№ 1 / 2012 / 67-80

Author: Karpov R.S.¹, Koshel`skaya O.A.², Vinnitskaya I.V.³

Objective: comparative estimation of the carotid arteries (CA) wall structure changes in the hypertensive patients with type 2 diabetes mellitus (DM) and without it during regular 12 months-long antihypertensive and hypoglycemic therapy in the absence of statins as well as assessment of significant determinants of “intima-media” thickening of CA wall. Material and methods: 69 patients with arterial hypertension (AH) without carbohydrate metabolism disorders (AH group) and 227 hypertensive patients with DM (AH + DM group) took part in this study. The data on 76 patients of the AH + DM group have been included into the prospective part of the investigation. Carotid “intima–media” thickness (IMT) has been evaluated with the ultrasound scanning; the indices of arterial compliance and stiffness have been calculated. Blood pressure (BP) was estimated by a 24-h recording. Plasma levels of the lipids, HbA1 and OUICKI index were estimated. Findings: Compared to the control group, there were no significant differences in IMT in hypertensive diabetic pts, whereas in the latter the mean values of carotid artery diameter and of distensibility index were significantly smaller. Among the hypertensive diabetic pts with thickening of the carotid wall,  median values of diabetes duration in men were significant shorter than in women: 4 (3-7) vs 11(7-15) yrs. The stepwise multiple regression analysis revealed that IMT were independently and negatively associated with QUICKI index as well as with LDL/HDL and postprandial insulinemia only in hypertensive diabetic males, whereas in hypertensive diabetic females IMT was associated with renin activity, duration of diabetes, systolic BP-24h and age. In the course of perspective part of the study two groups have been revealed: patients with thickening of the carotid wall (Gr.1) and patients without it (Gr.2). Among patients of Gr.1 females prevailed, compared with Gr.2. In Gr.1 average increase in “intima-madia” thickness was 0,08 mm per 1 year. In patients of Gr.1 we found control of systolic BP-24h and diastolic BP-night to be not strict. The decrease in systolic BP-24h was less than 7mm Hg with its levels being more than 134/80mm Hg at the end of the study despite taking adequate antihypertensive treatment. In females of Gr.1 there was tendency to an increase in carotid arterial stiffness. Patients of Gr.2 showed not only decrease in carotid intima-media thickness from 0,94±0,03 to 0,83±0,03mm but also significant decrease in internal diameters of carotid artery whereas any dynamic of internal diameter of CA was absent in Gr.1. In both groups there was the same control of glycemia and plasma lipids during the study period. Thus, our results suggest the existence of gender peculiarities of vessel remodeling in hypertensive diabetic patients and interrelations between insufficient BP control and increase in arterial stiffness in these patients with progression of subclinical atherosclerosis. Among hypertensive diabetic patients with sufficient glycemic control, progression of subclinical atherosclerosis was absent in case of marked decrease in systolic BP-24h and diastolic BP-night.

arterial hypertension, diabetes mellitus, BP-24h, carotid “intima-media” thickness, arterial stiffness

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About Authors (Correspondence):

Koshel`skaya O.A. –  e-mail: koshel@cardio.tsu.ru

Vinnitskaya I.V. –  e-mail: Irina_khor@list.ru