Blood Pressure And Glycemic Control In Older Patients With Hypertension And Diabetes: Association With Carotid Atherosclerosis

Objective:We aimed to investigate the detection rate and risk factors of carotidatherosclerosis in older patients with hypertension and type2diabetes mellitusfrom communities in Beijing, which may help for the early diagnosis, preventionand treatment of cardiovascular and cerebrovascular disease.Methods: We undertook a cross-sectional study included two independentpopulations: the community population and the hospitalized population. Thecommunity population included670cases (508men,162women) was enrolledfrom communities in Beijing among the total of15468people who participated ina health examination program；we recruited448patients (209men,239women)from the department of endocrinology in the Military General Hospital of Beijingamong the total of1785people as the hospitalized populations, who lived inBeijing over8years．The inclusion criteria were aged≥60years and with bothdiabetes and hypertension (as self-reported in the community population and withphysician diagnosis in the hospitalized population)．The inclusion criteria were:a. the subject was60years old or older; b. the subject had both diabetes andhypertension (identified by self-report in the community population and byphysician diagnosis report in the hospitalized population); c. the subject waswilling to fill out the questionnaire and receive a physical medical examination.A standardized questionnaire was used to collect information on current healthstatus, physical activity, smoking behavior, family history, and physician'sdiagnosis of hypertension, diabetes, stroke, myocardial infarction, angina, anddetails of current regular medication, including antihypertensive andhypoglycemic drugs．Carotid ultrasonography was performed on all subjects toevaluate the intima-media thickness and plaque．The critical condition for blood pressure was systolic blood pressure≥140mmHg；the critical condition forglycemia was hemoglobin A1c≥7.5．Carotid intima-media thickness (CIMT) of1.1mm or larger was defined as elevated CIMT．Carotid atherosclerotic plaque isdefined as the presence of focal wall thickening that is at least50%greater thanthat of the surrounding vessel wall or as a focal region with CIMT≧1.5mm thatprotrudes into the lumen. Carotid atherosclerosis was defined as having eithercarotid plaque or elevated CIMT, or both．Lab tests included:hemoglobin A1c(HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), fasting bloodglucose, serum creatinine and nitrogen level, and serum liver functiontests． Multivariate logistic regression models were used to compute odds ratios(ORs) and their95%confidence interval (95%CI) of having elevated CIMT orcarotid plaque．In addition, parameters significantly correlated with CIMT weredetermined using multiple linear regression analyses.Results:I Demographic and clinical features of the subjectsIn the community population, the average age was68.5±6.3years．Of allsubjects,47.3%had uncontrolled blood pressure and29.6%had uncontrolledglycemia．Bp control was poorer in male subjects, but there was no genderdifference in terms of glycemic control．There were no significant differencesbetween male and female subjects in other factors except that the male subjectshad longer duration of hypertension and diabetes, greater waist circumference andmore frequently current smokers.In the hospitalized population, the average age was72.4±7.8years．Of allpatients,58.0%had uncontrolled blood pressure and56.7%had uncontrolledglycemia．There was no gender difference in terms of glycemic and bloodpressure control．The male patients had higher diastolic blood pressure levels, andmore frequently were current smokers than the female patients．Compared to themale patients, the female patients had higher levels of TC, LDL-C and HDL-C． II The detection rate and risk factors for carotid atherosclerosisIn the community population, the mean CIMT was0.82±0.11mm, thedetection rate of carotid plaque was52.5%(352/670) subjects, and the detectionrate of elevated CIMT was18.7%(125/670),Overall,62.1%of the subjects hadcarotid atherosclerosis．Compared to female subjects, the males were more oftento have elevated CIMT and had greater mean CIMT level．Multiple linearregression shows:as the dependent variable, CIMT was positively correlatedwith age (β=0.183, P=0.006), SBP (β=0.215, P=0.002), and sex (β=0.149,P=0.031), and negatively correlated with HDL-C (β=-0.196, P=0.002). In themultivariate logistic regression analysis, age (OR=1.066,95%CI=1.034-1.098,P＜0.001), sex (OR=1.458,95%CI=1.080-1.968, P=0.014), SBP (OR=1.019,95%CI=1.006-1.032, P=0.004), TC (OR=1.306,95%CI=1.032-1.652, P=0.026),and LDL-C (OR=1.301,95%CI=1.021-1.657, P=0.033)were significant riskfactors for carotid atherosclerosis.In the hospitalized population, carotid plaque was found in77.0%(345/448)patients．The rate of elevated CIMT was35.7%(160/448)．Overall,80.8%of thepatients had carotid atherosclerosis．