Ambulatory blood pressure monitoring and serum nitric oxide concentration in type 1 diabetic children. Beneficial effect of lisinopril plus telmisartan in patients with type 2 diabetes, microalbuminuria and hypertension. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Effect of Cucurbita ficifolia and Probiotic Yogurt Consumption on Blood Glucose, Lipid Profile, and Inflammatory Marker in Type 2 Diabetes Identification of dietary patterns associated with blood pressure in a sample of overweight Australian adults Blood Pressure and Cardiovascular Disease Risk in the Veterans Affairs Diabetes Trial Efficacy and safety of acupuncture for hypertension: An overview of systematic reviews. Impact of Empagliflozin on Blood Pressure in Patients With Type 2 Diabetes Mellitus and Hypertension by Background Antihypertensive Medication Effect of Revised UPPP Surgery on Ambulatory BP in Sleep Apnea Patients with Hypertension and Oropharyngeal Obstruction Effects of ipragliflozin, a selective sodium–glucose co-transporter 2 inhibitor, on blood pressure in Japanese patients with type 2 diabetes mellitus: a pooled analysis of six randomized, placebo-controlled clinical trials Medical school-based teaching kitchen improves HbA1c, blood pressure, and cholesterol for patients with type 2 diabetes: Results from a novel randomized controlled trial. A new approach to assessing antihypertensive therapy: effect of treatment on pulse pressure. Candesartan cilexetil in Hypertension Ambulatory Measurement of Blood Pressure (CHAMP) Study Investigators. An ambulatory blood pressure monitoring study of the comparative antihypertensive efficacy of two angiotensin II receptor antagonists, irbesartan and valsartan Systolic Blood Pressure Goals to Reduce Cardiovascular Disease Among Older Adults Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. Effects of valsartan with or without benazepril on blood pressure, angiotensin II, and endoxin in patients with essential hypertension. Does metformin decrease blood pressure in patients with Type 2 diabetes intensively treated with insulin? Oral calcium supplementation ambulatory blood pressure and relation to changes in intracellular ions and sodium-hydrogen exchange. Description of clinical risk factor changes during naturopathic care for type 2 diabetes. The relationship between nut consumption and blood pressure in an Iranian adult population: Isfahan Healthy Heart Program. Pulse pressure lowering effect of dual blockade with candesartan and lisinopril vs. high-dose ACE inhibition in hypertensive type 2 diabetic subjects: a CALM II study post-hoc analysis. Epicatechin ingested via cocoa products reduces blood pressure in humans: a nonlinear regression model with a Bayesian approach. The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension.
Blood pressure can be determined more precisely with the use of 24 hours ambulatory measurement in type 1 diabetics .  Nitric oxide ( NO ) has been suggested to be responsible for the vascular changes described in early diabetic nephropathy . We aim ed to investigate serum NO concentration along with ambulatory blood pressure monitoring ( ABPM ) parameters in type 1 diabetic patients and to find out whether there are correlation between serum NO level and ABPM parameters . Forty type 1 diabetic subjects and 35 controls were enrolled . Diabetic subjects were grouped as microalbuminuric ( n=16 ) and normalbuminuric ( n=24 ) .  Casual and ambulatory blood pressure parameters and serum NO concentrations were measured in all study population . Microalbuminuric subjects had higher nighttime systolic blood pressure ( SBP ) , 24 hours diastolic blood pressure ( DBP ) and 24 hours mean arterial pressure ( MAP ) than controls . Both microalbuminuric and normalbuminuric subjects had also significantly higher nighttime DBP and nighttime MAP than controls . Serum NO concentrations were higher in normalbuminuric and microalbuminuric subjects than controls . Serum NO concentrations were positively correlated with daytime DBP and MAP , nighttime SBP , DBP and MAP , and 24 hours DBP and MAP in microalbuminuric subjects . Serum NO concentrations were also positively correlated with nighttime DBP in normalbuminuric subjects . Multiple linear regression analysis revealed that serum NO(2)- + NO(3)- concentrations and 24 hours DBP were independently associated with the development of microalbuminuria . Albuminuria seems to be closely associated with serum NO concentrations and ABPM parameters in type 1 DM patients . A prospect i ve follow-up study on diabetic patients with normo- and micro- albuminuria is needed to confirm the predictive values of increased NO concentrations and ABPM parameters on the development of albuminuria Angiotensin-converting enzyme ( ACE ) inhibitors have favourable effects on hypertension and diabetic nephropathy , but persistent use may result in incomplete blockade of the renin-angiotensin system . Long-term effects of dual blockade using the ACE inhibitor lisinopril and the long-acting angiotensin II receptor blocker ( ARB ) telmisartan on blood pressure and albumin excretion rate ( AER ) were evaluated . Patients with type 2 diabetes mellitus , hypertension ( systolic blood pressure [ SBP ] > or=140 mmHg or diastolic blood pressure [ DBP ] > or=90 mmHg ) and microalbuminuria ( AER 30 - 300 mg/24h ) received 20 mg of