Glucose Metabolic Status And The Association With Vascular Lesions In Patients With Essential Hypertension

Objective:There is a high proportion of abnormal glucose metabolism in essential hypertension patients, and in which hypertension often exists earlier than diabetes. The objective is to analyze the glucose metabolism status in this essential hypertensive population, the risk factors of abnormal glucose metabolism and the association between essential hypertension and diabetes.Method:It was a cross-sectional survey that included1011out-patients of essential hypertension aged20to80years old from the Department of Cardiology,Zhongshan Hospital (excluded known secondary hypertension and suspected endocrine hypertension by adrenal CT). All patients underwent75g OGTT, carotid color Doppler ultrasound examination, fundus photography check, three times24-hour urine collection and metabolic markers tests. Finally1011patients were included into the analysis. In this part study we analyze the glucose metabolism in hypertensive population. After adjustment for age, gender, blood lipids, BMI and smoking status et al, compare the affections to blood glucose of different control levels of blood pressure, duration of hypertension and the application of different antihypertensive drugs. Analyze the risk factors of FPG and2hPG by multivariate linear regression mode. Analyze the risk factors of impaired glucose regulation (IGR) and diabetes in essential hypertension patients by Logistic regression mode.Results:There are only473patients (47%) with normal glucose metabolism in the1011essential hypertension patients,362(38%) with IGR and176(17%) diabetic patients. And there were30new-onset diabetes,146diagnosed diabetes. Only20patients (11.4%) found diabetes before hypertension, and20(11.4%) are diagnosed together. There are136patients (77.3%) diagnosed hypertension earlier than diabetes.With the increase of blood pressure, plasma glucose also increased after adjustment for age, gender et al. In the antihypertensive drugs, only the plasma glucose in ARB application group is lower than that in nonapplication of ARB. FPG has a positive correlation with pulse pressure(b=0.247P<0.001)、TG(b=0.203P<0.001)、FINS(b=0.144P<0.001) and waist circumference (b=0.098P=0.013) in the essential hypertension patients and a negative correlation with HDL (b=-0.087P=0.029)and2hINS(b=-0.151P<0.001);2hPG has a positive correlation with pulse pressure (b=0.243P<0.001)、TG(b=0.084P=0.020)2hINS(b=0.170P<0.001)、 FINS (b=0.123P=0.002)、and BMI (b=0.077P=0.039)TG(OR=1.24195%CI1.083-1.421P=0.002)、FINS(OR=1.02995%CI1.008-1.050P=0.008)、pulse pressure(OR=1.02595%CI1.013-1.038P<0.001)、waist circumference(OR=1.02395%CI1.002-1.045P=0.033)are risk factors of diabetes. Age (OR=1.05595%CI1.032-1.079P<0.001),2hINS(OR=1.01795%CI1.013-1.021P<0.001)、male(OR=1.72495%CI1.152-2.580P=0.008) and TC(OR=1.29995%CI1.050-1.606P=0.016)are risk factors of IGR.Conclusions:1. There are only473patients (47%) with normal glucose metabolism in the1011essential hypertension patients,362(38%) with impaired glucose regulation and176(17%) diabetic patients. And there were30new-onset diabetes,146diagnosed diabetes. Only20patients (11.4%) found diabetes before hypertension, and20(11.4%) are diagnosed together. There are136patients (77.3%) diagnosed hypertension earlier than diabetes.2. Poorly controlled blood pressure is associated with increased plasma glucose; the plasma glucose in ARB application group is lower than that in nonapplication of ARB.3. FPG is positively associated with pulse pressure、TG、FINS and waist circumference and is negatively associated with HDL and2hINS;2hPG is positively associated with pulse pressure、TG、2hINS、FINS and BMI.4. TG、FINS、pulse pressure、waist circumference are risk factors of diabetes. Age, male,TC and2hINS are risk factors of IGR. Objective:Carotid intima-media thickness as an indicator of early evaluation of atherosclerotic lesions has been widely recognized. The increase of CIMT indicates the increased risk of cardiovascular events and carotid atherosclerotic plaque formation can be as a surrogate endpoint for cardiovascular events. CIMT is not only used to detect the degree of atherosclerotic lesions, but also can reflect the risk of large and medium-sized vascular lesions in hypertensive patients. Change in retinal vessel calibers is thought to reflect structural damage of microcirculation from hypertension and diabetes. With a computer-assist program, retinal vascular calibers (CRAE, CRVE and AVR) can be measured quantitatively. The objective of this part is to examine the relationship between retinal vascular calibers (small vascular lesion) and CIMT (large vascular lesion) and their association with glucose metabolism.Method:Excluding the uncompletement of carotid ultrasound and fundus photography failure,370patients with essential hypertension were analyzed. Carotid color Doppler ultrasound measured CIMT and determined the presence of carotid atherosclerotic plaque. Retinal vascular calibers were measured from digital retinal photographs using a computer-assist method. This part of study is to compare the CIMT and retinal vascular calibers between blood pressure controlled and uncontrolled group, different duration groups of hypertension. We also compared the retinal vascular calibers between plaque-positive and negative groups. We analyzed the risk factors of the increased CIMT and the change of retinal vascular calibers by Regression analysis; the risk factors of abnormal glucose metabolism and carotid atherosclerotic plaque in hypertension patients by Logistic regression analysis.Results:The patients were divided into two groups---blood pressure uncontrolled group and the controlled group, after adjustment for for age, sex, et al, showing that the CIMT of blood pressure uncontrolled group is thicker than the CIMT of controlled group (P=0.004). There was no significant difference between the two groups in retinal vascular calibers. In the comparison of