P5.13 CHANGES IN VENTRICULO-ARTERIAL COUPLING IN PATIENTS WITH HYPERTENSION AND TYPE-2-DIABETES AFTER A PERIOD OF INTENSIFIED ANTIHYPERTENSIVE TREATMENT

Abstract

Objective: To examine changes in ventriculo-arterial coupling (VAC) and left ventricular systolic function (LVFSYS) after a period of intensified antihypertensive treatment in patients with hypertension and type-2-diabetes. Methods: Patients were categorized as controlled- (CH), uncontrolled- (UH) or resistant (RH) hypertensives based on ambulatory blood pressures (BPs) and number of antihypertensive agents. Central BPs were estimated using radial applanation tonometry and a generalized transfer function. LVFSYS was evaluated using ejection fraction (EF) and S’ (echocardiography). VAC was estimated as the ratio of effective arterial elastance (EA) to end-systolic elastance (EES). Results: 100 Patients were included (CH N=34, UH N=32, RH N=34). Median [interquartile ranges] follow up time was 6 [5;8] months. At follow up patients with UH and RH had a significantly higher EA and EA/EES compared to patients with CH. Despite a significant reduction in central BPs of 6/4 and 8/3 mmHg there was a non-significant increase in EA/EES in patients with UH and RH respectively. EES was significantly reduced in all hypertension groups (figure 1). On average EF and S’ was below 55% and 8 cm/s in all hypertension groups. In patients with RH EF and S’ were further reduced from 48 [39;53] % to 42 [34;47] % (P=0.01) and 7 [6;8] to 7 [5;7] cm/s (P=0.01). Conclusion: VAC and LVFSYS did not improve despite a reduction in central BPs. Instead EES deteriorated in all hypertension groups. We speculate whether this is due to a reduction in myocardial perfusion or a gradual progression of diabetic cardiomyopathy.