lisinopril or 80 mg of telmisartan once a day for 24 weeks . Patients were then r and omised to continuing treatment with the respective monotherapy or with lisinopril plus telmisartan for a further 28 weeks . Significant ( P<0.001 ) declines in SBP ( 11.1 mmHg versus 10.0 mmHg ) , DBP ( 5.6 mmHg versus 5.3 mmHg ) and AER ( 98 mg/24 h versus 80 mg/24 h ) were achieved with lisinopril ( n=95 ) or telmisartan ( n=97 ) , respectively , after 24 weeks . Subsequent treatment with lisinopril plus telmisartan for 28 weeks result ed in further significant reductions ( P<0.001 ) in SBP , DBP and AER compared with either monotherapy . All treatments were well tolerated . Lisinopril plus telmisartan thus provides superior blood pressure and AER control than either monotherapy . We conclude that use of dual blockade may provide a new approach to prevention of diabetic nephropathy in patients with type 2 diabetes , hypertension and microalbuminuria AIMS To determine the blood glucose lowering effect of cinnamon on HbA1c , blood pressure and lipid profiles in people with type 2 diabetes . METHODS 58 type 2 diabetic patients ( 25 males and 33 females ) , aged 54.9 ± 9.8 , treated only with hypoglycemic agents and with an HbA1c more than 7 % were r and omly assigned to receive either 2 g of cinnamon or placebo daily for 12 weeks . RESULTS After intervention , the mean HbA1c was significantly decreased ( P<0.005 ) in the cinnamon group ( 8.22 % to 7.86 % ) compared with placebo group ( 8.55 % to 8.68 % ) . Mean systolic and diastolic blood pressures ( SBP and DBP ) were also significantly reduced ( P<0.001 ) after 12 weeks in the cinnamon group ( SBP : 132.6 to 129.2 mmHg and DBP : 85.2 to 80.2 mmHg ) compared with the placebo group ( SBP : 134.5 to 134.9 mmHg and DBP : 86.8 to 86.1 mmHg ) . A significant reduction in fasting plasma glucose ( FPG ) , waist circumference and body mass index ( BMI ) was observed at week 12 compared to baseline in the cinnamon group , however , the changes were not significant when compared to placebo group . There were no significant differences in serum lipid profiles of total cholesterol , triglycerides , HDL and LDL cholesterols neither between nor within the groups . CONCLUSIONS Intake of 2 g of cinnamon for 12 weeks significantly reduces the HbA1c , SBP and DBP among poorly controlled type 2 diabetes patients  . Cinnamon supplementation could be considered as an additional dietary supplement option to regulate blood glucose and blood pressure levels along with conventional medications to treat type 2 diabetes mellitus Background : Control of blood sugar , hypertension , and dyslipidemia are key factors in diabetes management . Cucurbita ficifolia ( pumpkin ) is a vegetable which has been used traditionally as a remedy for diabetes in Iran . In addition , consumption of probiotics may have beneficial effects on people with Type 2 diabetes . The aim of this study was an investigation of the effects of C. ficifolia and probiotic yogurt consumption alone or at the same time on blood glucose and serum lipids in diabetic patients . Methods : Eighty eligible participants r and omly were assigned to four groups : 1 - green C. ficifolia ( 100 g ) ; 2 - probiotic yogurt ( 150 g ) ; 3 - C. ficifolia plus probiotic yogurt ( 100 g C. ficifolia plus 150 g yogurt ) ; and 4 -control ( dietary advice ) for 8 weeks . Blood pressure , glycemic response , lipid profile , and high-sensitive C-reactive protein ( hsCRP ) were measured before and after the intervention . Results : Total cholesterol ( TC ) decreased significantly in yogurt and yogurt plus C. ficifolia groups ( within groups P = 0.010 , and P < 0.001 , respectively ) . C. ficifolia plus yogurt consumption result ed in a decrease in triglyceride ( TG ) and an increase in high-density lipoprotein cholesterol ( HDL-C ) ( within groups P < 0.001 and P = 0.001 , respectively ) . All interventions led to a significant decrease in blood sugar , hemoglobin A1c ( HbA1c ) , hsCRP , and low-density lipoprotein cholesterol ( LDL-C ) level within groups . Blood pressure decreased significantly in Cucurbita group and yogurt group ( within groups P < 0.001 , and P = 0.001 for systolic blood pressure [ SBP ] and P < 0.001 , and P = 0.004 for diastolic blood pressure [ DBP ] , respectively ) . All variables changed between groups significantly except LDL-C level . Conclusions : Variables including TG , HDL-C , TC , fasting blood sugar , HbA1c , SBP , DBP , and hsCRP changed beneficially between groups . It seems that consumption of C. ficifolia and probiotic yogurt may help treatment of diabetic patients The dietary approaches to stop hypertension ( DASH ) diet provides strong evidence for an optimal dietary pattern for blood pressure ( BP ) control ; however , investigation at the level of key foods in a dietary pattern is sparse . This study aim ed to assess the relationship between dietary patterns driven by key foods with BP in a sample of obese Australian adults . Secondary analysis was conducted on baseline data of 118 participants ( 45.1±8.4 years , mean BP=124.1±15.8/72.6±9.2 mm Hg ) recruited in a weight reduction r and omized controlled trial ( ACTRN12608000425392 ) . Dietary assessment was by a vali date d diet history interview . The average of three office BP measurements was taken . Factor analysis extracted dietary patterns