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Öğe The relationship between exercise capacity and masked hypertension in sedentary patients with diabetes mellitus(Taylor & Francis Inc, 2014) Akilli, Hakan; Kayrak, Mehmet; Aribas, Alpay; Tekinalp, Mehmet; Ayhan, Selim Suzi; Gunduz, Mehmet; Alibasic, HajrudinAim: Although exaggerated blood pressure responses (EBPR) to exercise have been related to future hypertension and masked hypertension (MHT), the relationship between exercise capacity and MHT remains unclear. A sedentary life style has been related to increased cardiovascular mortality, diabetes mellitus (DM), and hypertension. In this study, we aimed to examine the relationship between exercise capacity and MHT in sedentary patients with DM. Methods: This study included 85 sedentary and normotensive patients with DM. Each patient's daily physical activity level was assessed according to the INTERHEART study. All patients underwent an exercise treadmill test, and exercise duration and capacity were recorded. Blood pressure (BP) was recorded during all exercise stages and BP values >= 200/110 mmHg were accepted as EBPR. MHT was diagnosed in patients having an office BP < 140/90 mmHg and a daytime ambulatory BP > 135/85 mmHg. Patients were divided into two groups according to their ambulatory BP monitoring (MHT and normotensive group). Results: The prevalence of MHT was 28.2%. Exercise duration and capacity were lower in the MHT group than in the normotensive group (p < 0.05) and were negatively correlated with age, HbA1c, mean daytime BP, and mean 24 hour BP. Peak exercise systolic BP and the frequency of EBPR were both increased in the MHT group (25.0% and 8.1%, respectively, p = 0.03). According to a multivariate regression, exercise capacity (OR: 0.61, CI95%: 0.39-0.95, p = 0.03), EBPR (OR: 9.45, CI95%: 1.72-16.90, p = 0.01), and the duration of DM (OR: 0.84, CI95%: 0.71-0.96, p = 0.03) were predictors of MHT. Conclusion: Exercise capacity, EBPR, and the duration of DM were predictors of MHT in sedentary subjects with DM.Öğe The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus(Korean Assoc Internal Medicine, 2015) Aribas, Alpay; Kayrak, Mehmet; Tekinalp, Mehmet; Akilli, Hakan; Alibasic, Hayrudin; Yildirim, Serkan; Gunduz, MehmetBackground/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as poor sleepers. Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.Öğe Tip 2 diyabetes mellituslu hastalarda kardiyovasküler otonom nöropati sıklığı ve bununla ilişkili risk faktörlerinin belirlenmesi(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2011) Tekinalp, Mehmet; Soylu, AhmetTip 2 DM?li hastalarda KVONP sıklığını, KVONP risk faktörlerini ve bu risk faktörlerinin KVONP?un progresyonu ile ilişkisini araştırmayı amaçladık.Materyal ve Metod: Çalışmamız normotansif tip 2 DM tanısı olan, yaşları 32 ile 64 arasında değişen (ort. 49.20 ± 7.44 yıl), 38?i (%63.3) kadın, 22?si (%36.7) erkek olmak üzere toplam 60 hastanın dahil edildiği gözlemsel bir çalışmadır. Tüm hastalara başvuruda ve birinci yıl sonunda standart Ewing Battery testleri (derin solunum, Valsalva manevrası, 30:15 oranı, ayağa kalkmaya ve handgribe kan basıncı yanıtı) uygulandı. Test sonuçları bir skorlama sistemi kullanılarak ifade edildi. Test sonuçlarına göre KVONP yok (0-0.5 skor) ve KVONP var (1-5 skor) olarak sınıflandırıldı.Bulgular: Çalışmamızda başlangıçta KVONP prevalansı % 78.3 iken, birinci yılın sonunda % 70?e gerilerken (P=0.245), Ewing skoru toplamı 1.50 (1.00-2.50)?dan 1.00 (0.50-2.00)?e geriledi (P=0.035). KVONP grubunda başvuruda hastaların yaşı daha ileriydi ve 12.ayın sonunda sistolik kan basıncı (SKB) daha yüksekti (sırasıyla P=0.037, P=0.039). KVONP, yaş ve SKB?dan, anlamlılığa yakın olarak da statin kullanımının azlığından etkilenmekteydi (sırasıyla B=0.12, P=0.015; B=0.09, P=0.007; B= -1.83, P=0.052). Ewing skoru SKB ile anlamlı (r=0.38, P=0.034), yaş, diyabet süresi ve HbA1c ile anlamlılığa yakın koreleydi (sırasıyla r=0.25, P=0.062; r=0.24, P=0.063; r=0.24, P=0.071). Ewing skorundaki değişimle sadece total kolesteroldeki azalmanın anlamlı olduğu görüldü (B=0.26, P=0.047).Sonuç: Yaş, SKB ve total kolesterol seviyeleri tip 2 DM hastalarında KVONP ile ilişkili olabilir. Statinler KVONP tedavisinde umut vaat edebilir. Bu konuda farklı şekilde dizayn edilmiş ileri çalışmalara ihtiyaç vardırÖğe The value of serum asymmetric dimethylarginine levels for the determination of masked hypertension in patients with diabetes mellitus(Elsevier Ireland Ltd, 2013) Taner, Alpaslan; Unlu, Ali; Kayrak, Mehmet; Tekinalp, Mehmet; Ayhan, Selim S.; Aribas, Alpay; Erdem, Said SamiBackground: An increased prevalence of masked hypertension (MHT) has been demonstrated among patients with diabetes mellitus (DM). MHT appears to cause cardiovascular (CV) complications similar to clinically overt hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased CV risk in both the general population and among patients with DM. The aim of this study was to evaluate the relationship between MHT and ADMA in diabetic patients. Methods: This study included DM patients (n = 131) with normal office blood pressure (<140/90 mmHg). None of the participants were using antihypertensive medications. All participants utilized an ambulatory blood pressure monitor (ABPM) for 24 h. Serum ADMA and arginine levels were measured using the fluorescence detector high performance liquid chromatography method. Results: The prevalence of MHT was 24.4% among the study subjects. ADMA levels were increased in the MHT group when compared with normotensive diabetics (6.2 +/- 2.2 vs 4.2 +/- 1.7 mu mol/L p = 0.001, respectively). Furthermore, arginine/ADMA ratio was lower in the MHT group than among the normotensive group (29.9 +/- 12.1 vs 46.0 +/- 19.0 p = 0.001). In the multivariate logistic regression model, ADMA, BMI and HDL levels were found to be independent predictors of MHT Odds ratio: 1.63 (1.28-2.06), 1.19 (1.05-1.35), and 0.95 (0.90-0.99), respectively. The cut-off value of the ADMA was 4.34 mu mol/L with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 59.6%, of 40.3%, and 92.2%, respectively (AUC - 0.78). Conclusions: Serum ADMA may play a role in both the pathophysiology and screening of MHT in DM subjects. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
