Key result
Coexisting hypertension and diabetes was associated with a higher prevalence of increased left ventricular filling pressure (E/E' >15) compared to neither condition (14.7% vs 2.2%, P<0.01).
Why the study?
Do diabetes and hypertension have independent and synergistic effects on left ventricular diastolic function in a high-risk population without heart disease?
Cohort (n=708)
Do diabetes and hypertension have independent and synergistic effects on left ventricular diastolic function in a high-risk population without heart disease?
The coexistence of hypertension and diabetes has a synergistic negative effect on left ventricular diastolic function, leading to higher filling pressures than either condition alone.
Answers are grounded in this paper and cite their sources.
May prompt enhanced diastolic assessment in comorbid patients; leaves open causal links and therapeutic implications.
AIMS: To assess the independent and combined effects of diabetes and hypertension on left ventricular (LV) diastolic function in a community-based cohort at high cardiovascular risk. METHODS AND RESULTS: Two-dimensional echocardiography was performed in 708 subjects from the Cardiac Abnormalities and Brain Lesions (CABL) study. Peak diastolic early (E) and late (A) transmitral flow, and tissue Doppler-derived early mitral annulus velocity (E') were recorded, and E/A and E/E' ratios were calculated. The population was divided into four groups: those without hypertension or diabetes (HT-/DM-), those with only hypertension (HT), only diabetes (DM), and with hypertension plus diabetes (HT + DM). In multivariate analysis, hypertension and diabetes were independent predictors of worse diastolic function. The coexistence of hypertension and diabetes was associated with greater impairment of diastolic function (higher E/E' ratio than HT-/DM-, HT, or DM, all P < 0.05), independent of covariates. The negative, synergistic effect of hypertension and diabetes on LV diastolic function was present both in lean participants and in overweight/obese ones. An E/E' ratio >15, suggestive of increased LV filling pressure, was found in 2.2% of HT-/DM-, 8.9% of HT, 5.9% of DM, and 14.7% of HT + DM (P < 0.01). CONCLUSION: Hypertension and diabetes are independently associated with impaired LV diastolic function, independent of the effect of overweight/obesity and other covariates. Their coexistence results in a negative synergistic effect on LV diastolic mechanics and is associated with higher LV filling pressures than either condition alone.
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Russo et al. (2010) conducted a cohort in High cardiovascular risk without evidence of heart disease (n=708). Hypertension and diabetes vs. No hypertension or diabetes was evaluated on E/E' ratio >15 (suggestive of increased LV filling pressure) (p=<0.01). Coexisting hypertension and diabetes was associated with a higher prevalence of increased left ventricular filling pressure (E/E' >15) compared to neither condition (14.7% vs 2.2%, P<0.01).
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