Yeboah Kwame, Antwi Daniel A, Gyan Ben, Govoni Virginia, Mills Charlotte E, Cruickshank J Kennedy, Amoah Albert G B
Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana.
Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
BMC Endocr Disord. 2016 Sep 29;16(1):53. doi: 10.1186/s12902-016-0135-5.
Diabetes and hypertension increase arterial stiffness and cardiovascular events in all societies studied so far; sub-Saharan African studies are sparse. We investigated factors affecting arterial function in Ghanaians with diabetes, hypertension, both or neither.
Testing the hypothesis that arterial stiffness would progressively increase from controls to multiply affected patients, 270 participants were stratified into those with diabetes or hypertension only, with both, or without either. Cardio-ankle vascular index (CAVI), heart-ankle pulse wave velocity (haPWV), aortic PWV (PWVao) by Arteriograph, aortic and brachial blood pressures (BP), were measured.
In patients with both diabetes and hypertension compared with either alone, values were higher of CAVI (mean ± SD, 8.3 ± 1.2 vs 7.5 ± 1.1 and 7.4 ± 1.1 units; p < 0.05), PWVao (9.1 ± 1.4 vs 8.7 ± 1.9 and 8.1 ± 0.9 m/s; p < 0.05) and haPWV (8.5 ± 1 vs 7.9 ± 1 and 7.2 ± 0.7 m/s; p < 0.05) respectively. In multivariate analysis, age, having diabetes or hypertension and BMI were independently associated with CAVI in all participants (β = 0.49, 0.2, 0.17 and -0.2 units; p < 0.01, respectively). Independent determinants of PWVao were heart rate, systolic BP and age (β = 0.42, 0.27 and 0.22; p < 0.01), and for haPWV were systolic BP, age, BMI, diabetes and hypertension status (β = 0.46, 0.32, -0.2, 0.2 and 0.11; p < 0.01).
In this sub-Saharan setting with lesser atherosclerosis than the western world, arterial stiffness is significantly greater in patients with coexistent diabetes and hypertension but did not differ between those with either diabetes or hypertension only. Simple, reproducibly measured PWV/CAVI may offer effective and efficient targets for intervention.
糖尿病和高血压会增加动脉僵硬度并导致心血管事件，这在迄今所有已开展研究的社会群体中均有体现；撒哈拉以南非洲地区的相关研究较少。我们调查了影响加纳糖尿病患者、高血压患者、糖尿病合并高血压患者以及非糖尿病非高血压患者动脉功能的因素。
为验证从对照组到多重患病患者动脉僵硬度会逐渐增加这一假设，将270名参与者分为仅患有糖尿病或高血压、同时患有糖尿病和高血压以及既无糖尿病也无高血压三组。测量了心踝血管指数（CAVI）、心踝脉搏波速度（haPWV）、动脉造影仪测量的主动脉脉搏波速度（PWVao）、主动脉和肱动脉血压（BP）。
与仅患糖尿病或高血压的患者相比，糖尿病合并高血压患者的CAVI值更高（均值±标准差，分别为8.3±1.2、7.5±1.1和7.4±1.1单位；p<0.05），PWVao值更高（9.1±1.4、8.7±1.9和8.1±0.9米/秒；p<0.05），haPWV值更高（8.5±1、7.9±1和7.2±0.7米/秒；p<0.05）。在多变量分析中，年龄、患有糖尿病或高血压以及体重指数在所有参与者中均与CAVI独立相关（β分别为0.49、0.2、0.17和 -0.2单位；p<0.01）。PWVao的独立决定因素是心率、收缩压和年龄（β分别为0.42、0.27和0.22；p<0.01），haPWV的独立决定因素是收缩压、年龄、体重指数、糖尿病和高血压状态（β分别为0.46、0.32、 -0.2、0.2和0.11；p<0.01）。
在撒哈拉以南地区，与西方世界相比动脉粥样硬化程度较低，糖尿病合并高血压患者的动脉僵硬度显著更高，但仅患糖尿病或高血压的患者之间无差异。简单、可重复测量的PWV/CAVI可能为干预提供有效且高效的靶点。
