[Left ventricular remodeling in association of arterial hypertension with diabetes mellitus type 2: correlation with gender and disease duration].

AIM

To study specific features of left ventricular remodeling (LVR) in patients with hypertension and diabetes mellitus type 2 (DM-2).

MATERIAL AND METHODS

The study group comprised 290 patients, the control group consisted of 79 patients with essential hypertension free of carbohydrate tolerance impairment. The age of the examinees ranged from 35 to 60 years. Structural-geometric left ventricular model was determined by echocardiography. Estimation of significant determinants of myocardial mass index (MMI) and types of left ventricular remodeling was made with multiple regression analysis and logistic regression. The parameters of 24-h monitoring of blood pressure, glycemic control, blood lipid-transport function, plasma insulin, aldosteron, hydrocortisone levels, blood rennin activity were used as independent variants. Incidence of registration of left ventricular excentric hypertrophy (LVEH) in the study group was higher as compared to control (27.6 and 16.5%, respectively; p < 0.05). A rise of left ventricular MMI in the study group was related to 24-h systolic arterial pressure and basal insulinemia (R2 = 0.4229). Development of left ventricular structural-geometric model in the study group depended on the gender, duration of diabetes, 24-h systolic blood pressure (direct correlation) and 24-h diastolic blood pressure (inverse correlation), R2 = 0.6500. In DM duration about 5 years, percentage of males with concentric left ventricular hypertrophy (CLVH) and LVEH was 63% versus 37% (chi-square 5.0815, p < 0.03). In longer diabetes LVEH was seen more frequently than CLVH (73.3 and 26.7%, respectively). Among women with left ventricular hypertrophy and hypertension under 10 years LVEH and CLVH were detected in 69.1 and 30.9% cases, respectively (chi-square 7.9356, p < 0.01). Later, these differences became less obvious (41.7 and 58.3%, respectively).

CONCLUSION

Hypertensive patients with diabetes mellitus type 2 develop structural-geometric changes of the heart earlier. LVR in such patients is associated with gender, duration of DM and non-proportional growth of 24-h systolic blood pressure leading to gender-related differences in the time of formation of LVEH and CLVH.