and their relation to systolic BP ( SBP ) and diastolic BP ( DBP ) was analysed using multiple linear regression . Eight dietary patterns were identified based on leading foods : meat and alcohol ; seafood ; fats ; fruits and nuts ; legumes ; confectionery ; sweet foods ; and yeast extracts and seasonings . A lower SBP was associated with alignment with the fruit and nuts pattern ( β=−4.1 ( 95 % confidence interval −7.5 to −0.7 ) mm Hg ) and with seafood for DBP ( β=−2.4 ( −4.6 to −0.3 ) mm Hg ) . SBP and DBP were higher with yeast extract and seasonings ( β=4.3 ( 1.4–7.3 ) ; 2.5 ( 0.9–4.0 ) mm Hg , respectively ) . In obese adults attending for weight loss , dietary patterns that included larger amounts of fruits and nuts and /or seafood were associated with lower BP at baseline , whereas patterns that were characterised by yeast extract and seasonings were associated with higher BP OBJECTIVE Blood pressure ranges associated with cardiovascular disease ( CVD ) events in advanced type 2 diabetes are not clear . Our objective was to determine whether baseline and follow-up ( On- Study ) systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial ( VADT ) . RESEARCH DESIGN AND METHODS Participants in the VADT ( n = 1,791 ) with hypertension received stepped treatment to maintain blood pressure below the target of 130/80 mmHg in st and ard and intensive glycemic treatment groups .  Blood pressure levels of all subjects at baseline and On- Study were analyzed to detect associations with CVD risk . The primary outcome was the time from r and omization to the first occurrence of myocardial infa rct ion , stroke , congestive heart failure , surgery for vascular disease , inoperable coronary disease , amputation for ischemic gangrene , or CVD death . RESULTS Separated SBP ≥140 mmHg had significant risk at baseline ( hazards ratio [ HR ] 1.508 , P < 0.001 ) and On- Study ( HR 1.469 , P = 0.002 ) . DBP < 70 mmHg increased CVD events at baseline ( HR 1.482 , P < 0.001 ) and On- Study ( HR 1.491 , P < 0.001 ) . Combined blood pressure categories indicated high risk for CVD events for SBP ≥140 with DBP < 70 mmHg at baseline ( HR 1.785 , P = 0.03 ) and On- Study ( HR 2.042 , P = 0.003 ) and nearly all SBP with DBP < 70 mmHg . CONCLUSIONS Increased risk of CVD events with SBP ≥140 mmHg emphasizes the urgency for treatment of systolic hypertension . Increased risk with DBP < 70 mmHg , even when combined with SBP in guideline -recommended target ranges , supports a new finding in patients with type 2 diabetes . The results emphasize that DBP < 70 mmHg in these patients was associated with elevated CVD risk and may best be avoided BACKGROUND AND PURPOSE Acupuncture is widely used in the treatment of hypertension , yet its efficacy and safety for hypertension remain controversial . This overview aim ed to summarize the evidence on acupuncture for hypertension . METHODS Eight data bases were search ed . The Assessment of Multiple Systematic Review s ( AMSTAR ) tool and the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach were performed . RESULTS Fifteen systematic review s ( SRs ) were identified . Method ological quality and quality of evidence were unsatisfactory . Acupuncture combined with Western medicine ( WM ) was superior to WM in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , efficacy rate , and traditional Chinese medicine ( TCM ) syndrome .  Acupuncture was more effective in treating SBP and DBP than sham acupuncture plus WM . Evidence regarding the benefit of acupuncture alone for SBP and DBP , efficacy rate and TCM syndrome was inconsistent . No serious adverse effects were identified . CONCLUSION High- quality SRs and r and omized controlled trials ( RCTs ) are required In the EMPA-REG BP trial , empagliflozin 10 mg and 25 mg once daily reduced glycohemoglobin , blood pressure ( BP ) , and weight versus placebo in patients with type 2 diabetes mellitus and hypertension . Patients  received placebo ( n=271 ) , empagliflozin  10 mg ( n=276 ) , or empagliflozin 25 mg ( n=276 ) for 12 weeks ( n = full analysis set ) . This present analysis investigated changes from baseline to week 12 in mean 24-hour systolic BP ( SBP ) and diastolic BP ( DBP ) in patients receiving 0 , 1 , or ≥2 antihypertensive medications and patients receiving/not receiving diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers . Compared with placebo , empagliflozin 10 mg and 25 mg reduced mean 24-hour SBP/DBP in patients receiving 0 ( 10 mg : −3.89/−2.58 mm Hg ; 25 mg : −3.77/−2.45 mm Hg ) , 1 ( 10 mg : −4.74/−1.97 mm Hg ; 25 mg : −4.27/−1.81 mm Hg ) , or ≥2 ( 10 mg : −2.36/−0.68 mm Hg ; 25 mg : −4.17/−1.54 mm Hg ) antihypertensives . The effect of empagliflozin was not significantly different between subgroups by number of antihypertensives for changes in SBP ( interaction P value 0.448 ) or DBP ( interaction P value 0.498 ) . Empagliflozin  reduced 24-hour mean SBP/DBP irrespective of diuretic or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use , with no significant difference between subgroups by use/no use of diuretics ( interaction P values 0.380 [ systolic ] ; 0.240 [ diastolic ] ) or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers ( interaction P values 0.900 [ systolic ] ; 0.359 [ diastolic ] ) . In conclusion , in patients with type 2 diabetes mellitus and hypertension  , empagliflozin for 12 weeks reduced SBP and DBP  versus placebo , irrespective of the number of antihypertensives and use of diuretics or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers . Clinical Trial Registration —URL : https:// clinical trials.gov . Unique identifier : NCT01370005 This study aim ed to investigate the value of the surgery of revised uvulopalatopharyngoplasty ( UPPP ) on ambulatory blood pressure ( BP ) in obstructive sleep apnea/hypopnea syndrome ( OSAHS ) patients with hypertension and oropharyngeal obstruction . A retrospective cohort study was performed in 29 patients with OSAHS and hypertension , who received treatment with revised UPPP surgery .  