Trends in subclinical atherosclerosis in patients with arterial hypertension associated with diabetes mellitus: a relationship between the blood pressure achieved with antihypertensive therapy and the body weight


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Abstract

Aim. To analyze carotid artery morphofunctional changes in patients with arterial hypertension (AH) associated with type 2 diabetes mellitus (CD2) on regular antihypertensive and sugar-lowering therapy in relation with the changes in the diurnal blood pressure (BP) profile, the quality of metabolic control, and baseline clinical and laboratory data.
Materials and methods. Seven-six patients with CD2-associated AH who had received regular antihypertensive and sugar-lowering treatment without statins for 12 months were examined. The intima-media thickness (IMT) in the common carotid artery (CCA) was estimated by ultrasound scanning; the compliance and stiffness indices were calculated. The values of 24-hour BP monitoring, glycemic control, and blood lipids were studied.
Results. Among the patients with increased CCA IMT (Group 1), women were three times more than among those without it (Group 2). Subclinical atherosclerosis progression as an annual average CCA IMT increment of 0.08 mm was detected in the absence of a less than 7-mm Hg decrease in 24-hour mean systolic BP and/or a 24-hour mean BP of less than 134/80 mm Hg or if, during adequate BP control, HbA1 exceeded 9%. Group 1 women showed increased body mass index and a trend for worse vascular elastic properties. Group 2 displayed not only a CCA IMT reduction (from 0.94±0.03 to 0.83±0.03 mm; p < 0.01), but also a CCA decrease that seemed to show reduced vessel wall thickness. There were no changes in the CCA lumen in Group 1. Comparable control of glycemia and blood lipid-transport system indices was achieved in both groups. The magnitude for 24-hour BP reduction in which there was no subclinical atherosclerosis under stable glycemic control was determined.
Conclusion. The results of the study suggest a correlation between a inadequate BP reduction, worse elastic properties of large-sized arteries, and higher body mass index in patients (mainly women) with CD2 and underline the importance of correcting body weight and achieving goal BP in this group of patients.

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