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Markers of arterial stiffness according to daily monitoring and office measurement in patients with diabetes in combination with hypertension
1Penza State University - Penza - Russian Federation
Objective: a comparative assessment of the indicators characterizing the structural and functional properties of the vascular wall in patients with type 2 diabetes mellitus (DM) and arterial hypertension (AH) and hypertensive patients without metabolic disorders.
Methods: The study involved 73 people aged 40 to 65 years. Group 1 included 46 patients with type 2 diabetes. Obligatory condition was the presence of hypertension of 1-2 degrees, the average age - 56,4 ± 8,6 years, body mass index (BMI) - 35,3 ± 5,9 kg/m2; systolic blood pressure (SBP) - 147,5 (140; 160) mm Hg, diastolic blood pressure (DBP) - 90 (80, 95) mm Hg. Group 2 included 27 patients with hypertension, the average age - 53,7 ± 9,0 years, BMI - 24,1 (23,2; 27,5) kg/m2; SBP - 145 (143; 157,5) mm Hg, DBP - 95 (90; 100) mm Hg. Patients were matched for age, sex, height, office SBP. Structural and functional properties of the large arteries were assessed by ambulatory blood pressure monitoring (ABPM) and rigidity by Vasotens technology. The mean daily values of the central (aortic) pressure: SBPpao, DBPao, PPao were determined. Among the stiffness parameters the augmentation index in the aorta (Aixao), the propagation time of the reflected wave (RWTT), stiffness index (ASI) and the maximum rate of blood pressure increase (dPdt)max were analyzed.
Results: The patients did not differ on the SBPao level: in diabetic patients - 126 (119; 139) mm Hg, AH - 129 (125; 133) mm Hg. In patients with DM the values of DBPao were significantly lower (80,9 ± 8,8 mm Hg), than in patients with hypertension - 88,9 ± 7,9 mmHg (p <0,01). PPao in the studied groups was 46 (41; 53) and 38 (35; 44) mm Hg, respectively (p <0.01). Among the parameters characterizing the stiffness of the peripheral arteries in diabetic patients the prevalence of ASI values (167 (149; 220) mm Hg) and (dPdt)max (637 (534; 764) mm Hg/s) has been reported, in contrast to those in subjects with hypertension (147,5 (132; 177), and 526 mm Hg (480; 627) mmHg/s, respectively) (p <0,01). Whereas the RWTT parameter in group 1 had significantly lower value (128,7 ± 11,04 ms), than in group 2 (143 (137; 149) ms) (p <0,01). Parameter Aixao in diabetic patients was 26,9 ± 14,7%, in patients with hypertension - 26,7 ± 12,1% (ns).
Conclusions: the observed differences in central hemodynamics and vascular stiffness in patients with type 2 diabetes mellitus in combination with hypertension compared with patients suffering from hypertension without metabolic disorders are due to severe structural changes of arteries of different caliber.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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