P2.06 ENDOTHELIAL DYSFUNCTION IS ASSOCIATED WITH ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

Both endothelial dysfunction and arterial stiffness are considered as independent predictors of cardiovascular mortality, but their interrelationship has been poorly explored. Therefore we evaluated the relationship between endothelial function and pulse wave velocity (PWV) in essential hypertensive patients with (DM+) or without (DM-) diabetes mellitus, on chronic pharmacological treatment. 51 DM+ patients and 51 DM- patients matched for age, gender and BP were included. Applanation tonometry (Sphygmocor®) was used to determine aortic (carotid to femoral) PWV. Brachial artery endothelium-dependent flow-mediated dilation (FMD), and endothelium-independent dilation by 25 μg sublingual glycerol trinitrate (GTN) were assessed by high resolution ultrasound and computerized edge detection system. In DM+ PWV was higher (9.9±1.8 vs 8.4±1.4m/s, p=0.0001) and FMD was lower (3.1±1.7 vs 6.3±3.5, p<0.0001) than DM−. In DM+, PWV was related to BMI (r=0.47, p=0.0007), triglycerides (r=0.54, p=0.00006), systolic BP (r=0.54, p=0.00006) and FMD (r= −0.47; p=0.0005). In multivariate analysis, only FMD (r2=0.10, p=0.003), systolic BP (r2=0.17, p=0.002), BMI (r2=0.22, p=0.009) resulted significant independent predictors of PWV. On the contrary in DM−, PWV was related to age (r2=0.35, p=0.01), systolic BP (r2=0.45, p=0.001), but not to FMD. In multivariate analysis, only SBP (p=0.02) was an independent predictor of PWV (r2=0.23). In hypertensive type 2 diabetic subjects on chronic pharmacological treatment, a decline in endothelial function seems to be independently associated with increased aortic stiffness, possibly suggesting a cause-effect mechanism. The association is not present in hypertensive euglycemic patients, who have lower aortic stiffness and endothelial dysfunction.