What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertensive type 2 diabetes mellitus (n=176). Intervention: Type 2 diabetes mellitus vs. Essential hypertension. Primary outcome: Left ventricular mass index (LVMI) (p=<0.05).

September 12, 2006Open Access

Hyperglycemia and nocturnal systolic blood pressure are associatedwith left ventricular hypertrophy and diastolic dysfunction in hypertensive diabetic patients

Q: What are the key findings of this study?

Hypertensive type 2 diabetic patients had significantly higher left ventricular mass index (103 vs 89 g/m2) and nocturnal systolic blood pressure compared to essential hypertensive patients.

Key Result

Hypertensive type 2 diabetic patients had significantly higher left ventricular mass index (103 vs 89 g/m2) and nocturnal systolic blood pressure compared to essential hypertensive patients.

Study Design

Type

Cross-Sectional (n=176)

Multicenter

PICO

Population

176 subjects, including 91 hypertensive type 2 diabetics, 59 essential hypertensives, and 26 healthy controls, evaluated for left ventricular mass index and diastolic function.

Exposure / Comparator

Type 2 diabetes mellitus vs Essential hypertension

Primary Outcome

Left ventricular mass index (LVMI), p=<0.05

Main Result

Absolute Event Rate: 103% vs 89%

p-value: p=<0.05

Limitations

Cross-sectional design limits causal inference
Lack of HbA1c values to evaluate previous glycemic control
No assessment of microalbuminuria
Potential confounding by different antihypertensive drug classes used between groups
Small sample size in some subgroups

Abstract

BACKGROUND: The aim of this study was to determine if hypertensive type 2 diabetic patients, when compared to patients with essential hypertension have an increased left ventricular mass index (LVMI) and a worse diastolic function, and if this fact would be related to 24-h pressoric levels changes. METHODS: Ninety-one hypertensive patients with type 2 diabetes mellitus (DM) (group-1 G1), 59 essential hypertensive patients (group-2 G2) and 26 healthy controls (group-3 G3) were submitted to 24-h Ambulatory Blood Pressure Monitoring (ABPM) and echocardiography (ECHO) with Doppler. We calculated an average of fasting blood glucose (AFBG) values of G1 from the previous 4.2 years and a glycemic control index (GCI) (percentual of FBG above 200 mg/dl). RESULTS: G1 and G2 did not differ on average of diurnal systolic and diastolic BP. However, G1 presented worse diastolic function and a higher average of nocturnal systolic BP (NSBP) and LVMI (NSBP = 132 +/- 18 vs 124 +/- 14 mmHg; P or =140 mmHg showed a higher risk of LVH. Diabetics with NSBP> or =140 mmHg and AFBG>165 mg/dl showed an additional risk of LVH (P < 0.05; odds ratio = 11). In multivariate regression, both GCI and NSBP were independent predictors of LVMI in G1. CONCLUSION: This study suggests that hyperglycemia and higher NSBP levels should be responsible for an increased prevalence of LVH in hypertensive patients with Type 2 DM.

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