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

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. 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

8. 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

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