Hippokratia 2001, 5(2):69-75
D Psirropoulos, N Lefkos, G Boudonas, Ap Efthimiadis, G Tsapas
The role of hypertension and diabetes mellitus as risk factors in coronary heart disease is known but the role of elevated glucose levels in patients who are apparently non-diabetic but suffering from hypertensive heart failure is controversial.
Methods: Sixty eight hypertensive patients under sufficient anti-hypertensive treatment (M=42, F=26, mean age=70+8 years) with heart failure (II-IV NYHA class, EFΘ40%, LAEI5mm) and without known history of ischaemic heart disease, hyperlipidaemia or diabetes mellitus were studied. In all patients at baseline blood pressure and heart rate were measured, an echocardiogram, for determination of diastolic and systolic indices was performed, and fasting glucose and lipids levels were measured.
Results: Elevated glucose levels were found in 21 patients who consisted Group A and the remaining 47 patients without diabetes consisted Group B. Glucose levels were significantly higher in Group A (180mg/dl) compared to Group Β (106mg/dl); systolic dysfunction was also greater in Group A than in Group Β (EF=29.4% and EPSS=10.7mm vs. EF=34.2% and EPSS=6.8mm respectively); diastolic dysfunction was also greater in Group A than in Group Β (LAEI=0.32 vs. LAEI =0.41); cholesterol levels were higher in Group A than in Group Β (224.4mg/dl vs. 204mg/dl); and triglycerides were also higher in Group A than in Group Β (2l6.8mg/dl vs. 189mg/dl). The antihypertensive treatment was sufficient without significant differences in both groups.
Conclusions: The hyperglycemia, in our study, shows a clear significant negative effect on the systolic function of the left ventricle in the hypertensive patients. In hypertensive patients with heart failure the endothelial dysfunction and/or the insufficient treatment of diabetes may contribute to appearance of systolic dysfunction of the left ventricle. The coexistence also of diabetes and hyperlipidaemia could indicate underlying coronary arterial disease which may predispose to failure.