Peak percentage increase in acetylcholine-stimulated forearm blood flow (HR 0.77; 95% CI 0.61-0.99; P=0.04) and C-reactive protein independently predicted type 2 diabetes in essential hypertension.
Cohort (n=400)
Impaired endothelial function and elevated C-reactive protein are independent predictors of incident type 2 diabetes in patients with essential hypertension.
Hazard Ratio: 0.77 (95% CI 0.61–0.99)
p-value: p=0.04
OBJECTIVE: Type 2 diabetes and essential hypertension are major risk factors for cardiovascular diseases. Endothelial dysfunction is an early step in the development of atherosclerosis and has been demonstrated in hypertensive and diabetic patients. RESEARCH DESIGN AND METHODS: We designed this study to determine whether forearm endothelial dysfunction is an independent predictor of type 2 diabetes in patients with essential hypertension. We enrolled 400 white never-treated hypertensive outpatients, free of type 2 diabetes at the time of the first evaluation. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine. Insulin resistance was estimated by homeostasis model assessment. RESULTS: During the follow-up (4.5 +/- 1.6 years), 44 patients developed type 2 diabetes. The event rate was 2.4 events/100 patient-years. In a multivariate Cox regression analysis, the peak percentage increase in acetylcholine-stimulated forearm blood flow (hazard ratio HR 0.77 95% CI 0.61-0.99; P = 0.04) and C-reactive protein (1.16 1.03-1.32; P = 0.01) resulted in the only independent predictors of type 2 diabetes. CONCLUSIONS: An impaired vasodilatory response to acetylcholine predicts development of type 2 diabetes in patients with essential hypertension. Present data also extend recent findings regarding a possible inflammatory pathogenesis of type 2 diabetes and suggest a new approach in treatment of essential hypertension.
Perticone et al. (Thu,) conducted a cohort in Essential hypertension (n=400). Peak percentage increase in acetylcholine-stimulated forearm blood flow was evaluated on Development of type 2 diabetes (HR 0.77, 95% CI 0.61-0.99, p=0.04). Peak percentage increase in acetylcholine-stimulated forearm blood flow (HR 0.77; 95% CI 0.61-0.99; P=0.04) and C-reactive protein independently predicted type 2 diabetes in essential hypertension.