Features of Cardiovascular Risk Factors, Target Organ Damage in Patients with Diabetes Mellitus Type 2 and Arterial Hypertension
https://doi.org/10.18087/cardio.2019.9.10271
Abstract
Aim: to investigate relationship between arterial hypertension (AH) and risk factors / subclinical damage of target organs in patients with type 2 diabetes mellitus (DM2). Methods. We included into this clinical epidemiological study 528 patients with DM2 (30.5 % men, 69.5 % women; mean age 54.1±0.3 years; 80.3 % with AH, 19.7 % without AH), who answered questions of the ARIC study questionnaire related to risk factors. Also, we studied features of target organ damage and laboratory indicators. Results. In comparison with normotensives patients with AH more frequently had ischemic heart disease (12.7±1.6 % vs. 5.8±2.3 %, p<0.05), chronic heart failure (CHF) (30.9±2.2 % vs. 9.6±2.9 %, p<0.001), atherosclerosis of vessels of lower extremities (69.8±2.2 % vs. 53.8±4.9 %, p<0.01) and cerebral vessels (50.9±2.4 % vs. 28.8±4.4 %, p<0.001), history of stroke (5.0±1.1 % vs. 0 %, p<0.05), hypertonic angiopathy (14.5±1.8 % vs. 6.5±2.5 %, p<0.05), low level of high density lipoprotein (87.3±2.2 % vs. 74.5±6.4 %, p<0.05), electro- and echocardiographic signs of left ventricular hypertrophy (75.6±2.1 % vs. 45.4±5.1 %, p<0.001; 61.1±2.6 % vs. 24.4±4.7 %, p<0.001, respectively), lowering of left ventricular ejection fraction (12.5±1.7 % vs. 7.8±2.8 %, p<0.001), diastolic disfunction of the left ventricle (52.6±2.7 % vs. 23.2±4.7 %, p<0.001), atherosclerosis of the aorta (38.0±2.6 % vs. 20.7±4.5 %, p<0.01), lowering of the ankle-brachial index (left – 29.8±2.3 % vs. 14.9±3.5 %, p<0.01; right – 31.5±2.3 % vs. 9.9±3.0 %, p<0.001, respectively), increased intima-media thickness of the right carotid artery (84.6±5.0 % vs. 60.0±11.0 %, p<0.05). Conclusion. In patients with type 2 diabetes and AH, in order to develop strategy of macro- and microvascular complications prevention, it is necessary to conduct early screening of risk factors and subclinical damage of target organs.
About the Authors
S. Kh. MehdiyevAzerbaijan
Phd
Baku
I. I. Mustafaev
Azerbaijan
Baku
M. N. Mamedov
Russian Federation
Moscow
References
1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–104. DOI: 10.1093/eurheartj/ehy339
2. American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes–2019. Diabetes Care. 2019;42(Supplement 1):S103–23. DOI: 10.2337/dc19-S010
3. Muddu M, Mutebi E, Ssinabulya I, Kizito S, Mondo CK. Hypertension among newly diagnosed diabetic patients at Mulago National Referral Hospital in Uganda: a cross sectional study. Cardiovascular Journal of Africa. 2018;29(4):218–24. DOI: 10.5830/CVJA-2018-015
4. Oliveras A, Armario P, Sans L, Clarà A, Vázquez S, Molina L et al. Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The DENERVHTA (Denervación en Hipertensión Arterial) study. The Journal of Clinical Hypertension. 2018;20(1):69–75. DOI: 10.1111/jch.13156
5. Sehestedt T, Jeppesen J, Hansen TW, Rasmussen S, Wachtell K, Ibsen H et al. Thresholds for pulse wave velocity, urine albumin creatinine ratio and left ventricular mass index using SCORE, Framingham and ESH/ESC risk charts: Journal of Hypertension. 2012;30(10):1928–36. DOI: 10.1097/HJH.0b013e328356c579
