All patients using systemic corticosteroids, and two patients using topical steroids with extreme MSC values were excluded as contamination was suspected (22)

All patients using systemic corticosteroids, and two patients using topical steroids with extreme MSC values were excluded as contamination was suspected (22). In non-users of AHD, multiple logistic regression analyses (Backward: Wald) were performed with high MSC as a dependent variable. The Hosmer and Lemeshow test for goodness-of-fit and Nagelkerke (%). aFishers exact test unless otherwise indicated. bMannCWhitney test. Missing values for all/users of AHD/non-users of AHD: cAbdominal obesity (%). aFishers exact test unless otherwise indicated. bMannCWhitney test. For missing values, see Table 1. In Table 3 associations with high systolic BP are presented for all patients. Physical inactivity (adjusted odds ratio (AOR) 6.5), high MSC (AOR 3.9), abdominal obesity (AOR 3.7), AHD (AOR 2.9), age (per year) (AOR 1.07), and p-creatinine (per mol/L) AF64394 (AOR 1.03) were associated with high systolic BP. Table 3 Associations with high systolic BP in all patients. values 0.10 AF64394 for the CORs, sex and age are included in the analyses; values 0.10 for the CORs, sex and age are included in the analyses; em n /em ?=?a60/b123; Nagelkerke em R /em 2: a0.277/b0.381; Hosmer and Lemeshow Test: a0.154/b0.136. There were no associations between high MSC and high diastolic BP, neither for all patients ( em P /em ?=?0.63), users of AHD ( em P /em ? ?0.99), nor non-users of AHD ( em P /em ?=?0.63). Discussion The principal finding in this study of 196 adult patients with T1D was that patients with high systolic BP ( 130 mmHg) compared to patients with low systolic BP, had higher prevalence of high MSC (9.3 nmol/L). This was the case for both users and non-users of AHD. In all patients, physical inactivity, high MSC, abdominal obesity, AHD, p-creatinine, and age, were independently associated with high systolic BP. In the users of AHD, high MSC and age were associated with high systolic BP. In the non-users of AHD, abdominal obesity, physical inactivity, male sex, smoking, and age, were associated with high systolic BP. In the non-users of AHD, high MSC was not independently AF64394 associated with systolic BP. No association between high diastolic BP (80 mmHg) and high MSC was found in any group. The first strength of this study was that the population of patients with T1D AF64394 was well defined. Patients with severe somatic or psychiatric comorbidities and/or substance abuse were excluded. Of particular importance is that no patients with diagnosed Cushings syndrome/disease (4, 5, 7), ESRD (4, 6) or severe substance abuse were included (25, 26). All patients using systemic corticosteroids, and two patients using topical steroids with extreme MSC values were excluded as contamination was suspected (22). We have previously controlled that the MSC levels did not differ between users and non-users of inhaled steroids, and we have performed non-response analyses (22). The non-response analyses showed AF64394 no differences regarding age, diabetes duration, sex, metabolic variables, smoking, physical inactivity, or depression, between those who delivered and those who did not deliver MSC samples (22). Second, salivary cortisol measurement has advantages compared to blood measurements as it is noninvasive. Blood sampling can be stressful leading to increased cortisol secretion. Beneficial is also that participants can collect samples in their normal environment (31). Third, the cut-off level we chose to indicate high MSC has clinical implications. In previous research this cut-off level for high MSC was highly predictive of Cushings disease in patients with clinical Rabbit Polyclonal to RUFY1 features of hypercortisolism (33). Fourth, we presented our results for all patients, and separately for users and non-users of AHD. Fifth, we have adjusted for relevant variables such as age, sex, glycaemic control, abdominal obesity, severe hypoglycaemia episodes, depression, smoking, physical inactivity, and kidney function, which all have been associated with either hypertension or increased cortisol secretion, or both (4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 21, 22, 23, 24, 27, 28). The main limitation was that only one MSC sample was collected from each patient. Due to the inconvenience of midnight sampling, we anticipated a lower participation rate if we had demanded repeated samplings. A second limitation was that we did not perform any dexamethasone suppression tests for the participants with high MSC values. A third limitation was that we did not have any matched controls without T1D. There is clear evidence from previous research that increased cortisol secretion contributes to the development of hypertension (4, 5, 6, 7), which in turn has impact on the development of atherosclerosis, CV disease and mortality (3, 7, 15, 16, 17). We found a clear independent association between high MSC and high systolic BP in.