DIABETES MELLITUS AND ASSOCIATED HYPERTENSION, A TOXIC COMBINATION FOR CARDIOVASCULAR RISK

Abstract

Objective: The coexistence of hypertension in diabetic patients greatly enhances their likelihood of developing CVD. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, inflammation, retinopathy, and “diabetic cardiomyopathy”. We aimed to assess the impact of type 2 diabetes mellitus associated with high blood pressure over these cardiovascular risk factors. Design and method: We performed a transversal study, lasting 12 months, in which 100 patients with essential hypertension, and type 2 diabetes, with medium age 60.7 ± 9.3 years were evaluated in comparison with 100 patients with only hypertension. We evaluate these patients for: BMI; waist circumference; IMT by carotid ultrasonography; microalbuminuria in a spot morning urine; fundus oculi, LVMI for left ventricular hypertrophy by echocardiography. Serum PCR and lipid concentrations were measured. Results: The diabetic hypertensive subjects significantly had higher BMI (p = 0.01) and waist circumference statistically significant (p = 0.005). Patients with hypertension and diabetes had a greater left ventricular mass index (66% vs 51%, P = 0.04). Mean value for IMT was 1.1 ± 0,3 mm for diabetic patients and 0.93 ± 0,2 mm for the other group (P < 0.001) and its prevalence was high in diabetics (75% vs 64%, P = 0.1). Prevalence of microalbuminuria was significantly high in diabetics (44% vs 14%, P < 0.001). PCR as marker of inflammation was prevalently high in people with diabetes and hypertension (32% vs 16%, P = 0.013) Also, prevalence of retinopathy was significantly high in people with diabetes and hypertension compare to other group (27% vs 12%, P = 0.012). There was strong relation between LVMI, microalbuminuria, IMT and PCR. Waist circumference had correlation with IMT and microalbuminuria. Conclusions: DM is an independent risk factor for the increased LV mass and impaired diastolic function regardless of association with hypertension or not. Central obesity is associated with an increased risk for cardio metabolic diseases such as atherosclerosis and diabetic nephropathy. Atherosclerosis is characterized by chronic inflammation affecting the arterial intimae. Thus, individuals with type 2 diabetes and hypertension had increased risk for CVD.