6. Volpe M, Battistoni A, Tocci G, Rosei EA, Catapano AL, Coppo R et al. Cardiovascular risk assessment beyond Systemic Coronary Risk Estimation: a role for organ damage markers. Journal of Hypertension. 2012;30(6):1056–64. DOI: 10.1097/HJH.0b013e3283525715
7. Okin PM, Oikarinen L, Viitasalo M, Toivonen L, Kjeldsen SE, Nieminen MS et al. Serial assessment of the electrocardiographic strain pattern for prediction of new-onset heart failure during antihypertensive treatment: the LIFE study. European Journal of Heart Failure. 2011;13(4):384–91. DOI: 10.1093/eurjhf/hfq224
8. Kostapanos MS. High density lipoproteins and type 2 diabetes: Emerging concepts in their relationship. World Journal of Experimental Medicine. 2014;4(1):1–6. DOI: 10.5493/wjem.v4.i1.1
9. Indovina F, Falcetta P, Del Prato S. Type 2 Diabetes Mellitus. From the start – combination therapy. Diabetes mellitus. 2018;21(5):386–94. DOI: 10.14341/DM9867
10. Yano Y, Fujimoto S, Sato Y, Konta T, Iseki K, Iseki C et al. New-onset hypertension and risk for chronic kidney disease in the Japanese general population. Journal of Hypertension. 2014;32(12):2371–7. DOI: 10.1097/HJH.0000000000000344
11. Moiseev V.S., Mukhin N.A., Smirnov A.V., Kobalava Zh.D., Bobkova I.N., Villevalde S.V. et al. Cardiovascular risk and chronic kidney disease: cardio-nephroprotection strategies. Russian Journal of Cardiology. 2014;19(8):7–37. DOI: 10.15829/1560-4071-2014-8-7-37
12. Nitsch D, Grams M, Sang Y, Black C, Cirillo M, Djurdjev O et al. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis. BMJ. 2013;346(jan29 1):f324–f324. DOI: 10.1136/bmj.f324
13. Fomin V.V., Svistunov A.A. Prevention of diabetic kidney damage: focus on antihypertensive drugs. Consilium Medicum. 2013;15(5):56–9.
14. Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). European Heart Journal. 2013;34(39):3035–87. DOI: 10.1093/eurheartj/eht108
15. Roever L. Risk Factors for Cardiovascular Disease: Evidence from Studies. Journal of Cardiovascular Diseases & Diagnosis. 2015;3(2):e107. DOI: 10.4172/2329-9517.1000e107
16. Näslund U, Ng N, Lundgren A, Fhärm E, Grönlund C, Johansson H et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet. 2019;393(10167):133–42. DOI: 10.1016/S0140-6736(18)32818-6
17. Zanchetti A, Hennig M, Hollweck R, Bond G, Tang R, Cuspidi C et al. Baseline Values but Not Treatment-Induced Changes in Carotid Intima-Media Thickness Predict Incident Cardiovascular Events in Treated Hypertensive Patients: Findings in the European Lacidipine Study on Atherosclerosis (ELSA). Circulation. 2009;120(12):1084–90. DOI: 10.1161/CIRCULATIONAHA.108.773119
18. Williams B. Recent hypertension trials: implications and controversies. Journal of the American College of Cardiology. 2005;45(6):813–27. DOI: 10.1016/j.jacc.2004.10.069
19. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB et al. Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(3):272–80. DOI: 10.1001/jama.2018.8359
20. Aboyans V, Ricco J-B, Bartelink M-LEL, Björck M, Brodmann M, Cohnert T et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal. 2018;39(9):763–816. DOI: 10.1093/eurheartj/ehx095
21. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–104. DOI: 10.1093/eurheartj/ehy339
Review
For citations:
Mehdiyev S.Kh., Mustafaev I.I., Mamedov M.N. Features of Cardiovascular Risk Factors, Target Organ Damage in Patients with Diabetes Mellitus Type 2 and Arterial Hypertension. Kardiologiia. 2019;59(9):20-28. (In Russ.) https://doi.org/10.18087/cardio.2019.9.10271