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Type 2 diabetes mellitus worsens arterial stiffness in hypertensive patients through endothelial dysfunction.

Diabetologia. 2012 Mar 13 Bruno RM, Penno G, Daniele G, Pucci L, Lucchesi D, Stea F, Landini L, Cartoni G, Taddei S, Ghiadoni L, Del Prato S. Department of Internal Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.

AIMS/HYPOTHESIS: Endothelium-derived factors are thought to be physiological modulators of large artery stiffness. The aim of the study was to investigate whether endothelial function could be a determinant of arterial stiffness in essential hypertensive patients, in relation with the concomitant presence of type 2 diabetes mellitus.

METHODS: The study included 341 participants (84 hypertensive patients with and 175 without type 2 diabetes mellitus, 82 matched controls). Brachial artery endothelium-dependent flow-mediated dilation (FMD) was determined by high-resolution ultrasound and computerised edge detection system. Applanation tonometry was used to measure carotid-femoral pulse wave velocity (PWV).

RESULTS: Hypertensive patients with diabetes had higher PWV (10.1&#8201;±&#8201;2.3 m/s vs 8.6&#8201;±&#8201;1.4 m/s, p&#8201;<&#8201;0.001) and lower FMD (3.51&#8201;±&#8201;2.07 vs 5.16&#8201;±&#8201;2.96%, p&#8201;<&#8201;0.001) than non-diabetic hypertensive patients, who showed impaired vascular function when compared with healthy participants (7.9&#8201;±&#8201;1.6 m/s and 6.68&#8201;±&#8201;3.67%). FMD was significantly and negatively correlated to PWV only in hypertensive diabetic patients (r&#8201;=&#8201;-0.456, p&#8201;<&#8201;0.001), but not in hypertensive normoglycaemic patients (r&#8201;=&#8201;-0.088, p&#8201;=&#8201;0.248) or in healthy participants (r&#8201;=&#8201;0.008, p&#8201;=&#8201;0.946). Multivariate analysis demonstrated that, in the diabetic group, FMD remained an independent predictor of PWV after adjustment for confounders (r (2)&#8201;=&#8201;0.083, p&#8201;=&#8201;0.003). Subgroup analysis performed in non-diabetic hypertensive patients revealed that neither obesity nor the metabolic syndrome affected the relationship between FMD and PWV.

CONCLUSIONS/INTERPRETATION: Endothelial dysfunction is a determinant of aortic stiffness in hypertensive diabetic patients but not in hypertensive patients without diabetes. These results suggest that type 2 diabetes mellitus on top of hypertension might worsen arterial compliance by endothelium-related mechanisms.

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