Abstract
ObjectivesPulse wave velocity (PWV) is a surrogate end-point for cardiovascular morbidity and mortality. A plasma glucose value ≥155 mg/dl for the 1-hour post-load plasma glucose during an oral glucose tolerance test (OGTT) is able to identify subjects with normal glucose tolerance (NGT) at high-risk for type-2 diabetes (T2D) and for subclinical organ damage. Thus, we addressed the question if 1-hour post-load plasma glucose levels, affects PWV and its central hemodynamic correlates, as augmentation pressure (AP) and augmentation index (AI).MethodsWe enrolled 584 newly diagnosed hypertensives. All patients underwent OGTT and measurements of PWV, AP and AI. Insulin sensitivity was assessed by Matsuda-index.ResultsAmong participants, 424 were NGT and 160 had impaired glucose tolerance (IGT). Of 424 NGT, 278 had 1-h post-load plasma glucose <155 mg/dl (NGT<155) and 146 had 1-h post-load plasma glucose ≥155 mg/dl (NGT≥155). NGT≥155 had a worse insulin sensitivity and higher hs-CRP than NGT<155, similar to IGT subjects. In addition, NGT ≥155 in comparison with NGT<155 had higher central systolic blood pressure (134±12 vs 131±10 mmHg), as well as PWV (8.4±3.7 vs 6.7±1.7 m/s), AP (12.5±7.1 vs 9.8±5.7 mmHg) and AI (29.4±11.9 vs 25.1±12.4%), and similar to IGT. At multiple regression analysis, 1-h post-load plasma glucose resulted the major determinant of all indices of vascular stiffness.ConclusionHypertensive NGT≥155 subjects, compared with NGT<155, have higher PWV and its hemodynamic correlates that increase their cardiovascular risk profile.
Highlights
Abnormal arterial stiffness, which usually develops with aging, is associated with increased risk for various adverse outcomes, including cardiovascular disease [1,2], stroke [2,3], and renal disease [4]
There are some evidences demonstrating that arterial stiffness is associated with an important disparity between peripheral and aortic blood pressure (BP); several evidences suggest that aortic BP and its indices, such as augmentation pressure (AP) and augmentation index (AI), correlate more closely with intermediate markers of cardiovascular risk than brachial BP [6]
Normoglucose tolerant (NGT) subjects are considered at very low cardiovascular risk, recently a cutoff point of 155 mg/ dl for the one-hour (1-h) post-load plasma glucose, during an oral glucose tolerance test (OGTT), was able to identify normoglucose tolerant (NGT) subjects at high risk for type-2 diabetes mellitus (T2D) [9]
Summary
Abnormal arterial stiffness, which usually develops with aging, is associated with increased risk for various adverse outcomes, including cardiovascular disease [1,2], stroke [2,3], and renal disease [4]. Arterial stiffness increases in subjects with traditional cardiovascular risk factors suggesting, in addition to a background effect of aging per se, the effect of the exposure of the vessel wall to the cardiovascular risk factors, including hypertension, obesity, impaired glucose tolerance (IGT), and dyslipidemia [5]. 1-hour post-load plasma glucose value $155 mg/dl is strongly associated with different subclinical organ damages [10,11,12,13] that are independent predictors for cardiovascular events [7,8,14]
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