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Abstract

Coexisting hypertension and diabetes is on rise in industrialized nations because populations are aging, and both diabetes and hypertension increase with age. Diabetes mellitus and hypertension strongly predispose people to atherosclerotic cardiovascular disease. The aim of our study was to evaluate the influence of blood pressure and non insulin dependent diabetes mellitus (NIDDM) on arterial distensibility in patients with NIDDM, and in patients with NIDDM coupled with hypertension. We studied 110 patients, 59 with NIDDM and essential hypertension (group A, mean age 57±8 years, 22 men - 37 women) and 51 with NIDDM (group B, mean age 55±8 years, 34 men - 17 women). All participants had been diagnosed with diabetes for at least 1 year. For each patient we evaluated clinical parameters such as age, sex, body mass index, smoking habit, duration of diabetes (years), office systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate. We also determined lipid profile, glucose level, uric acid and fibrinogen in serum. Arterial distensibility was assessed by automatic measurement of carotid-femoral pulse wave velocity (PWV), a widely used index of arterial distensibility and stiffness using Complior. Statistical analysis was carried out by Stat View software (SAS Institute, Cary, NC). Comparison between groups was performed using the Student's t-test for unpaired data. Multiple regression analysis was performed to assess which factors independently influence PWV. Group A patients presented higher blood pressure values than group B (SBP: 153±16 mmHg vs 129±12 mmHg, p = 0.000; DBP: 87±9 mmHg vs 77±11 mmHg, p= 0.000). Of biochemical parameters, only fibrinogen was significantly higher in group A than in group B (416±80 mg/dl vs 379±70 mg/dl, respectively; p= 0.01). Moreover, PWV in group A patients was greater than in group B (14±4 m/s vs 12±2 m/s, respectively; p= 0.002). Multivariate analysis showed that PWV was associated with fibrinogen (p= 0.02; R = 0.31) and DBP (p = 0.008; R= 0.42). In NIDDM, hypertension plays an important role in worsening arterial structural changes. By increasing arterial stiffness, hypertension may accelerate progression of complications in NIDDM. The increased PWV, highly correlated with other cardio-vascular risk factors such as fibrinogen and DBP, in patients with NIDDM and hypertension suggests an underlying diffuse atherosclerosis involving large and small arteries.

diabetes mellitus, arterial distensibility, hypertension
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© American Journal of Hypertension, Ltd. 2001
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