PP.19.05

Abstract

Objective: Sustained hyperglycemia, even in the prediabetic range, is associated with endothelial dysfunction, vascular stiffness and adverse cardiovascular outcomes. Aim of our study was to explore the additive effects of impaired glycated-hemoglobin (HbA1c) on essential hypertension sequelae. Design and method: We studied 465 never treated, newly diagnosed, essential hypertensive patients stage I-III (mean age 52 ± 13 years, 47% female), non-diabetic and without known cardiovascular disease. Evaluation of hypertension was performed according to ESH Guidelines. Traditional glycemic indices (fasting plasma glucose-FPG, HBA1c and 2hr oral glucose tolerance-OGTT) were performed in all patients. Euglycemic group (E) included patients with all the above glycemic indices normal (FPG < 100 mg/dl + HBA1c < 5.7% + OGTT < 140 mg/dl), while impaired HBA1c group (IH) included patients with HBA1c in prediabetic range (5.7–6.4%). Results: The mean values of HBA1c and FPG were higher in IH compared to E (92 ± 7 vs. 90 ± 7, p = 0.001), while they did not differ regarding OGTT (p = 0.455). Moreover, IH compared to E were older (54 ± 12 vs. 49 ± 14, p = 0.003), had higher ultrasonographic-derived preperitoneal and visceral fat thickness (18.9 ± 6.4 vs. 17 ± 7 mm, p = 0.019 and 70.1 ± 29 vs. 60.3 ± 24.5 mm, p = 0.003, respectively), with higher prevalence of metabolic syndrome (80,5% vs. 26,1%, p < 0,001), while they didn’t differ regarding gender (males 48,4% vs. 50,6%, p = 0.723), BMI (28 ± 5 vs. 29 ± 5 kg/m2, p = 0.133), waist and hip circumference, waist to hip ratio and prevalence of abdominal obesity (p > 0.05 for all). With the only exception of the family history of cardiovascular disease (54% vs. 41%, p = 0.004), the two groups didn’t differ significantly regarding classical cardiovascular risk factors, including office and 24hr blood pressure and heart rate (p > 0.05 for all). However, IH presented higher prevalence of diastolic dysfunction (76% vs. 58%, p = 0.008), c-f PWV (8.9 ± 2.4 vs. 8.2 ± 1.6, p = 0.002) and carotid plaques (55% vs. 40%, p = 0.017), and lower TDI Em/Am (0.89 ± 0.2 vs. 1 ± 0.4, p = 0.007), while they did not differ regarding LVMI, carotid IMT, ankle-brachial index, ACR and Aix (p > 0.05 for all). Conclusions: In essential hypertension, presence of impaired HbA1c augments arterial stiffness, carotid atherosclerosis and left ventricular diastolic dysfunction. Compared to anthropometric measurements, preperitoneal and fat thicknesses represents more sensitive indices of impaired glycated-hemoglobin.