PRE-DIABETES AND ASYMPTOMATIC HYPERTENSION-MEDIATED ORGAN DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

Abstract

Objective: Patients with arterial hypertension (AH) and abdominal obesity (AO) are characterized by a high risk of developing type 2 diabetes mellitus, the addition of which significantly worsens the prognosis. One of the early disorders of carbohydrate metabolism, which has been subclinical for a long time and remains undiagnosed, is pre-diabetes. The aim of our study was to evaluate the frequency of pre-diabetes in patients with AH and AO and its relationship with asymptomatic hypertension-mediated organ damage (HMOD). Design and method: The survey included 87 patients (50 men) with essential AH of 2-3 degrees with AO of I-II degrees, aged 40 to 59 years. Patients were examined using standard clinical, laboratory and instrumental methods. Pre-diabetes was diagnosed in accordance with the recommendations of the European Society of Cardiology and the European Association for the Study of Diabetes (2019). Diagnosis of HMOD was also carried out in accordance with the recommendations of the European Society of Cardiology and the European Society of Hypertension (2018). Insulin resistance (IR) was determined by HOMA-IR. Results: The frequency of pre-diabetes among AH patients with AO in the whole group was 40.3%. A significant increase in the subgroup of patients with pre-diabetes compared with the subgroup of patients without pre-diabetes was found in the frequency of more severe AH of the 3rd degree (71.4% and 50.0%, P<0.05), more pronounced obesity-AO of the 2nd degree (68.6% and 32.7%, P<0.05), IR (88.6% and 40.4%, P<0.05) and dyslipidemia (94.3% and 76.9%, P<0.05). The subgroup of patients with pre-diabetes differed from the subgroup of patients without pre-diabetes by a significantly higher incidence of such HMOD as: left ventricular hypertrophy (97.1% and 75.0%, P<0.05), increased pulse pressure (48.6% and 25.0%, P<0.05) and microalbuminuria (42.9% and 23.1%, P<0.05). Conclusions: Pre-diabetes in AH patients with AO is associated not only with a significantly more severe course of hypertension and obesity, more pronounced metabolic disorders, but also with a higher incidence of asymptomatic HMOD such as heart, vascular, and kidney damage.