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Archived Comments for: Hyperglycemia and nocturnal systolic blood pressure are associatedwith left ventricular hypertrophy and diastolic dysfunction in hypertensive diabetic patients

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  1. Hypertensive Constitution accounts for the exsistence of diabetics with and without Hypertension.

    Sergio Stagnaro, Biophysical Semeiotics Research Laboratory

    21 October 2006

    Sirs.

    Interestingly,“clinical” biophysical semeiotic evidence demonstrates that natriuretic peptides (NP) act acutely to reduce plasma volume by at least 3 mechanisms: increased renal excretion of salt and water, vasodilation, and increased vascular permeability (1, 2, 3, 4). Fortunately, all these actions can nowadays be evaluated quantitatively, for the first time, at the bed-side by means of Biophysical-Semeiotics (See http://www.semeioticabiofisica.it, Practical Applications) (2). Firstly, we can assess the basal vasodilation of whatever artery, e.g., of brachial artery, and, secondly, the NP-dependent artery dilation, according to methods described also in above-cited site (2, 3). At this point, from both diagnostic and prognostic view-point, it is really usefull the precise “clinical” biophysical-semeiotic evaluation of renal and artery NP acute effects, observed during and soon therefater stretch-ischaemia test, in detail described formerly (ibidem). In healthy, doctor may observe these known renal and artery effects, brought about by NP (during intense, obstructive digital pressure upon the precordium for about 20 sec.), which cause both vasodilation, by relaxing vascular smooth muscle (in a “similar” way as acetyl-choline does) (1), and an acute increase in vascular permeability via receptors on the microvascular endothelium, clinically evaluated by artery compliance test (2) as well as Bilancini-Lucchi’s sign (3). These mechanisms, infact, also decrease blood volume by favoring redistribution of plasma protein and fluid from the vascular space to the interstitial space.

    To summarize, my clinical biophysical data enlighten the hypertension problem, i. e., they account for the reason that some, but not all, diabetic patients are hypertensive, providing new data to support the hypothesis of hypertensive constitution, by investigating the regulation of plasma volume due to NP. For the first time, in an ongoing clinical research (book in press), biophysical-semeiotic methods were utilized in 25 young “healthy” individuals, but involved by hypertensive constitution (4) and “white cloth” hypertension, aiming to assess NP-dependent vasodilation and modulation of vascular permeability, confronting them with data observed in controls without hypertensive constitution.

    In fact, soon after the discovery of the natriuretic peptides, authors recognized the importance of changes in vascular permeability in regulating the distribution of water between the plasma space and the interstitial space , now-a-days fortunately assessed clinically (1, 4, 5, 6)

    Although preliminary, these data of my study are very promising, allowing to recognize individuals with hypertensive biophysical-semeiotic Constitution, apparently “healthy, but evolving slowly and symptomless to artery hypertension (Pre-Metabolic Syndrome worsening to Metabolic Syndrome) (4,5).

    References.

    1) Stagnaro Sergio, Stagnaro-Neri Marina. Introduzione alla Semeiotica Biofisica. Il Terreno oncologico”. Travel Factory SRL., Roma, 2004.

    http://www.travelfactory.it/semeiotica_biofisica.htm

    2) Stagnaro-Neri M., Stagnaro S., Stadio pre-ipertensivo e monitoraggio terapeutico della ipertensione arteriosa. Omnia Medica Therapeutica. Archivio, 1-13, 1989-90, 19904)

    3) Stagnaro-Neri M., Stagnaro S., Il Segno di Bilancini-Lucchi nella diagnosi clinica del diabete mellito. The Pract. Ed. It. 176, 30, 1993

    4) Sabrane, K. et al. 2005. Vascular endothelium is critically involved in the hypotensive and hypovolemic actions of atrial natriuretic peptide. J. Clin. Invest. 115:1666-1674. doi:10.1172/JCI23360

    5) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Ediz. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm

    6) Stagnaro S., Stagnaro-Neri M., Single Patient Based Medicine.La Medicina Basata sul Singolo Paziente: Nuove Indicazioni della Melatonina. Travel Factory SRL., Roma, 2005. http://www.travelfactory.it/semeiotica_biofisica.htm

    Competing interests

    Not declared

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