Abstract Introduction Both Type II Diabetes mellitus (DM) and hypertension have been associated with an increased risk for cardiovascular disease and linked to impairments in micro- and macrocirculation. However, previous studies examining micro-and macrocirculation in DM mainly include patients with comorbid hypertension. Therefore, the aim of the study was to compare hemodynamic and vascular indices in DM and non-DM patients, independently of their hypertension status. Materials and Methods Fifty-seven DM patients and 79 non-DM participants were enrolled. Participants underwent physical examination, ambulatory BP monitoring and estimation of pulse wave velocity (PWV) and intima-media thickness (IMT). Resting hemodynamic parameters were assessed by impedance cardiography. Participants also performed a 3-min-submaximal isometric handgrip (30% MVC) with continuous beat-by-beat BP/HR assessment (Finapress). The double product (DP = systolic blood pressure * heart rate) during HG was calculated, as an index of myocardial stress. Results No differences were observed in age, BMI, and resting BP among groups. Patients with DM had significantly higher PWV and IMT ( p < 0.01) but lower velocity (VI) and acceleration index (ACI) compared to non-DM individuals ( p < 0.05). Hypertensives had significantly higher myocardial stress during exercise compared to normotensives, independently of the presence of diabetes. Conclusion Despite similar blood pressure levels in DM and non-DM groups, the DM patients had higher PWV and IMT than non-DM participants. There were no differences between patients with isolated adequately controlled DM or isolated hypertension in macrocirculation indices, suggesting a possible equal impact of the above diseases on the macrovascular network.
Arterial stiffness and central hemodynamics attract increasing scientific interest within the hypertensive community during the last decade. Accumulating evidence indicates that aortic stiffness is a strong and independent predictor of cardiovascular events and all-cause mortality in hypertensive patients, and its predictive value extends beyond traditional risk factors. The role of central hemodynamics and augmentation index (a marker of reflected waves), remains less established and requires further investigation. Several lines of evidence indicate that antihypertensive therapy results in significant reductions of pulse wave velocity and central hemodynamics. However, beta-blockers seem to be the only exception with significant within-class differences. Conventional beta-blockers, although equally effective in reducing pulse wave velocity, seem to be less beneficial on central hemodynamics and augmentation index than the other antihypertensive drug categories, whereas the newer vasodilating beta-blockers seem to share the benefits of the other antihypertensive drugs. In conclusion, aortic stiffness seems ready for ‘prime-time’ in the management of essential hypertension, while further research is needed for central hemodynamics and augmentation index.
Objective: Increased urinary albumin excretion (UAE) is a potent predictor of future cardiovascular disease that corresponds to a state of generalized microvascular dysfunction, even below the threshold values usually considered for microalbuminuria. This holds true in patients with hypertension and particularly in those with diabetes mellitus (DM), in whom it is associated with macrovascular disease. At the same time, both hypertension and DM are associated with large artery stiffening, while hypertension often coexists with DM. In the present study, we investigated whether an association exists between UAE and arterial stiffness in newly-diagnosed patients with DM, independent of blood pressure (BP) levels. Design and method: Consecutive patients with newly-diagnosed DM were studied. All patients underwent office BP measurements and 24-hour ambulatory BP monitoring (Spacelabs 90207). Microalbuminuria was calculated from 24-hour urine samples. Arterial stiffness was evaluated with measurement of carotid-femoral pulse wave velocity (PWV) with applanation tonometry. Blood samples were drawn to estimate fasting glucose, glycated hemoglobin (HbA1c), lipid profile and renal function Results: A total of 65 patients aged 57 ± 11 years, 40 males and 25 females, with median DM duration of 2 months were included in the study. Fasting glucose was 121.5 (IR: 36) mg/dl and HbA1c 7.47 (IR: 2) %. The majority of patients (66.2%) had concomitant hypertension. In particular, 26 patients (40%) had a history of known hypertension with median duration of 8 (IR: 8) years, while 17 (26.2%) were simultaneously diagnosed with hypertension and DM. In our cohort, UAE was associated with fasting glucose (r = 0.294, p = 0.040), HbA1c (r = 0.426, p = 0.002), creatinine (r = 0.308, p = 0.035), glomerular filtration rate (r = 0.442, p = 0.002), office systolic (r = 0.403, p = 0.009) and diastolic (r = 0.447, p = 0.026) BP and PWV (r = 0.308, p = 0.031). However, in the multivariate analysis adjusting for BP and other variables, HbA1c (beta = 0.351, p = 0.015) was the only significant predictor of UAE, whereas the association between UAE and PWV no longer remained significant. Conclusions: In newly-diagnosed patients with DM, hyperglycemia is an independent predictor of UAE, emphasizing the need for early and effective glycemic control. The observed association between UAE and arterial stiffening seems to be mediated by hyperglycemia and increased BP.