After surgery 1 month , the Apnea-hypopna index ( AHI ) and body mass index ( BMI ) significantly decreased ( P < 0.05 ) , and mini SpO2 and mean SpO2 increased than before ( P < 0 . 05 ) , but the heart rate showed no significant difference ( P > 0.05 ) . In the meantime , compared to pretreatment , nighttime systolic SBP , nighttime diastolic DBP , morning systolic SBP , morning diastolic DBP , 24-h DBP , and 24-h SBP , decreased significantly ( P < 0.05 ) , but daytime SBP and daytime DBP showed no significant difference ( P > 0.05 ) . The results of this study indicated that the BP in the sleep apnea patients with hypertension might gradually decrease by revised UPPP surgery Our aim was to examine the effects of ipragliflozin , a selective sodium – glucose co-transporter 2 inhibitor , on blood pressure in Japanese patients with type 2 diabetes mellitus ( T2DM ) . We conducted a pooled analysis of double-blind trials of Japanese T2DM patients , r and omized to 50 mg ipragliflozin or placebo  , with patient-level data for the change in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) from baseline to end of treatment ( 12–24 weeks ) . Data from six trials were analyzed : ipragliflozin was administered as monotherapy in two ; in combination with metformin , pioglitazone , or sulfonylurea in one each ; and in combination with prior therapy in patients with renal impairment in one . Overall , 628 and 368 patients were treated with ipragliflozin and placebo , respectively . The placebo-adjusted mean changes ( 95 % confidence interval ) in SBP and DBP ( mmHg ) were −2.8 ( −4.4 , −1.3 , P < 0.001 ) and −1.6 ( −2.7 , −0.6 , P < 0.002 ) , respectively , in all patients . The reductions in SBP and DBP were significantly greater in patients with baseline SBP ≥140 mmHg [ −5.5 ( −9.1 , −1.8 ) and −2.9 ( −5.3 , −0.5 ) , respectively ] than in patients with SBP < 140 mmHg [ −2.1 ( −3.8 , −0.4 ) and −1.3 ( −2.5 , −0.1 ) , respectively ] . The reductions in SBP and DBP were also significantly greater in the ipragliflozin group than in the placebo group in patients treated with [ −2.8 ( −5.1 , −0.4 ) and −2.4 ( −4.0 , −0.8 ) , respectively ] or without [ −3.0 ( −5.0 , −1.0 ) and −1.0 ( −2.4 , 0.4 ) , respectively ] concomitant antihypertensive therapy . In conclusion , this pooled analysis showed that ipragliflozin was associated with significant reductions in SBP and DBP compared with placebo AIMS A medical school-based teaching kitchen sought to establish proof-of-principle for its h and s-on Mediterranean diet (MD)-based cooking and nutrition curriculum for patients with type 2 diabetes ( T2D ) . METHODS This pilot r and omized controlled trial ( RCT ) allocated 27 patients with T2D between the control and GCCM arms . Mixed effects linear regression with repeated measures was used to investigate differences from baseline to 6 months . The primary and secondary endpoints were HbA1c -0.3 % ( -27 mmol/mol ) and diastolic blood pressure ( DBP ) -10 mmHg and a 25 % improved responses in dietary habits and attitudes and competencies in healthy nutrition . RESULTS Compared to the control group , the GCCM group had superior HbA1c reduction ( -0.4 % vs. -0.3 % , p = 0.575 ) that was not statistically significant . There were significantly greater reductions in the GCCM vs. control group for DBP ( -4 vs. 7 mmHg , p=0.037 ) and total cholesterol ( -14 vs. 17 mg/dL , p = 0.044 ) . There was a greater proportion increase though not significant of GCCM subjects compared to controls who mostly believed they could eat correct portions ( 18 % vs. -11 % , p = 0.124 ) , and who used nutrition panels to make food choices ( 34 % vs. 0 % , p = 0.745 ) . CONCLUSION This is the first known RCT demonstrating improved biometrics using a novel MD-based h and s on cooking and nutrition curriculum for patients with T2D . These results suggest subsequent clinical trials are warranted on the grounds of documented feasibility and clinical efficacy BACKGROUND A high pulse pressure is an independent cardiovascular risk factor . It has therefore been suggested that antihypertensive treatment should not only reduce systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , but should also decrease pulse pressure ( SBP minus DBP ) . In a previous analysis , we showed that two angiotensin II type 1 (AT1)-receptor blockers , c and esartan cilexetil and losartan , differed in their effects in reducing SBP and DBP . OBJECTIVE To compare the efficacy of c and esartan cilexetil and losartan according to a new approach -- their effect on pulse pressure-- and to describe the dose-effect relationship for SBP , DBP and pulse pressure , in a placebo-controlled study . METHODS