Arterial Stiffness and Diastolic Dysfunction Explored in Relation to Diabetes From ESH 2016 | LB 3: Davide Agnoletti, MD Sacro Cuore Hospital, Verona, Italy

Study Population Relation between diastolic function and arterial hemodynamics in diabetic and nondiabetic hypertension investigated 123 patients screened for primary or secondary cardiovascular (CV) prevention at Paris hospital; ≥1 CV risk factor Hemodynamics measured centrally by tonometry and peripherally, diastolic function by echocardiography Patients with diabetes older, more were smokers and metabolic syndrome, but better lipid control Diabetic hypertension more commonly treated with angiotensin- receptor blockers, less likely with calcium channel blockers

Baseline Characteristics Variables NO DIAB (n=79) DIAB (n=44) Mean (SD) P value Age, years 56(14) 64(9) 0.0028 Male gender, n (%) 39(49) 28(64) 0.1277 Weight, kg 78(15) 80(14) 0.457 Height, cm 168(9) 168(8) 0.8058 Body mass index, kg/m2 28(5) 28(4) 0.5132 Waist circumference, mm 94(13) 100(11) 0.0073 Total cholesterol, mmol/L 4.79(1.02) 4.08(1.02) 0.0004 HDL cholesterol, mmol/L 1.38(0.41) 1.22(0.42) 0.0513 Triglycerides, mmol/L 1.20(0.77) 1.41(0.79) 0.1647 LDL cholesterol, mmol/L 2.88(0.84) 2.24(0.83) 0.0001 Creatinine, µmol/L 84(21) 90(25) 0.1185 eGFR, mL/min 81(20) 76(20) 0.2229 DIAB, diabetes; eGFR, estimated glomerular filtration rate.

Baseline Characteristics Variables NO DIAB (n=79) DIAB (n=44) N (%) P value Smoking 35(44) 28(64) 0.0398 Hypertension 71(90) 38(86) 0.5569 Familiarity for CHD 5(6) 5(11) 0.3274 Stroke 4(5) 3(7) 0.6872 CHD 6(8) 6(14) 0.2411 Myocardial infarction 3(4) 4(9) 0.2245 Revascularization 0.1734 Peripheral artery disease 2(3) 0.0969 Metabolic Syndrome 17(22) <.0001 DIAB, diabetes; CHD, coronary heart disease.

Results Similar central and peripheral blood pressure levels in patients with hypertension with and without diabetes Carotid-femoral pulse wave velocity significantly higher in diabetic hypertension Augmentation index and pulse pressure amplification similar regardless of diabetes status Diastolic and systolic function similar regardless of diabetes status

Hemodynamic Outcomes By Diabetic Status Hemodynamics: *p<0.05 AIx, augmentation index; cf-PWV, carotid-femoral pulse wave velocity; DIAB, diabetes; PPA, pulse pressure amplification.

Results Pulse wave velocity and E/E’ ratio positively and significantly related in total population (r=0.199; p=0.027) No difference by diabetes status after adjustment for age, sex, mean arterial pressure, heart rate Pulse pressure amplification and the E/E’ ratio negatively and significantly related in total population (r=0.172; p=0.057) and in diabetic hypertension (r=0.352; p=0.019) Determinant of pulse pressure amplification differ by diabetic status Diabetes: use of blockers of renin angiotensin system, E/E’ ratio No diabetes: family history of coronary heart disease, mean arterial pressure

Conclusion Positive relation between arterial stiffness and diastolic dysfunction found in total study population of patients with hypertension with and without diabetes In diabetic hypertension, pulse pressure amplification inversely related to diastolic dysfunction 14% of the variance in pulse pressure amplification due to E/E’ ratio

Arterial Stiffness and Diastolic Dysfunction Explored in Relation to Diabetes From ESH 2016 | LB 3: Davide Agnoletti, MD Sacro Cuore Hospital, Verona, Italy