INFLUENCE OF PREDIABETES ON CARDIOVASCULAR REMODELING INDICATORS IN HYPERTENSIVE PATIENTS WITH OBESITY

Abstract

The purpose of the study was to evaluate the effect of prediabetes on cardiovascular remodeling in hypertensive patients with obesity.

Materials and methods: To examine 200 patients with stage II hypertension (grade 2) and obesity (grades I-II), clinical, anamnestic, anthropometric, biochemical, and instrumental methods were employed. Among these, 60 patients had carbohydrate metabolism disorders. The degree of these disorders was assessed using fasting glycemia, impaired glucose tolerance, glycosylated hemoglobin (HbA1c), and glucose tolerance tests. Impaired fasting glycemia was established at values ​​of glucose concentration in venous plasma ≥ 6.1 and < 7.0 mmol/l, in whole capillary blood ≥ 5.6 and < 6.1 mmol/l, and glucose index < 7.8 mmol/l both in whole capillary blood and in venous plasma during the oral glucose tolerance test. Impaired glucose tolerance was diagnosed based on fasting glucose concentrations of < 6.1 mmol/l in whole capillary blood and < 7.0 mmol/l in venous plasma, and ≥ 7.8 < 11.1 mmol/l both in whole capillary blood and in venous plasma according to the oral glucose tolerance test. The HOMA index determined insulin resistance. The data were analyzed using the statistical software SPSS 17 (IBM) and Microsoft Office Excel 2003. Results are presented as means ± standard deviation, with significance as p < 0.05 in all cases.

Research results. In obese hypertensive patients with prediabetes, significantly higher values of the intima-media thickness of the common carotid artery and the carotid artery at the bifurcation level were recorded (p = 0.027 and p = 0.012 respectively), as well as a significantly higher pulse wave velocity in the carotid artery (p = 0.022). Cardiac remodeling assessment results demonstrated that patients with prediabetes had significantly larger left ventricular, left atrial, wall thickness, and left ventricular myocardial mass index, with no differences in ejection fraction values, compared to patients without prediabetes. The presence of prediabetes was characterized by a decrease in the rate of early filling of the left ventricle (p = 0.000) and the ratio of the rates of early and late filling (p = 0.000) in the absence of significant differences in the levels of the integral index of diastolic function: the ratio of the maximum speed of early diastolic flow to the maximum speed of early filling of the left ventricle (E/e').

Conclusions. Violations of carbohydrate metabolism at the stage of prediabetes in hypertensive patients with obesity contribute to the progression of vascular remodeling. They are associated with the severity of hypertrophic changes in the left ventricle. Evaluation of indicators of cardiovascular remodeling depending on the variant of prediabetes (fasting hyperglycemia and impaired glucose tolerance) did not demonstrate reliable differences in any of the indicators.