After a 4-week placebo run-in period , 268 patients with mild-to-moderate hypertension were allocated r and omly to groups to receive placebo , c and esartan cilexetil ( 8 mg once daily ) or losartan ( 50 mg once daily ) , for 4 weeks . The doses were then doubled to 16 and 100 mg , respectively , for the final 4 weeks of the study . Clinic blood pressure was measured 24 and 48 h after each dose of drug or placebo , and ambulatory blood pressure was monitored from 0 to 36 h after each dose , at baseline and after 4 and 8 weeks of treatment . RESULTS C and esartan cilexetil decreased ambulatory pulse pressure significantly ( P < 0.05 ) more than did losartan during both daytime and night-time , and over the 24 h period after the previous dose . A different dose-effect relationship on SBP , DBP and pulse pressure was observed . The duration of action of c and esartan cilexetil was greater than that of losartan . After a missed dose ( i.e. approximately 24 - 36 h after the previous dose ) , mean ambulatory pulse pressure values after 4 and 8 weeks of treatment with c and esartan cilexetil were lower than those observed with losartan ( P < 0.005 ) . Clinic pulse pressure measurements were consistent with these ambulatory measurements . CONCLUSIONS AT1 -receptor blockers differ both in their ability to reduce pulse pressure and in their duration of effect , c and esartan cilexetil having a greater and more sustained effect than losartan . Different dose-effect relationships on SBP , DBP or pulse pressure were observed . Further prospect i ve studies based on pulse pressure are needed to analyse the mechanism of reduction of pulse pressure and to determine its prognostic value Background The primary objective of this study was to compare the change from baseline in mean diastolic ambulatory blood pressure ( ABP ) at 24 h post dose ( trough measurement ) after 8 weeks of treatment with irbesartan or valsartan in subjects with mild-to-moderate hypertension . Secondary objectives included comparing the mean changes from baseline in systolic ABP at trough ; 24-h ABP ; morning and night-time ABP ; self-measured systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) ; and office-measured SBP and DBP at trough . Design After a 3-week , single blind , placebo lead-in period , 426 subjects were r and omized to receive either irbesartan 150 mg or valsartan 80 mg for 8 weeks . Methods Ambulatory blood pressure measurements were obtained at baseline and at week 8 . Self-measured morning and evening DBP and SBP readings were obtained at home over a 7-day period at baseline and at week 8 . Office-measured seated DBP and SBP measurements were obtained at trough , at baseline , and at week 8 . Results Irbesartan demonstrated significantly greater reductions than valsartan for mean change from baseline in diastolic ABP at trough ( −6.73 versus −4.84 mmHg , respectively;P = 0.035 ) . Irbesartan produced significantly greater reductions than valsartan for mean systolic ABP at trough ( −11.62 versus −7.5 mmHg , respectively;P < 0.01 ) and for mean 24-h diastolic ABP ( −6.38 versus −4.82 mmHg , respectively;P = 0.023 ) and systolic ABP ( −10.24 versus −7.76 mmHg;P < 0.01 ) . Irbesartan also produced significantly greater reductions than valsartan for office-measured seated DBP ( −10.46 versus 7.28 mmHg , respectively;P < 0.01 ) and SBP ( −16.23 versus −9.96 mmHg , respectively;P < 0.01 ) and for self-measured morning DBP ( −6.28 versus −3.75 mmHg , respectively;P < 0.01 ) and SBP ( −10.21 versus −6.97 mmHg , respectively;P < 0.01 ) . Both drugs were well tolerated . Conclusion Irbesartan was more effective than valsartan in reducing DBP and SBP at trough and in providing greater overall 24-h blood pressure-lowering efficacy Abstract : The 2014 Evidence -Based Guideline for the Management of  High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee ( JNC 8) was recently published . This guideline recommended that older adults ( ≥60 years ) without diabetes or chronic kidney disease with systolic blood pressure ( SBP ) ≥150 mm Hg or diastolic blood pressure ( DBP ) ≥90 mm Hg be initiated on antihypertensive medication with a treatment goal SBP/DBP < 150/90 mm Hg . In contrast , the previous 3 JNC guidelines recommended treatment for these individuals be initiated at SBP/DBP ≥140/90 mm Hg with goal SBP/DBP < 140/90 mm Hg . In this article , we review r and omized trials of antihypertensive medication and observational data on SBP and DBP with cardiovascular outcomes among older adults , possible explanations underlying the different findings from these r and omized trials and observational studies , and contemporary antihypertensive treatment patterns among older U.S. adults . In closing , we highlight future research needs related to hypertension and outcomes among older adults OBJECTIVES We assessed the short-term antihypertensive effects of soluble fiber-rich whole oat cereals when added to a st and ard American diet . In addition , multiple assessment s of insulin sensitivity were conducted . STUDY DESIGN This was a r and omized , controlled , parallel-group pilot study design ed to compare an oat cereal group ( st and ardized to 5.52 g/day beta-glucan ) to a low-fiber cereal control group ( less than 1.0 g/day total fiber ) over 6 weeks . POPULATION A total of 18 hypertensive and hyperinsulinemic (= 