VASCULAR REMODELING IN HYPERTENSIVE PATIENTS WITH DIABETES AND OBESITY

Shelest B. O.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The article deals with the problem of changing in the vascular wall in patients with hypertension, combined with type 2 diabetes and obesity. Structural and functional indicators such as the pulse wave velocity (PWV), the thickness of the carotid intima-media complex (CIMT), the cardio ankle vascular index (CAVI), the aortic stiffness index (ASI) and laboratory data, namely endothelin-1 and endothelium dependent vasodilation (EDVD) were studied. Purpose of the study. Study of the characteristics of endothelial dysfunction and arterial wall stiffness in patients with arterial hypertension (AH) in combination with diabetes mellitus type 2. Methods: 69 patients were examined, 39 consisted the 1st (main) group with AH of the stage II in combination with diabetes (19 men (60.6%), average age 56.7 ± 6.4 years. The comparison group (2nd) is represented by 30 patients with hypertension stage II without carbohydrate metabolism disorders - 17 (60.2%) men, average age 54.9 ± 6.1 years. Patients did not differ according to the levels of blood pressure (BP). HbA1c was determined by reaction with a phosphorus-tungsten. Enzyme immunoassay and Doppler methods of investigation of peripheral vasoregulation were used. Results. The level of PWV in patients with essential hypertension combined with diabetes mellitus is exceeded by 5.11% (p>0.1) comparing to the group without diabetes. At the same time, CAVI was increased in the main group by 8.3% (p> 0.1) comparing to the 2nd group. Analysing the results of the evaluation ED of the endothelial function of the endothelium and the stiffness of the arteries in the whole, it should be noted that levels of ASI, CIMT, ET-1, PWV and CAVI in the main group are higher than in the group without concomitant diabetes mellitus. All studied parameters, directly (ET-1) or indirectly (PWV, CAVI), or through increased rigidity (ASI, CIMT) have an adverse effect, worsening the function of the vascular wall. The identified structural changes in the arteries indicate the presence of early atheromatous process in the arterial wall in patients with hypertension with diabetes. The addition of diabetes contributes to endothelial dysfunction and worsens the course of hypertension. An unfavourable prognosis for the course of hypertension with diabetes mellitus has an increase in such indicators as PWV, ASI, ET-1 level. Conclusion. Determination of ASI, PWV, ET-1 level along with such additional criteria as EDV and CIMT can be used as risk criteria for the development of cardiovascular complications in patients with combined course of AH and diabetes mellitus. The further deeper studies of endothelial function and artery wall remodelling in patients with hypertension combined with diabetes are necessary, and searching for new additional diagnostically significant markers in patients of this cohort seems to be perspective.

hypertension, diabetes mellitus, arterial stiffness, endothelial function

1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
2. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: International Diabetes Federation, 2017.
3. Yi SW, Park S, Lee YH, Park HJ, Balkau B, Yi JJ. Association between fasting glucose and all-cause mortality according to sex and age: a prospective cohort study. Sci Rep. 2017;7(1):81-94.
4. De Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Sep;40(9):1273-84.
5. Oparil S, Zaman MA, Calhoun DA. Pathogenesis of hypertension. Ann Intern Med. 2003;139(9):761-76.
6.  Victor RG. In Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine. 9 th Philadelphia, PA: Elsevier, Saunders. 2012. Chapter 45, Systemic Hypertension: Mechanisms and Diagnosis. p. 935.
7. Khangura DS, Salam MW, Brietzke SA, Sowers RJ. Hypertension in Diabetes. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000, [updated 2018; cited 2019 Mar 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279027/
8.  Kolluru GK, Bir SC, Kevil CG. Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med. 2012; Volume 2012, Article ID 918267.
9. Chen Y, Shen F, Liu J, Yang GY. Arterial stiffness and stroke: de-stiffening strategy, a therapeutic target for stroke. Stroke Vasc Neurol. 2017;2(2):65-72.
10.  Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru T, et al. Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. J Atheroscler Thromb. 2011;18(11):924-38.
11. Okura T, Watanabe S, Kurata M, Manabe S, Koresawa M, Irita J, et al. Relationship between Cardio-Ankle Vascular Index (CAVI) and carotid aterosclerosis in patients with essential hypertension. Hypertens Res. 2007;30(4):335-40.
12.  Miyoshi T, Ito H. Assessment of Arterial Stiffness Using the Cardio-Ankle Vascular Index. Pulse (Basel). 2016;4(1):11-23.
13.  Sirenko YuM, Radchenko GD, Kushnir SM. Pulsoviy arterialniy tisk ta Indeks zhorstkosti aorti: vpliv na prognoz u patsientiv z arterialnoyu gipertenzieyu, yaki proyshli likuvannya v spetsializovanomu viddilenni. Arterialna gipertenziya. 2009;2(4):25-58. [in Ukrainian].
14. Celermajer DS, Sorensen KE, Gooh VM. Noninvasive detection of endothelial dysfunction in children and adults at risk atherosclerosis. Lancet. 1999;340:1111-5.
15. Ishibashi F, Taniguchi M, Kosaka A, Uetake H, Tavakoli M. Improvement in Neuropathy Outcomes With Normalizing HbA1c in Patients With Type 2 Diabetes. Diabetes Care. 2019 Jan;42(1):110-8.
16. Subirana I, Fitó M, Diaz O, Vila J, Francés A, Delpon E, et al. Prediction of coronary disease incidence by biomarkers of inflammation, oxidation, and metabolism. Scientific Reports. Article number: 3191 (2018).
17.  Matsuura Y, Yamashita A, Zhao Y, Iwakiri T, Yamasaki K, Sugita C, et al. Altered glucose metabolism and hypoxic response in alloxan-induced diabetic atherosclerosis in rabbits. PLoS One. 2017 Apr 14;12(4):e0175976.
18. Gao X, Ke C, Liu H, Liu W, Li K, Yu B, et al. Large-scale Metabolomic Analysis Reveals Potential Biomarkers for Early Stage Coronary Atherosclerosis. Sci Rep. 2017;7(1):11817.

«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 197-200 pages, index UDK [616.12-008.331.1+616.379-008.64]-056.25-005-07:616.13/.14

10.29254/2077-4214-2019-1-2-149-197-200