Inflammatory responses in small vessels play an important role in the development of cardiovascular diseases, including hypertension, stroke, and small vessel disease. This involves various complex molecular processes including oxidative stress, inflammasome activation, immune-mediated responses, and protein misfolding, which together contribute to microvascular damage. In addition, epigenetic factors, including DNA methylation, histone modifications, and microRNAs influence vascular inflammation and injury. These phenomena may be acquired during the aging process or due to environmental factors. Activation of proinflammatory signaling pathways and molecular events induce low-grade and chronic inflammation with consequent cardiovascular damage. Identifying mechanism-specific targets might provide opportunities in the development of novel therapeutic approaches. Monoclonal antibodies targeting inflammatory cytokines and epigenetic drugs, show promise in reducing microvascular inflammation and associated cardiovascular diseases. In this article, we provide a comprehensive discussion of the complex mechanisms underlying microvascular inflammation and offer insights into innovative therapeutic strategies that may ameliorate vascular injury in cardiovascular disease.
The aim of this study was to assess the effect of the level of adherence to the DASH diet on hypertension risk by conducting a systematic review and meta-analysis. A systematic literature search was performed. Two independent investigators performed the study selection, data abstraction, and assessment of the included studies. The meta-analysis was performed separately with the adjusted hazard (HR) or incident rate ratios (IRR) and the odds ratios (OR) of the highest compared to the lowest DASH diet adherence scores using a random effects model. A total of 12 studies were included in the qualitative and quantitative synthesis. When cohort studies reporting HR were pooled together, high adherence to the DASH diet was associated with a lower risk of hypertension (HR: 0.81, 95% CI 0.73-0.90,
Background: We aimed to determine the influence of coronavirus disease 2019 (COVID-19) pandemic on blood pressure (BP) control assessed by ambulatory blood pressure monitoring (ABPM). Methods: Office BP and ABPM data from two visits conducted within a 9–15 months interval were collected from patients treated for hypertension. In the prepandemic group, both visits took place before, while in the pandemic group, Visit-1 was done before and Visit-2 during the pandemic period. Results: Of 1811 collected patients 191 were excluded because they did not meet the required ABPM time frames. Thus, the study comprised 704 patients from the pandemic and 916 from the prepandemic group. Groups did not differ in sex, age, duration of hypertension, frequency of first line antihypertensive drug use and mean 24 h BP on Visit-1. The prevalence of sustained uncontrolled hypertension was similar in both groups. On Visit-2 mean 24 h BP, daytime and nighttime systolic BP and diastolic BP were higher in the pandemic compared to the prepandemic group ( P < 0.034). The prevalence of sustained uncontrolled hypertension on Visit-2 was higher in the pandemic than in the prepandemic group [0.29 (95% confidence interval (95% CI): 0.26–0.33) vs. 0.25 (95% CI: 0.22–0.28), P < 0.037]. In multivariable adjusted analyses a significant difference in BP visit-to-visit change was observed, with a more profound decline in BP between visits in the prepandemic group. Conclusions: This study using ABPM indicates a negative impact of the COVID-19 pandemic on BP control. It emphasizes the need of developing strategies to maintain BP control during a pandemic such as the one induced by COVID-19.
Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70–95%]) than MRA (20% [10–30%]), SGLT2i (30% [20–50%]) or (GLP1-RA (10% [5–15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15–40%) vs 18% [10%–25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5–5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers' dosage reduction was the usual management.
