Glycated hemoglobin correlates with arterial stiffness and endothelial dysfunction in patients with resistant hypertension and uncontrolled diabetes mellitus

Abstract

This study aimed to evaluate the effects of glycated hemoglobin (HbA ) on flow-mediated dilation, intima-media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN-controlled diabetes mellitus and RHTN-uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA <7.0% (RHTN-controlled diabetes mellitus: n = 98) and HbA ≥7.0% (RHTN-uncontrolled diabetes mellitus: n = 122). Intima-media thickness and flow-mediated dilation were measured by high-resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid-femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN-uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN-uncontrolled diabetes mellitus. Intima-media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA was an independent predictor of flow-mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function.

Association of hypertension and incident diabetes in Chinese adults: a retrospective cohort study using propensity-score matching

“…However, there is a substantial overlap between hypertension and diabetes in etiology and disease mechanisms. The two diseases share common mediators, including obesity, endothelial dysfunction, inflammation, oxidative stress and insulin resistance [9]. In hypertensive people, the presence of obesity leads to overactivation of the sympathetic nervous and renin-angiotensinaldosterone systems, as well as proinflammatory/pro-oxidative mechanisms, which are related to diabetes [43,44].…”

“…Besides, endothelial dysfunction could inhibit NO synthase and reduce NO bioavailability which is a crucial factor for the vasodilator action [47]. Therefore, endothelial dysfunction reduces vasodilation, increases vascular resistance, thus, limit insulin and glucose delivery in the sensitive tissues (ie, skeletal muscle, liver, and adipose tissue) and blunts insulin-stimulated glucose uptake [9,48]. There was a low-grade inflammatory reaction in patients with diabetes and hypertension [49,50].…”

“…Hypertension and diabetes often co-exist in the same individual [6][7][8]. The two diseases have etiological aspects in common such as obesity, inflammation, oxidative stress, insulin resistance, and factors associated with increased microvascular and macrovascular impairment [9]. Diabetes mellitus is more frequent in hypertensive than normotensive subjects [10][11][12].…”

Cardiovascular Risk Profile in Dupuytren’s Disease: A Systematic Review and Meta-Analysis.

“…Good control of diabetes with a low glycated hemoglobin level was reported to permit a decrease in CV risk [23,24]. Moreno et al reported that glycated hemoglobin is an independent predictor of ow-mediated dilation, and a non-invasive marker of endothelial dysfunction in atheroma [25]. Similarly, discussing alcohol consumption is important in everyday management of DD (e.g., by general practitioners).…”

Molecular Mechanisms of Endothelial Function and Dysfunction in Human Diseases

“…Preeklampsiyi önlemede maternal dolaşımdan plasenta türevli anti-anjiogenik faktörlerin uzaklaştırılması, statin ve metformin kullanımı ile ilgili çalışmalar devam etmektedir (58) . (59) . Yüksek glukoz seviyeleri, prostanoidler ve tromboksanlar gibi vazokonstriktörlerin üretimini arttırarak vasküler kontraktilite oluşturmaktadır.…”