6.6 AORTIC-BRACHIAL STIFFNESS MISMATCH IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Abstract

Background: Patients with type 2 diabetes have a high risk of CVD. Arterial stiffness gradient is a new prognostic predictor of mortality previously assessed only in dialysis population1–2. The aim of the study was to assess arterial stiffness and stiffness gradient in diabetic patients with arterial hypertension (AH). Methods: The study included 55 patients with AH and DM (38% male, mean age 61.6±12.7 years), mean office BP 142.5±25.5/82.7±10.7mmHg. All patients receive combination antihypertensive therapy, 7.27% of patients received statins. Target BP values (<140/85 mmHg) were achieved in 52.7% of patients. Target HbA1c levels were achieved in 10.9% of patients. Carotid-femoral (CF) and carotid-radial (CR) PWV were assessed and increased arterial stiffness was defined as an elevation of pulse pressure (PP)>60 mmHg,PWV>10 m/s. Stiffness gradient was assessed by CF-PWV/CR-PWV ratio, with values>1 indicating the stiffness mismatch.p<0.05 was considered significant. Results: Mean PP was 47.6±12.7mmHg. PP>60mmHg was observed in 18,1%.Group with PP>60 mmHg was characterized by higher HbA1c (9.8±1.8vs8.4±2.0%) and stiffness gradient (1.4±0.4vs1.2±0.1)p<0.05 for trend. Mean CR-PWV was 7.7±1.2 m/s, mean CF-PWV was 10.3±2.0 m/s. CF-PWV>10m/s was observed in 27.2% of patients. Groups with PWV above and below 10m/s were similar by age, gender, metabolic risk factors and haemodynamic parameters. Mean stiffness gradient was 1.3±0.4, gradient >1 was observed in 92,7%. Patients with high stiffness gradient were older (63.3±11.6vs54.0±10.2,p<0.05). All other parameters were similar. Conclusion: Patients with AH and type 2DM are characterized by aortic-brachial stiffness mismatch. Thus it can be used as early marker of vascular ageing in this patients’ population.