tertile of duration of hypertension, after adjustment for age, sex, et al, CIMT thicken with the extension of the hypertensive course(P=0.045).The positive rate of carotid atherosclerosis plaque is26.76%in this study population. There are no significant difference in retinal vascular calibers between the plaque positive group and plaque negative group. The presence of carotid atherosclerosis plaque as dependent, age, sex, blood glucose, blood lipids, blood pressure, duration of smoking, FINS,2hINS, HOMA-IR, HOMA-β, ISI and BMI as covarites, we find that pulse pressure and the duration of hypertension are the risk factors of carotid atherosclerosis plaque by Logistic regression analysis.The average CIMT is0.61mm in this study population.In the tertile of CIMT after adjustment for age, sex, et al, there was no significant difference in the retinal vascular calibers among the three groups. CIMT as dependent,above factors and CRAE,CRVE,AVR as independents came into the multivariate regression analysis, found CIMT is positively associated with age, waist circumference and pulse pressure.The average CRAE is128.30μm and the average CRVE is196.03μm in this population. In the tertile of CRAE and CRVE adjustment for age, sex, et al, there was no significant difference in CIMT among the three groups. CRAE as dependent,above factors, CIMT and CRVE as independents came into the multivariate regression analysis, found that CRAE is positively associated with CRVE.CRVE as dependent,above factors,CRAE and CIMT as independents came into the multivariate regression analysis, found that CRVE is positively associated with CRAE. Also CRAE in female patients is wider than that in male patients. Smoker’s CRVE is widener than nonsmoker’s CRVE.Univariate analysis showed that CIMT was positively correlated with2hPG (r=0.190P<0.001) and FINS(r=0.158P=0.019); pulse pressure was positively correlated with2hPG (r=0.190P<0.001). Retinal vascular calibers (CRAE, CRVE, and AVR) aren’t correlated with plasma glucose and insulin. After age, waist circumference et al came into the multiple linear regression model, CIMT is only independently positively correlated with age, waist circumference and pulse pressure, while there is no independent correlation between CIMT and2hPG, FINS; After age came into the multiple linear regression model, pulse pressure is independently positively correlated with age, while there is no independent correlation between pulse pressure and2hPG.Conclusions:1. CIMT is thicker in the blood pressure uncontrolled group than in the controlled group. CIMT thickening is associated with the extension of duration of hypertension. CRAE and CRVE are smaller in the longer duration of hypertension than in the shorter duration of hypertension. 2. The positive rate of carotid atherosclerosis plaque is26.76%in this population. Pulse pressure, duration of hypertension is the risk factors of carotid atherosclerosis plaque.3. The average CIMT is0.61mm in this population. CIMT is positively associated with age, waist circumference and pulse pressure.4. The average CRAE is128.30μm and the average CRVE is196.03μm in this population.CRAE is positively associated with CRVE.CRAE in female patients is wider than that in male patients. Smoking is a risk factor of CRVE widening.5. Univariate analysis showed that CIMT was positively correlated with2hPG and FINS; Pulse pressure was positively correlated with2hPG. Retinal vascular calibers aren’t correlated with plasma glucose and insulin. After age, waist circumference et al came into the multiple linear regression model, CIMT is only independently positively correlated with age, waist circumference and pulse pressure, while there is no independent correlation between CIMT and2hPG, FINS; After age came into the multiple linear regression model, pulse pressure is independently positively correlated with age, while there is no independent correlation between pulse pressure and2hPG. Objective:Microalbuminuria may represent systemic vascular endothelial extensive damage.Microalbuminuria may represent one manifestation of ongoing systemic microvascular damage in kidney from hypertension and diabetes, and the predictive value of microalbuminuria for the development of cardiovascular events is well established. In this study we analyzed the relationship between microalbuminuria and CIMT, Retinal vascular caliber. Also we analyzed the risk factors of microalbuminuria.Method:266patients completing the three times collection of separate24-hour urine samples were analyzed. In this part of study, we compared the retinal vascular calibers and CIMT between microalbuminuria positive and negative groups; analyzed the relationships between microalbuminuria and CIMT and retinal vascular calibers after adjustment for age, gender, et al in the tertile groups of microalbuminuria. We also analyzed the risk factors of the increased urinary albumin by multivariate linear regression mode.Results:The positive rate of microalbuminuria was9%in266hypertensive patients. In the tertile of microalbuminuria after adjustment for for age, sex, et al, compared with retinal microvascular diameter, there was a trend of CRAE narrowing along with increased microalbuminuria (P=0.005), further adjustment for for CRVE, the impact of the differences remained (P=0.006); there also a trend of CIMT thickening along with increased microalbuminuria (P=0.037). Ln(microalbuminuria) as dependent,above factors and CIMT, CRAE, CRVE as independents came into the multivariate regression analysis, found that microalbuminuria is positively associated with CIMT(b=1.000P=0.033),BMI(b=0.061, P=0.001), GFR (b=0.005P=0.021) and microalbuminuria is negatively associated with CRAE (b=-0.011P=0.006)Conclusions:The positive rate of microalbuminuria was9%in266hypertensive patients. Increasing microalbuminuria is associated with CIMT thickening and decreasing CRAE. Risk factors of microalbuminuria are increasing CIMT, increasing BMI, increasing GFR and the decreasing CRAE.