The Assessment of Micro and Macro Vascular Complications in People With Systemic Hypertension Associating Uncontrolled Type 2 Diabetes

Objective: to assess the percentage of complications in patients with systemic hypertension associating uncontrolled type 2 diabetes Design and method: SH diabetic patients (SH for more than 8 years) with T2DM duration at least 5 years. SH was diagnosed previous to DM. The subjects were assessed between January 2016 and end October 2018 in a cross sectional study. All the patients were evaluated by clinical examination (including exam for polyneuropathy), paraclinical exams (HbA1c in the last 3 months, fasting plasma glucose - FPG, glomerular filtration rate), cardio and ophthalmological examination (ECG, echocardiography, ocular fundus). Results: 166 adult T2DM patients, 46% male, mean age 59.2 years, mean duration of T2DM 7.6(3.9) years, mean duration of SH 9.3 years. average HbA1c 8.5 %, FPG: 224.9 mg/dl were included. Patients were treated for DM with metformin (88.5%), sulphonilureas (81%), and alpha glucosidase inhibitors (9.4%) in monotherapy or combination. The blood pressure was well controlled in all patients. The microvascular complication of these T2DM patients were: retinopathy in 18.5% of the patients, chronic kidney diseases (declining glomerular filtration rate) in 10.8% and neuropathy (defined as distal symmetrical polyneuropathy) in 57.4%. 10.6% of the patients had previous stroke, 9.4% previous myocardial infarction, 42.9% ischemic heart disease (ECG changes in almost 64% of them), 9.8% heart failure, and 16.4% peripheral arterial disease. Conclusions: : It is well known that most of the complications in diabetes arise from damages to small blood vessels and narrowing of large arteries (atherosclerosis) due to chronic hyperglycemia and hypoglycemic episodes. Our study confirm the observation that microvascular complications affect more diabetic patients than macrovascular complications. The most frequent microvascular complication was polyneuropathy due to neuronal damage cause by vasa vasorum injury. It is absolutely necessary to screen more often these patients and to maintain their glycemic control on long term, avoiding also hypoglycemic episodes.