Association of Hemodynamic and Non-Hemodynamic Factors With Diastolic Dysfunction in Patients With Resistant Hypertension and Type 2 Diabetes Mellitus

Abstract

Objective: To identify factors associated with the development of diastolic dysfunction in diabetic patients with resistant hypertension (RHTN). Design and method: The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4 ± 6,4 years, 14 men, mean 24-hour (24 h) blood pressure (BP) (systolic/diastolic) 158,6 ± 15,2/79,8 ± 12,7mmHg, mean HbA1c 7,2 ± 1,2%). Office BP, and 24 h ambulatory BP measurements (ABPM), renal Doppler ultrasound, tissue doppler echocardiography, lab tests (24 h urine volume, the plasma levels of metalloproteinases-9 (MMP-9)) were performed in all patients. Results: Average E/e‘ significantly correlated with the duration of diabetes (p = 0.005, R = 0.46), the level of daytime (p = 0.003, R = 0.48), nighttime (p = 0.007, R = 0.44 and average daily (p = 0.037, R = 0.35) pulse BP; the level of MMP- 9 (p = 0.016, R = 0.47), with renal resistive indices (RI) in the main renal arteries: right-sided R = 0.37, p = 0.034, left-sided R = 0.38, p = 0.029; in the segmental arteries - on the right R = 0.41, p = 0.020 and R = 0.35, p = 0.048 on the left. In a multiple regression analysis, average E / e ’ significantly correlated with nighttime pulse BP (b ∗ = 0.42; SE (b) = 0.041; p = 0.004), MMP -9 (b ∗ = - 0.47; SE (b) = 0.001; p = 0.002), 24 h urine volume (b ∗ = - 0.47; SE (b) = 0.001; p = 0.001). Final model R = 0.81, R2 = 0.65, adjusted R2 = 0.61, estimate standard error = 2.56, p = 0.00004. Residuals did not differ from the normal distribution (p = 0.09) Conclusions: Diastolic dysfunction in diabetic patients with RHTN depends from complex of hemodynamic and non-hemodynamic factors, including duration of DM, value both of pulse BP, MMP and 24 h urine volume, as well of renal resistive indexes.