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    Metformin and parameters of physical health
    (Japan Soc Internal Medicine, 2008) Helvaci, Mehmet Rami; Kaya, Hasan; Borazan, Ali; Ozer, Cahit; Seyhanli, Mahmut; Yalcin, Atilla
    Background The prevalence of excess weight, including overweight and obesity, is increasing with a high cost on health in society. Methods Consecutive cases with excess weight, aged between 50 and 70 years and desiring weight loss, were divided into two subgroups according to wishes of patients about whether they prefer medication or just a diet. Metformin at a daily dose of 2,550 mg was given to the medication group. Results As for the very high prevalences, 84.8% (313/369) of cases at or above the age of 50 years were overweight or obese, 67.2% (248/369) of them had white coat hypertension (WCH)or hypertension (HT), 52.5% (194/369) of them had impaired glucose tolerance (IGT) or diabetes mellitus (DM), and 68.8% (254/369) of them had dyslipidemia. Initially 143 cases with excess weight preferred the diet and 162 of them preferred the metformin therapy. But 42 cases (25.9%) stopped the drug because of excessive anorexia. At the end of the six-month period, there were highly significant differences between the two groups according to prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight, and obesity and a decreased fasting plasma glucose below 110 mg/dL (p < 0.001 for all). Conclusion Due to the very high prevalences of excess weight and probably many associated disorders with the excess weight, including IGT or DM, WCH or HT, and dyslipidemia, above the age of 50 years, and the detected significant benefits of metformin on all of the above parameters, metformin treatment should be initiated in patients with excess weight in their fifties.
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    White Coat Hypertension in Definition of Metabolic Syndrome
    (Int Heart Journal Assoc, 2008) Helvaci, Mehmet Rami; Kaya, Hasan; Seyhanli, Mahmut; Yalcin, Atilla
    Although white coat hypertension (WCH) is believed to have,in effect on health, there is no term defining WCH in metabolic syndrome. Consecutive patients 20 years old or older Who Underwent a check-up were included. The study included 1068 cases. The prevalences of hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired glucose tolerance (IGT), and WCH were similar to excess weight in that they increased significantly until the seventh decade of life and decreased thereafter significantly (P < 0.05 in most steps'). On the other hand, the prevalences of hypertension (I-IT), diabetes mellitus (DM), and coronary heart disease (CHD) always increased significantly with age without any decrease (P < 0.05 in most steps), indicating their irreversibility in contrast to the reversibility of excess weight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH. Metabolic syndrome is a reversible progression step between health and irreversible final diseases terminating with increased mortality and disabilities. Thus, the definition of metabolic syndrome should include reversible metabolic risk factors such as excess weight (overweight and obesity), hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT. and WCH, instead of irrevesible diseases such as DM, I-IT, Cl-ID, and stroke that have already developed and require drug therapy. After development of one of the final metabolic diseases, the term metabolic syndrome probably loses most of its significance, since from that point on, nonpharmacetical approaches Such as lifestyle changes, diet, and exercise will provide little benefit to prevent development of the others, most likely due to the cumulative effects of the risk factors on body systems over a long period of time. (Int Heart J 2008; 49: 449-457)
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    White coat hypertension is associated with a greater all-cause mortality
    (Pharmaceutical Soc Japan, 2007) Rami Helvaci, Mehmet; Kaya, Hasan; Seyhanli, Mahmut; Cosar, Emine
    Background: Prognostic significance of white coat hypertension (WCH) remains controversial and most of the studies have just focused on the progression to hypertension (HT) or whether or not it already causes target organ damage. Methods: We studied consecutive adults and eldelies with sustained normotension (NT), WCH, and HT applying to the Internal Medicine Polyclinic. A 10 day twice daily measurement of blood pressure at home (HBP) was obtained in all cases, and a 24 hr ambulatory blood pressure monitoring (ABPM) was performed just for the cases with higher office and/or HBP measurements. Prevalences of smoking, overweight, obesity, impaired glucose tolerance, type II diabetes mellitus, hyperbetalipoproteinemia, hypertriglyceridemia, and dyslipidemia were calculated in each group and results were compared in between. Comparison of proportions was used as the statistical analysis method. Results: The study totally included 169 cases, 54 with sustained NT, 66 with WCH, and 49 with HT. The 115 patients with WCH and HT were both diagnosed via HBP and ABPM, and no difference was observed between the two methods for the diagnosis of WCH and masked or obvious HT. Except the smoking and overweight, almost all of the above disorders showed a stepwise and significant progression in frequencies from sustained NT toward WCH and HT. Conclusions: WCH should preferentially be accepted as a disorder associated with a greater all-cause mortality, rather than a predisposing factor of HT or atherosclerosis alone, and its management should be focused on the above comorbid disorders.