Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension

Climie, Rachel E.; Sloten, Thomas T. van; Bruno, Rosa Maria; Taddei, Stefano; Empana, Jean‐Philippe; Stehouwer, Coen D. A.; Sharman, James E.; Boutouyrie, Pierre; Laurent, Stéphane

doi:10.1161/hypertensionaha.118.11769

Cited by 134 publications

(123 citation statements)

References 168 publications

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“…Diabetes and hypertension often coexist and may act synergistically to promote adverse clinical events (24,25). The persistent hyperglycemic condition and metabolism changes in diabetes together with coexisting hypertension lead to microvascular and macrovascular changes and form a vicious cycle that further contributes to cardiovascular events (26). Recent study also suggested that hypertension was associated with increased risk of severe and fatal COVID-19, and ACE inhibitors reduced the mortality in COVID-19 patients with hypertension (27,28).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

et al. 2020

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OBJECTIVEDiabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics and outcomes and to analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes. RESEARCH DESIGN AND METHODSThis two-center retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N 5 153) who were discharged or died from 1 January 2020 to 8 March 2020 were identified. One sexand age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients. RESULTSOf 1,561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (interquartile range 56.0-72.0) years. A higher proportion of intensive care unit admission (17.6% vs. 7.8%, P 5 0.01) and more fatal cases (20.3% vs. 10.5%, P 5 0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazard ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23), and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs. 63.0 years), most were male (71.0% vs. 29.0%), and were more likely to have underlying hypertension (83.9% vs. 50.0%) and cardiovascular disease (45.2% vs. 14.8%) (all P values <0.05). Age ‡70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes. CONCLUSIONSCOVID-19 patients with diabetes had worse outcomes compared with the sex-and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

et al. 2020

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“…In both hypertension and T2DM, there are structural and functional abnormalities in coronary microvasculature, including hypertrophic remodeling of small arteries and arterioles, microvascular rarefaction, and functional increases in vasoconstriction due to endothelial dysfunction [2,21,22] . However, resting myocardial perfusion re ecting autoregulated blood ow correlates with myocardial oxygen consumption and is mainly determined by LV wall stress, myocardial contractility and heart rate [1] .…”

Section: Discussionmentioning

confidence: 99%

The Additive Effects of Type 2 Diabetes Mellitus on Left Ventricular Deformation and Myocardial Perfusion in Essential Hypertension: a 3.0T Cardiac Magnetic Resonance Study

Jiang

Guo

et al. 2020

Preprint

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Background Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals. Materials and Methods Seventy hypertensive patients without T2DM [HTN(T2DM-)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni’s post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension. Results Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM-), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM-) and control groups. Compared with controls, HTN(T2DM-) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM-) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p = 0.002, model R2 = 0.383; GCPS: p < 0.001, model R2 = 0.472; and GLPS: p = 0.002, model R2 = 0.424, respectively) and perfusion indices (upslope: p < 0.001, model R2 = 0.293; TTM: p < 0.001, model R2 = 0.299; and MaxSI: p < 0.001, model R2 = 0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p = 0.044 and 0.017, model R2 = 0.390) and GCPS (p = 0.002 and 0.001, model R2 = 0.424), and TTM but not perfusion indices was independently associated with GLPS (p = 0.002, model R2 = 0.424). Conclusion In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.

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“…Furthermore, the registry will constitute the basis for facilitating future shared initiatives, including the design of a novel generation of interventional trials. A number of drug treatments already available in clinical practice have demonstrated potential for slowing or regressing vascular aging, as recently reviewed [1,4]. The constitution of the European registry will make it possible to run registry-based, pragmatic interventional trials, a powerful tool for conducting studies efficiently and cost-effectively [5].…”

Section: Wg4: Data and Research Studies -Big Data Approachesmentioning

confidence: 99%

“…Vascular ageing, the decline in vascular structure and function, is an integrated marker of overall cardiovascular risk burden on the vasculature over time and ultimately leads to end organ damage in the heart, brain and kidney [1]. While age-dependent arterial damage typically appears in the fifth or sixth decade of life, there is wide variability between individuals with some displaying early vascular ageing.…”

Section: Introductionmentioning

confidence: 99%

Addressing the Unmet Needs of Measuring Vascular Ageing in Clinical Practice—European COoperation in Science and Technology Action VascAgeNet

Climie¹,

Mayer²,

Bruno³

et al. 2020

Artery Res

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Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality worldwide, regardless of gender, ethnicity or income. Evidence that vascular age, as opposed to chronological age, is better related to the prognosis of CVD is convincing. Despite recent technological advances for the measurement of vascular ageing, unmet needs remain which currently limit the assessment of vascular ageing in routine clinical practice. These unmet needs include: (1) lack of easy-to-use, affordable techniques/devices, (2) insufficient validation in clinical settings, (3) fragmentation of expertise in few research laboratories globally, and (4) lack of investigator/research driven intervention studies and head-to-head comparisons between different measurement techniques. This paper summarises how a recently awarded European COoperation in Science and Technology (COST) Action on Vascular Ageing (VascAgeNet) will address these unmet needs. The broad aim of the COST Action VascAgeNet is to establish a network which will work to refine, harmonize and promote the use of vascular ageing biomarkers, in order to improve clinical practice and to reduce the burden of CVD globally.

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Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension

Cited by 134 publications

References 168 publications

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

The Additive Effects of Type 2 Diabetes Mellitus on Left Ventricular Deformation and Myocardial Perfusion in Essential Hypertension: a 3.0T Cardiac Magnetic Resonance Study

Addressing the Unmet Needs of Measuring Vascular Ageing in Clinical Practice—European COoperation in Science and Technology Action VascAgeNet

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