10 U/mL or more ) men and women completed the trial . OUTCOMES MEASURED Primary study outcomes were changes in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) . Secondary outcomes included blood lipid , fasting glucose , and insulin levels and side effects related to elevated blood pressure and increased dietary fiber intake . RESULTS The oat cereal group experienced a 7.5 mm Hg reduction in SBP ( P < .01 ) and a 5.5 mm Hg reduction in DBP ( P < .02 ) , while there was virtually no change in either SBP or DBP in the control group . In the oat cereal group , a trend was observed for a lower total insulin response to a glucose load , suggesting improved insulin sensitivity . However , this could not be confirmed using estimates from the Bergman Minimal Model , perhaps because of our small sample size . The oats group experienced a significant reduction in both total cholesterol ( 9 % ) and low-density lipoprotein cholesterol ( 14 % ) . CONCLUSIONS The addition of oat cereals to the normal diet of patients with hypertension significantly reduces both SBP and DBP .  Soluble fiber-rich whole oats may be an effective dietary therapy in the prevention and adjunct treatment of hypertension AIM To evaluate the effects of valsartan ( Val ) with or without benazepril ( Ben ) on blood pressure and plasma levels of angiotensin ( Ang II ) and digoxin-immunoreactive factors ( endoxin ) in patients with essential hypertension . METHODS Ninety patients with essential hypertension were r and omly divided into 3 groups ( n=30 per group ) : Ben group ( Ben 10 mg/d , po ) ; Val group ( Val 80 mg/d , po ) ; combination drug therapy group ( Val 80 mg/d+Ben 10 mg/d , po ) ; all patients were treated for 12 weeks . Age and sex-matched 20 normal subjects were served as control group . RESULTS The levels of plasma endoxin and Ang II in patients with essential hypertension were remarkably higher than those in normal subjects . The levels of plasma Ang II and endoxin were all obvious positive correlation with systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) ( Ang II : r=0.5151 , 0.7978 ; endoxin : r=0.4706 , 0.7274 , respectively ) . Within 6 weeks of drug intervene , SBP and DBP were remarkably decreased in 3 groups . After 6 weeks , SBP and DBP were continuously decreased in Ben group and Val+Ben group , but not in Val group . Level of plasma Ang II was remarkably decreased as SBP and DBP decreased in Ben group and Val+Ben group ; level of plasma Ang II was remarkably increased in Val group . CONCLUSION Val with or without Ben remarkably decreased SBP and DBP in patients with essential hypertension within 6 weeks . Antihypertensive efficacy was weakened after long-term use of Val alone . The antihypertensive effect of Val+Ben group was the most remarkable among 3 groups and could avoid the side effects of high plasma Ang II AIMS We investigated in a double-blind study whether metformin reduces blood pressure ( BP ) in patients with Type 2 diabetes intensively treated with insulin . METHODS A total of 220 patients with Type 2 diabetes were asked to undergo 24-h ambulatory BP monitoring ( 24-h ABPM ) . One hundred and eighty-two gave informed consent . Eighty-nine were r and omized to metformin and 93 to placebo . Thirty-five subjects dropped out ( 13 placebo  , 22 metformin users ) ; 147 patients underwent a second  24-h ABPM , 16 weeks after r and omization . RESULTS Systolic BP ( SBP ) , diastolic BP ( DBP ) , pulse BP ( PP ) , mean BP ( MP ) and heart rate ( HR ) were measured as office BP measurements and as 24-h ABPM for 24-h , day and night . Office BP measurements did not differ significantly between the placebo- and metformin-treated groups for any BP measure , but showed a non-significant trend for SBP reduction with metformin use ( mean baseline-adjusted difference , metformin minus placebo : -4.2 mmHg , 95 % CI , -9.9 to + 1.5 ; P = 0.15 ) . The baseline-adjusted differences of the ambulatory measurements were -0.2 mmHg ( 95 % CI , -2.9 to + 2.6 ) for the 24-h SBP , and + 1.1 mmHg ( 95 % CI , -0.7 to + 2.8 ) for the 24-h DBP . On the whole , BP differences between metformin- and placebo-treated groups were not statistically significant . The only significant difference was for night-time PP ( baseline-adjusted difference : -2.2 mmHg ; 95 % CI , -4.2 to -0.2 ) . These results were not different after adjustment for age and diabetes duration , or for ( changes in ) body mass index , glycated haemoglobin , insulin dose or plasma homocysteine . CONCLUSION Metformin does not significantly affect BP in patients with Type 2 diabetes intensively treated with insulin BACKGROUND Calcium ( Ca2 + ) supplementation has been shown paradoxically to reduce intracellular Ca2 + and induce vascular relaxation . The aim of the study was to assess 24-h blood pressure ( BP ) change after Ca2 + supplementation and to investigate its relation to changes in intracellular ions and the activity of the first isoform of sodium-hydrogen exchange ( NHE-1 ) in subjects with hypertension and type 2 diabetes . METHODS This parallel , r and omized controlled , single-blinded trial , consisted of 31 patients with type 2 diabetes , and hypertension who were allocated to receive 1,500 mg of Ca2 + per day ( n = 15 ) or no treatment ( n = 16 ) for 8 weeks . RESULTS In the Ca2 + group a decrease of 1.7 + /- 2.7 mm Hg ( mean + /- SE ) P = 0.52 for mean 24-h systolic BP ( SBP ) and 2.1 + /- 1.5 mm Hg , P = 0.19 for mean 24-h diastolic BP ( DBP ) was recorded . Whereas in the control group an increase of 1.4 + /- 2.7 mm Hg , P = 0.59 for mean 24-h SBP and 1.2 + /- 2.8 mm Hg , P = 0.83 for mean 24-h DBP was observed . Intraplatelet Ca2 + decreased whereas intraplatelet magnesium ( Mg2 + ) and erythrocyte K+ increased in the intervention group . Change in mean 24-h SBP in the pooled group correlated with both change in intraplatelet Ca2 + ( r = 0.49 , P < 0.05 ) and NHE-1 activity ( r = 0.6 , P < 0.001 ) . The contribution of intraplatelet Ca2 + was attenuated when both parameters were entered in a multivariate regression model . CONCLUSIONS The present study shows a weak , statistically nonsignificant trend towards association of  Ca2 + supplementation on 24-h BP in hypertensive subjects with type 2 diabetes . However , our results indicated an interrelation of [Ca2+]i levels and NHE-1 activity on BP in patients with hypertension and type 2 diabetes BACKGROUND Survey findings report that 48 % of people with type 2 diabetes use complementary and alternative medicine ( CAM ) practice . Publications suggest a high incidence of health promotion counseling in naturopathic practice , yet clinical data on risk factor changes are not available in the literature . OBJECTIVES The primary aim of this study was to describe clinical risk factor changes during the utilization of naturopathic CAM services in patients with type 2 diabetes . DESIGN A retrospective , observational study design was used to describe naturopathic care . SETTING Abstract ed medical charts were from patients of the Bastyr Center for Natural Health in Seattle , WA . PARTICIPANTS The patients in this study had type 2 diabetes and received naturopathic care between 2001 and 2006 . OUTCOMES Abstract ed data included patient demographics , duration of care , number of visits , laboratory values for hemoglobin A1c ( HbA1c ) , low density lipoprotein ( LDL ) and high density lipoprotein ( HDL ) cholesterol , triglycerides ( TAG ) ; and systolic/diastolic blood pressure ( SPB , DBP ) . RESULTS Thirty-seven ( 37 ) patient records met inclusion criteria and were abstract ed in detail . Mean and median duration of care were 27 and 20 months , respectively . The mean number of visits was 11 . Significant mean changes in clinical laboratory risk factors over the duration of care were : -0.65 % for HbA1c ( p = 0.046 ) , -45 mg/dL for TAG ( p = 0.037 ) , -7 mm Hg in SBP ( p = 0.02 ) , and -5 mm Hg in DBP ( p = 0.003 ) . Mean changes for cholesterol did not reach statistical significance . The percentage of patients who reached new control , had clinical ly significant risk factor improvements , or had any improvement was : 26 % , 42 % , and 68 % for HbA1c , 7 % , 28 % , and 62 % for LDL , 0 % , 25 % , and 39 % for HDL , 14 % , 38 % , and 52 % for TAG , 16 % , 51 % , and 86 % for SBP , and 27 % , 54 % , and 70 % for DBP . COMMENTS/ CONCLUSIONS : These preliminary outcomes suggest that risk factor improvements occur during naturopathic care for diabetes , although the contribution of naturopathic care to these changes can not be determined . Effectiveness and generalizability of naturopathic approaches in treating type 2 diabetes should be evaluated in controlled prospect i ve studies in representative population s or r and omized trials BACKGROUND AND AIMS Few studies outside of Western countries have evaluated the relationship between consumption of nuts and blood pressure ( BP ) . This study aim ed to investigate the relationship between nut consumption and blood pressure in an Iranian adult population . METHODS AND RESULTS We performed a cross-sectional investigation among 9660 r and omly selected Iranian adults , sample d to represent three large Iranian regions , using data collected in the Isfahan Healthy Heart Program in 2007 . The frequency of nut consumption was assessed by a food frequency question naire  . Systolic and diastolic BPs ( SBP and DBP ) were measured in duplicate by trained personnel using a st and ard protocol . Multiple linear and logistic regressions were applied to assess the relationship between nut intake and BP levels and the presence of hypertension as SBP ≥ 140 mmHg , and /or a DBP ≥ 90 mmHg and /or current use of at least one type of anti-hypertensive medication . Those with nut consumption ≥4 times/week showed less mean of BPs and hypertension prevalence , compared to those who consumed nuts < 1 times/week ( p < 0.001 ) . Compared to no consumption , consuming nuts ≥4 times/week was associated with a 34 % lower prevalence of hypertension ( multivariate odds ratio ( OR ) = 0.66 ; confidence interval ( CI ) = 0.51 - 0.87 ; p for trend = 0.009 ) . CONCLUSIONS More frequent nut consumption is associated with lower BP and lower risk of hypertension among Iranian adults BACKGROUND Elevated pulse pressure ( PP ) is strongly associated with micro- and macrovascular complications in type 2 diabetic patients . We examined the effect of 12 months of dual blockade with c and esartan and lisinopril vs. high-dose lisinopril monotherapy on ambulatory PP in hypertensive type 2 diabetic patients from the CALM ( C and esartan and Lisinopril Microalbuminuria Trial ) II study . METHODS The CALM II study was a 12-month prospect i ve , r and omized , parallel-group , double-masked study that included 75 type 1 and type 2 diabetic subjects with hypertension . Participants were r and omized for treatment with either high-dose lisinopril ( 40 mg once daily ( o.d . ) ) or for dual blockade treatment with c and esartan ( 16 mg o.d . ) and lisinopril ( 20 mg o.d . ) . In this article , we present data from the post-hoc subgroup of 51 type 2 diabetic subjects who completed the full 12-month study period with successful ambulatory blood pressure ( BP ) measurements  at both baseline and follow-up visits . RESULTS Baseline 24-h BP values were similar in the two groups ( 24-h systolic BP ( SBP ) 130 + /- 12 vs. 127 + /- 9 , 24-h diastolic BP ( DBP ) 77 + /- 8 vs. 74 + /- 7 , and 24-h PP 53 + /- 8 vs. 53 + /- 7 mm Hg , for the lisinopril and dual blockade groups , respectively , P > 0.2 for all ) . Compared with lisinopril monotherapy , dual blockade treatment caused a highly significant reduction in 24-h PP levels ( -5 + /- 5 mm Hg , P = 0.003 ) , albeit the difference in the BP lowering effect between the treatment groups did not differ significantly for 24-h systolic ( P = 0.21 ) or diastolic ( P = 0.49 ) BP . Dual blockade treatment significantly lowered 24-h SBP ( -5 + /- 11 mm Hg , P = 0.03 ) , but not 24-h DBP ( -2 + /- 7 mm Hg , P = 0.29 ) , whereas in the lisinopril group , the opposite effect was observed ( 24-h SBP -1 + /- 9 mm Hg , P = 0.45 , 24-h SBP -3 + /- 7 mm Hg , P = 0.03 ) . CONCLUSIONS Twelve months of dual blockade with c and esartan and lisinopril significantly reduced PP when compared with high-dose monotherapy with lisinopril . Larger studies are needed to confirm this observation , and to evaluate whether this effect translates into a greater degree of end-organ protection from dual blockade treatment than from conventional angiotensin-converting enzyme ( ACE ) inhibition BACKGROUND Four meta-analyses of r and omized controlled trials ( RCTs ) based on the classical r and om-effects model showed that cocoa consumption can reduce  systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) . Because epicatechin is suggested to be responsible for the treatment effect , changes in blood pressure should depend on the dose of ingested epicatechin , which may explain the between- study differences . OBJECTIVE The objective was to quantify the effect of epicatechin ingested via cocoa products on changes in SBP and DBP . DESIGN A nonlinear meta-regression model was chosen to investigate the impact of the epicatechin dose on changes in SBP and DBP . A Bayesian approach using Markov chain Monte Carlo methods was applied for an appropriate treatment of the nonlinearity . RESULTS Data from 16 RCTs on SBP and 15 RCTs on DBP were included . The dose of epicatechin ingested via cocoa products influenced the changes in SBP and DBP . The asymptotic limit for the reduction was estimated at -4.6 mm Hg ( 95 % CI : -5.4 , -3.9 mm Hg ) for SBP and at -2.1 mm Hg ( 95 % CI : -2.7 , -1.6 mm Hg ) for DBP . An intake of 25 mg epicatechin/d led to a mean reduction of -4.1 mm Hg ( 95 % CI : -4.6 , -3.6 mm Hg ) in SBP and of -2.0 mm Hg ( 95 % CI : -2.4 , -1.5 mm Hg ) in DBP . CONCLUSIONS Blood pressure reduction by consumption of cocoa products depends on the dose of ingested epicatechin , which explains most of the between- study differences in classical meta-analyses . Similar effects may be achieved by consumption of other foods that are also rich in epicatechin In this study , efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension . After a 2-week , single-blind , placebo run-in period , 60 patients were r and omised to double-blind , once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks . Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases . Both telmisartan and perindopril significantly ( p < 0.0001 ) reduced clinic systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) compared with baseline values . Also , both drugs significantly ( p < 0.0001 ) reduced 24-h mean ambulatory SBP and DBP compared with baseline . Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater ( p < 0.05 ) in telmisartan-treated patients . A 24-h mean DBP of < 85 mmHg was observed in 66.6 % of the telmisartan-treated patients but in only 46.6 % of the perindopril-treated patients ( p < 0.05 ) . It is concluded that telmisartan and perindopril both produce significant reductions in clinic SBP and DBP , but the mean reduction in ambulatory DBP during the last 8 h of the dosing interval is greater in patients treated with telmisartan
The dietary modifications were more effective in reducing both SBP and DBP vs. control diet .
The Low-sodium , High-fiber , DASH , Low-fat , Low-protein and Vegan dietary approach were significantly more effective in reducing SBP compared to a control diet .
The High-fiber , Low-fat , Low-protein and Vegan diet were significantly more effective in reducing DBP .
The Low-sodium and High fiber diets had the greatest lowering effect on SBP and DBP in T2D patients .
CONCLUSIONS Adopting healthful dietary modifications were more effective in reducing both SBP and DBP vs. control .
The High-fiber and Low-sodium diets had the greatest lowering effect on SBP and DBP in T2D
AIMS We aim ed to investigate the effect of different dietary approaches on systolic and diastolic blood pressure ( SBP and DBP )  in Type II diabetes ( T2D ) .