Left ventricular dysfunction in hypertensive patients with Type 2 diabetes mellitus

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Abstract
Aims  To characterize left ventricular function in hypertensive patients with Type 2 diabetes and normal ejection fraction, and to relate these findings to pathogenic factors and clinical risk markers.Methods  We examined 70 hypertensive patients with Type 2 diabetes mellitus with ejection fraction > 0.55 and fractional shortening > 0.25, all without any cardiac symptoms. Thirty‐five non‐diabetic subjects served as control subjects. Left ventricular longitudinal function was examined by tissue Doppler derived myocardial strain rate and peak systolic velocities.Results  Hypertensive patients with diabetes had a significantly higher systolic strain rate (−1.1 ± 0.3 s−1 vs. −1.6 ± 0.3 s−1, P < 0.001) and lower systolic peak velocities (3.3 ± 1.0 vs. 5.6 ± 1.0 cm/s, P < 0.001) compared with control subjects. Myocardial systolic strain rate correlated significantly to left ventricular mass (r = 0.40, P < 0.01) and to both HbA1c (r = 0.43, P < 0.01), and fructosamine (r = 0.40, P < 0.01), but was not related to serum levels of carboxymethyllysine, albuminuria, blood pressure (dipping/non‐dipping), or oral hypoglycaemic therapy. Patients with diastolic dysfunction had significantly higher levels of urine albumin [21.0 (5–2500) mg/l, vs. 9.5 (1–360), P < 0.01], heart rate (78 ± 13 vs. 67 ± 10 b.p.m., P < 0.005), and seated diastolic blood pressure (85 ± 6 vs. 81 ± 7 mmHg, P < 0.05) and non‐dipping diastolic blood pressure was more frequent.Conclusions  Long axis left ventricular systolic function was significantly decreased in hypertensive patients with Type 2 diabetes mellitus, and is associated with hyperglycaemia and left ventricular hypertrophy. Diastolic dysfunction was closely related to increased diastolic blood pressure, non‐dipping and increased urinary albumin excretion.