Left ventricular dysfunction in hypertensive patients with Type 2 diabetes mellitus.

Aims  To characterize left ventricular function in hypertensive patients with Type 2 diabetes and normal ejection fraction, and to relate these findings to pathogenic factors and clinical risk markers. Methods  We examined 70 hypertensive patients with Type 2 diabetes mellitus with ejection fraction > 0.55 and fractional shortening > 0.25, all without any cardiac symptoms. Thirty-five non-diabetic subjects served as control subjects. Left ventricular longitudinal function was examined by tissue Doppler derived myocardial strain rate and peak systolic velocities. Results  Hypertensive patients with diabetes had a significantly higher systolic strain rate (−1.1 ± 0.3 s−1 vs. −1.6 ± 0.3 s−1, P < 0.001) and lower systolic peak velocities (3.3 ± 1.0 vs. 5.6 ± 1.0 cm/s, P < 0.001) compared with control subjects. Myocardial systolic strain rate correlated significantly to left ventricular mass (r = 0.40, P < 0.01) and to both HbA1c (r = 0.43, P < 0.01), and fructosamine (r = 0.40, P < 0.01), but was not related to serum levels of carboxymethyllysine, albuminuria, blood pressure (dipping/non-dipping), or oral hypoglycaemic therapy. Patients with diastolic dysfunction had significantly higher levels of urine albumin [21.0 (5–2500) mg/l, vs. 9.5 (1–360), P < 0.01], heart rate (78 ± 13 vs. 67 ± 10 b.p.m., P < 0.005), and seated diastolic blood pressure (85 ± 6 vs. 81 ± 7 mmHg, P < 0.05) and non-dipping diastolic blood pressure was more frequent. Conclusions  Long axis left ventricular systolic function was significantly decreased in hypertensive patients with Type 2 diabetes mellitus, and is associated with hyperglycaemia and left ventricular hypertrophy. Diastolic dysfunction was closely related to increased diastolic blood pressure, non-dipping and increased urinary albumin excretion.