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Emergence of structural arterial stiffness in diabetes and the role of abnormalities of autonomic tone in the sequence of events

Journal of Human Hypertension volume 18, pages 755–756 (2004)Cite this article

Biochemically defined diabetes as a marker of future cardiac and vascular events is now routinely accepted as a major adverse cardiovascular risk factor within international guidelines.1 The management of diabetes is increasingly recognized as dependent on the management of accelerated vascular disease, which necessitates more than attempting to correct glucose control.2 In this regard, control of arterial pressure and vascular function in diabetic patients is at least, if not more important than managing glycaemic control.

Over the last 10 years, the boundaries of where altered carbohydrate metabolism or altered insulin responsiveness to a carbohydrate load start to influence vascular structure and vascular risk are increasingly extending into what was previously regarded as a nominal normal range.3 In a similar vein, the relationship between arterial pressure and vascular change and subsequent event rates also appears to be one that extends into the normal range. The amplification of this relationship in diabetes is reflected by lower targeted blood pressure in diabetes. One of the key aspects of these relationships that remains unanswered are the ordering or control over these inter-relationships. In the present issue of the Journal, van Ittersum and colleagues from the Netherlands and Belgium add further insight.

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  1. Department of Cardiology, University Department of Medicine, City Hospital, Birmingham, UK

    R J MacFadyen & H S Lim

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  1. R J MacFadyen
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  2. H S Lim
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Correspondence to R J MacFadyen.

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MacFadyen, R., Lim, H. Emergence of structural arterial stiffness in diabetes and the role of abnormalities of autonomic tone in the sequence of events. J Hum Hypertens 18, 755–756 (2004). https://doi.org/10.1038/sj.jhh.1001755

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