These thresholds were chosen because they identified people at particularly high risk for retinopathy based on epidemiological data. These data also have shown that people with diabetes and poorly controlled glucose levels have higher risks of retinopathy than people with diabetes and well-controlled glucose levels. 1,2 Moreover, recent studies have shown that the relationship between chronically elevated glucose levels (as measured by A 1c ) and retinal disease is not confined to people with diabetes and is apparent (although less marked) in people with high glucose levels that are below the diabetes cutoffs such as those with impaired glucose tolerance and/or impaired fasting glucose. 3–5 Thus, there is a progressive relationship between glycemia and retinopathy that extends below glucose thresholds for diabetes.

Article p 812

Clearly, diabetes also is a risk factor for many other serious chronic diseases, including cardiovascular disease. SKECHERS Bikers Biodiesel SINs6v
Indeed, a recent meta-analysis of large prospective studies comprising 450 000 people showed that men and women with diabetes are 2 and 3 times more likely, respectively, to die of coronary heart disease than men and women without diabetes. 7 Other studies have shown that the degree of glucose elevation measured by A 1c , fasting glucose, or postload glucose is progressively related to the incidence of cardiovascular outcomes in people with established diabetes and in people without diabetes after adjustment for age and varying numbers of other risk factors. BirkenstockMemphis NMcoEq0JKG
Moreover, several studies that recruited people from both ambulatory and hospitalized settings suggest that there may be a stronger relationship between glycemia and incident cardiovascular outcomes in people without diabetes than in people with diabetes. 8,9,15–17 Such a discrepancy may occur because in people with established diabetes, markers of glycemia are a measure of both adequacy of therapy and exposure to hyperglycemia, whereas they reflect only exposure to hyperglycemia in people without diabetes (in whom glucose and A 1c levels are not targets for therapy).

EMBASE Classic + EMBASE (Ovid) (1947 to Week 47 2013);

CINAHL Plus (EBSCOhost);

Science Citation Index Expanded (SCI-EXPANDED) (1970 to 22 November 2013), and Conference Proceedings Citation Index – Science (CPCI-S) (1990 to 22 November 2013) in Web of Science (Thomson Reuters).

The search strategies used are included in Appendix 1 . The MEDLINE strategy includes the Cochrane RCT filter (sensitivity-maximizing version) ( Lefebvre 2011 ) and this has been adapted for use in the other databases except CENTRAL.

We did not apply any language restrictions.

We conducted searches in clinical trial registers using the terms “exercise” AND “cardiovascular risk”. This search was conducted in November 2013 in the following clinical trial registers:

Meta Register of Controlled Trials ( ); ( PUMA SafetyAerial Low lKdHewd8Zz

WHO International Clinical Trials Registry Platform (ICTRP) ( ).

Additionally, we reviewed references of relevant articles. It was not necessary to contact any trial authors to obtain unpublished data.

References of trials found through the aforementioned search were evaluated for inclusion by reading their respective titles and abstracts. Of those that remained, two authors (PS, FL) independently analyzed their full texts to determine their eligibility. Disagreements were solved by consensus or by consulting a third author (XB).

Two authors (PS, FL) independently extracted data of interest from each of the included trials. Disagreements were resolved by consensus or by consulting a third author (XB).

In studies that did not include 10-year Framingham risk scores, we proceeded to calculate the scores from the data reported for each of the individual risk factors at the beginning and end of the monitoring period.

We started with baseline measurements. For continuous variables, we used mean values and standard deviations (SD). For categorical variables (smoking status and presence of left ventricular hypertrophy) the most conservative (or less risky) scenario was assumed. The total average cardiovascular risk of the sample was estimated (using averages) as well as the minimum and maximum values ​​(using SD). We made these estimates separately for men and women.

Regarding cardiovascular risk at the end of the follow-up period, we implemented the same parameters except that we used the 95% confidence intervals reported in each study instead of SD.

We assessed the risk of bias in all trials under the following domains ( Higgins 2011 ).

Sequence generation: the methods used to generate the allocation sequence allow groups to be comparable.

Measures to conceal allocation: the intervention allocation could have been foreseen, before or during recruitment, or changed after assignment.


Climate Capitalism An ecosocialist journal
Essential reading for Ecosocialists
Posted on

If you have been waiting for the perfect time to subscribe to , wait no longer. The latest issue of my favorite Marxist journal is a special double issue devoted to explaining and expanding the ecological critique embodied in Marx’s theory of metabolic rift.

Each article uses the metabolic rift perspective to uncover core contradictions of capitalism, as well as possible paths toward a new system that will meet human needs while protecting the earth and future generations. (Full disclosure: I am one of the authors.)

The articles will be posted online over the next two months — the online availability dates are shown below.

If you subscribe to MR, you can read the entire issue online, right now, before your paper copy arrives!

Which is a very good reason to Nine West Vesuvio Mule Womens HJNNY

Here’s what you’ll read in the July-August 2018 issue of :

John Bellamy Foster Brett Clark THE ROBBERY OF NATURE Capitalism and the Metabolic Rift Marx’s notion of “the robbery of the soil” is intrinsically connected to the rift in the metabolism between human beings and the earth. To get at the complexities of his metabolic rift theory, it is useful to look separately at the issues of the robbery and the rift, seen as separate moments in a single development.

Hannah Holleman NO EMPIRES, NO DUST BOWLS Ecological Disasters and the Lessons of History When scientists describe the increase of Dust Bowl-like conditions under climate change, they signal a particular kind of violent ecological and social change. But equally violent are the social forces, historical developments, policies, and practices that produce such massive socioecological crises in the first place.

Ian Angus CESSPOOLS, SEWAGE, AND SOCIAL MURDER Environmental Crisis and Metabolic Rift in Nineteenth-Century London The accumulation of human excrement in nineteenth-century cities, particularly London, precipitated a historic environmental crisis—an aspect of the metabolic rift mostly overlooked in ecosocialist analysis. The solution that was finally adopted only shifted the problem out of sight, setting the stage for even greater crises in our time.

Michael Friedman METABOLIC RIFT AND THE HUMAN MICROBIOME Metabolic rift theory can deepen our understanding of the human microbiota—organisms living on and inside of humans—and the ways that capitalism has disrupted these microbial ecosystems, with serious consequences for our health.

Brett Clark Stefano B. Longo LAND–SEA ECOLOGICAL RIFTS A Metabolic Analysis of Nutrient Loading Increasing rates of nitrogen and phosphorus application have caused severe damage to aquatic systems, as rivers, streams, lakes, bays, and ocean systems have been inundated with nutrient runoff. Only by addressing the metabolic rupture in the soil nutrient cycle and the contradictions of capital can we begin to mend these land–sea rifts.

John Bellamy Foster MARX, VALUE, AND NATURE In recent years ecological critiques of capitalism have deepened and multiplied, resulting in new debates over the conception, scope, and purpose of Marx’s value theory and its relation to the natural world.

1859: ON ENGLISH FARMING AND SEWERS “If the British people do not take the pains to secure the natural conditions of the permanent fertility of their land, if they allow these conditions as hitherto to be squandered, their fields will at no distant day cease to yield their returns of corn and meat.” 1862: PREFACE TO THE AGRICULTURAL CHEMISTRY “I have had abundant opportunity of estimating the impediments which stand in the way of scientific doctrines passing into the domain of practical Agriculture. The reason of which is, especially, that no connexion was formed between Practice and Science.”

Special issue features new articles
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