Vascular risk factors in women with hypertension and diabetes mellitus type 2

摘要

Background. Diabetes mellitus and arterial hypertension are two very frequent diseases. Both of them have important effects on vascular system and their major complications are caused by alterations of vasculature. Arterial hypertension and type 2 diabetes are frequently associated. Beyond classical risk factors implicated in both diseases, in recent years some novel markers of vascular involvement have been studied, such as intima - media thickness (IMT) and parameters of arterial stiffness. Women seem to have an increased vascular risk associated with diabetes than do men but this is not clean from the current literature. The aim of our study was to determine the consequences of hypertension and of hypertension associated with diabetes on intima media thickness and arterial stiffness in women. Patients and methods. We studied 30 women with hypertension (group 1), 33 with diabetes mellitus and hypertension (group 2) and 21 healthy controls (HC), matched for age. We evaluated some classical risk factors for atherosclerosis, such as age, body mass index, smoking, lipid and glucose profile in all patients and controls. We determined IMT of the common carotid artery using an ultrasound device (ALOKA prosound 10) and parameters of aortic stiffness - pulse wave velocity (PWV) and augmentation index (Aix) in all patients and controls using an oscillometric device, Arteriograph (Tensio Med Ltd., Budapest, Hungary). We also determined with the same device central aortic systolic blood pressure (SBPao) and aortic pulse pressure (PPao). We compared data obtained between the three different groups examined. Results. We found that PWV was increased in group 1 patients compared HC (p<0.05) but those from group 2 had even higher values of PWV compared to HC (p=0.001). IMT was increased in patients from group 1 compared with HC and diabetic patients had a supplementary increase of this parameter compared with hypertensive patients but the values were significantly higher only when compared to controls. From the classical risk factors, BMI and also fasting plasma glucose were significantly higher in diabetic patients. Parameters of arterial stiffness were correlated with age. IMT was correlated with age, fasting plasma glucose, values of brachial systolic, diastolic and mean pressure and with aortic systolic blood pressure. IMT was also correlated with parameters of arterial stiffness, PWV and AIx. Conclusion. Women with hypertension had increased arterial stiffness compared to controls. Those with hypertension and diabetes had more increased arterial stiffness and also increased IMT compared to hypertensive women and to HC. In our patients age was an important determinant of parameters of arterial stiffness. IMT was correlated with age, values of peripheral and central arterial pressure and with parameters of arterial stiffness. Coexistent diabetes and hypertension in women is associated with increased markers of vascular disease that may be a link to the important cardiovascular risk seen in these patients.