Compared to female subjects, the males hadhigh mean CIMT level．Multiple linear regression analysis:With CIMT as thedependent variable, analysis revealed that CIMT was positively correlated withage (β=0.117, P=0.014), SBP(β=0.245, P﹤0.001), and sex (β=0.096, P=0.034),whereas CIMT was negatively correlated with HDL-C (β=-0.119, P=0.008), anddiastolic blood pressure(β=-0.183, P=0.001)．In the multivariate logisticregression analysis, age (OR=1.093,95%CI=1.054-1.133, P﹤0.001) and SBP(OR=1.023,95%CI=1.008-1.037, P=0.002) were significant risk factors forcarotid atherosclerosis. The detection rates of carotid plaque, elevated CIMT andcarotid atherosclerosis for hospitalized population were significantly higher thanthat for community population, and the percentages of subjects with uncontrolledblood pressure and with uncontrolled glycemia in hospitalized population weresignificantly higher than that in community population as well. Conclusions:The poor control of glycemic and blood pressure in older patientswith diabetes mellitus and hypertension are common, especially in thehospitalized population, with a detection rate of over60%regarding carotidatherosclerosis. It is almost as high as that of the same age group in the west. Themajor relevant risk factors include age, sex, blood pressure and serum lipid levels. Objective:We aimed to access the association between blood pressure&bloodglucose levels and carotid atherosclerosis in older patients with essentialhypertension and type2diabetes mellitus, which may provide evidence for bloodpressure control and glycemic control in older patients with hypertension anddiabetes to prevent cardiovascular and cerebrovascular diseases.Methods:We used the same design, subjects and methods in part II as in Part I.Subjects were categorized by their systolic blood pressure (SBP)(tight control,<130mmHg；usual control,130-139mmHg, or uncontrolled,≥140mmHg), andby their HbA1c level(tight control,<6.5%； usual control,6.5%-7.4%, oruncontrolled,≥7.5%), respectively. By doing so, we studied the relation betweenCIMT/carotid plaque/carotid atherosclerosis and blood pressure/glycemic control.Multivariate logistic regression models were used to compute odds ratios (ORs)and their95%confidence interval (95%CI) of having elevated CIMT or carotidplaque by different blood pressure and glycemic control categories.Results:I Patient demographics by BP controlIn the elderly groups from communities, BP uncontrolled group had higherlevels of systolic BP and longer duration of hypertension than the other twogroups. There were fewer women in BP uncontrolled group than other the twogroups.In the elderly groups from the hospital, the levels of SBP, diastolic bloodpressure (DBP), TC and LDL-C were higher in BP uncontrolled group than the other two groups．BP tight group had lower triglyceride levels than the other twogroups．II Patient demographics by glycemic controlIn the elderly group from communities, glycemic uncontrolled group hadhigher levels of HbA1c, fasting serum glucose than the other two groups.In the elderly group from the hospital, glycemic uncontrolled group hadhigher levels of HbA1c, fasting serum glucose than other two groups．In addition,the levels of TC and LDL-C were higher in glycemic uncontrolled group thanglycemic tight group.III Prevalence of carotid plaque or having elevated CIMT by BP and glycemiccontrol categoriesBoth ederly groups demonstrated that there was significant difference in theprevalence of elevated CIMT and carotid plaque in terms of BP control, whereasit did not reach significant difference among glycemic control groups.IV． The association between blood pressure/blood glucose levels andCIMT/carotid plaque/carotid atherosclerosisIn the elderly group from communities, Compared with tight control of Bp,patients with uncontrolled Bp were associated with a41%higher risk of havingcarotid plaque(OR=1.41,95%CI:1.02–1.93), a35%higher risk of havingelevated CIMT or carotid atherosclerosis(OR=1.35,95%CI1.00–1.83；OR=1.35,95%CI1.06–1.68)．But the present study did not show glycemic control asindependent predictor of either having carotid plaque or elevated CIMT.In the elderly group from the hospital, Compared with tight control of Bp,patients with uncontrolled Bp were associated with a1.12-fold increase in the riskof having carotid plaque(OR:2.12,95%CI:1.17-3.79), a81%higher risk ofhaving elevated CIMT(OR:1.81,95%CI:1.00-3.26), and a1.22-fold increase inthe risk of having carotid atherosclerosis(OR:2.22,95%CI:1.21-4.09)．But thepresent study did not show glycemic control as independent predictor of eitherhaving carotid plaque or elevated CIMT. Conclusions:In the elderly population with diabetes and hypertension,maybe it is not glycemic control, but blood pressure control that is moremeaningful for preventing progression of clinical carotid atherosclerosis．Controlof blood pressure to delay the occurrence of atherosclerosis may have morepreventive and clinical significance.