CLINICAL FEATURES OF PATIENTS WITH ARTERIAL HYPERTENSION AND DIABETES MELLITUS

ABSTRACT

The high risk of cardiovascular complications, including fatal ones, is 2-4 times higher in patients with diabetes mellitus.  Meanwhile, it was shown that the joint association of hypertension and diabetes is 2.5 times higher than in patients with hypertension alone (the incidence of hypertension + diabetes over 6 years is 14.9% or 29.1 cases per 1000 patients, the incidence of hypertension alone is 6.6% or 1000:12 cases.

On the basis of the city Polyclinic №4, Almaty, from January 1 to December 31, 2021, we conducted a retrospective analysis of the medical histories of n=72 patients registered "D" by cardiologists and endocrinologists, including n=29 (40.27%) men (average age 62.68±8.75 years) and n=43 (59.72%) women (average age 60.03±9.59 years).

АННОТАЦИЯ

Высокий риск сердечно-сосудистых осложнений, в том числе фатальных, в 2-4 раза выше у пациентов с сахарным диабетом.  Между тем, было показано, что совместная ассоцировка АГ  и СД в 2,5 раза выше, чем у пациентов с только артериальной гипертензией (частота развития АГ + СД в течение 6 лет составляет 14,9% или 29,1 случая на 1000 пациентов, частота развития только АГ составляет 6,6% или 1000:12 случаев.

На базе городской поликлиники №4 г. Алматы с 1 января по 31 декабря 2021 года нами проведен ретроспективный анализ историй болезни n=72 больных, состоящих на учете «Д» кардиологов и эндокринологов, в том числе n=29 (40,27%) мужчин (средний возраст 62,68±8,75 лет) и n=43 (59,72%) женщина (средний возраст 60,03±9,59 лет).

Keywords: diabetes mellitus, arterial hypertension, methobolic syndrome, complications, comorbidity.

Ключевые слова: сахарный диабет, артериальная гипертензия, метоболический синдром, осложнения, коморбидность

Introduction. Arterial hypertension is one of the most common diseases today, which is a risk factor for the development of myocardial infarction, stroke, vision loss, chronic heart and kidney failure. However, half of those affected are unaware that their blood pressure is high. According to the World Health Organization(who), 1.28 billion adults aged 30-79 will suffer from arterial hypertension (hereinafter referred to as AG) worldwide in 2022, of which 22.4% of people aged 18 to 39 among the general population have arterial hypertension, 54.5% of people aged 40 to 59 and 74.5% of people over 60. Most of them (2/3) live in low-and middle-income countries[1]. It is estimated that 7.5 million people die annually from hypertension and its complications [2].

The main urgency of the problem of diabetes mellitus (DM) is increasing due to the steady increase in morbidity, disability of patients due to the development of complications, sudden death, especially cardiovascular diseases and social problems [3].

The increased risk of cardiovascular complications, including fatal ones, is 2-4 times higher in patients with DM [5]. It has been shown that the co-association of AH and DM is 2.5 times higher than in patients with AH alone (the incidence of AH + DM over 6 years is 14.9% or 29.1 cases per 1000 patients, the incidence of AH alone is 6.6% or 1000:12 cases)[4].

In recent years, the global prevalence of diabetes has been growing rapidly, i.e. the incidence has acquired the character of a non-infectious epidemic [5]. According to the IDF, the number of diabetics in 2000 was 151 million people, 537 million people in 2021 having reached a person [5]. Taking into account the rate of spread of the disease, IDF experts estimated that the number of diabetic patients in 2045 increased 1.5 times and amounted to 783 million people. It can reach a person, that is, every 10 people in the world predicted that they would have DM [5]. In 2021, there are 326.5 million people in the world. working age (20-64 years) and 122.8 million. Diabetes occurs in people aged 65-99 years [5]. The prevalence of diabetes among women aged 20 to 79 years was 8.4%, which is low compared to men (9.1%), that is, women living with diabetes (219.3 million people), compared to men (231.7 million) a lot [5]. According to WHO, approximately 1.6 million deaths in 2020 were directly related to diabetes, which ranks 7th among the causes of death in the world. However, mortality worldwide is associated with high blood glucose levels and various complications (such as kidney failure, stroke, heart disease, etc.) that lead to premature death [6].

According to IDF data, in 2021, the regions with the most DM are China  (140.9 million.), India (74.2 million.), Pakistan (33 million.), USA (32.2 million.), Indonesia (19.5 million.), Brazil (15.7 million.), Mexico (14.1 million.), Indonesia (10.3 million.), Bangladesh (13.1 million.), Japan (11 million.), Egypt (10.9 million.) countries [5].

In Kazakhstan, the incidence of DM is also increasing every year. For example, Kazakhstan is the leader in terms of the pace of development of the DM among the states of Central Asia [6]. According to data, as of January 1, 2017, 293,171 patients were registered (this is 1.5% of the average annual population), including adults – 290,335, children and adolescents – 2,836 patients with Type I DM-17,231 and patients with Type II DM - 275,736 people, other types of diabetes-204 patients [6].

Arm: description of clinical features in patients with arterial hypertension and diabetes mellitus in clinical practice

Materials and methods:  On the basis of the city Polyclinic №4, Almaty, from January 1 to December 31, 2021, we conducted a retrospective analysis of the medical histories of n=72 patients registered "D" by cardiologists and endocrinologists, including n=29 (40.27%) men (average age 62.68±8.75 years) and N=43 (59.72%) women (average age 60.03±9.59 years).

Inclusion criteria: according to the International Classification of diseases I10. - Patients aged 18-90 years with arterial hypertension and diabetes mellitus according to I13, E11-E11.8. Exclusion criteria: children with HIV infection, pituitary and adrenal tumors, congenital heart defects, Type I diabetes, and pregnant women with gestational diabetes, hypertension.

All studied medical histories were classified into 2 groups: group I – AH + DM n= 34 (47.22%), group II – a group of patients in whom only AH n =38 (52.77%) was detected.

According to the therapeutic protocols of the Ministry of Health of the Republic of Kazakhstan №158 "Type II diabetes mellitus" dated March 4, 2022 and №74 "Arterial hypertension" dated October 3, 2019, complaints of all examined patients, clinical data, Hb1Ac, cholesterol-lipid spectra, ECHOCG, ECG, artery ultrasound results, specialist consultations and recommendations of the European Society Data on special scales approved by the Organization of Cardiology (ESC) have been thoroughly analyzed. Patient n=1 had a fatal case associated with the registration of an acute hemorrhagic brain disease.

Statistical methods were used that made it possible to verify the analyzed data, the accuracy of the differences between the average values (М±m), the arithmetic mean values were evaluated by the T – criterion of Studenten. the difference at the level of р˂0,05 was considered statistically reliable. Statistical edits were collected in the electronic application Microsoft Office Excel.

Results. In our study, information on age and sexual characteristics was analyzed (Figure - 1): the proportion of men in patients of Group I is n=11 (15.27%) – average age -60.54±7.71, women-n=23 (31.94%) -58.6±6.48 years, men in Group II=18 (25%) – 64,83±5,62 young, women-n=20 (27,77%) – 61,46±7,29 was young. The proportion of women is dominant among both groups. It was found that women between Group I and Group II had an age difference of 4.88%, men – 7.08% (p<0.01).

Figure 1. Group of patients in the study

In the course of the study of lipid spectrum indicators, certain differences between the AH and AH+DM groups were revealed (Table - 1).  AH+DM in the group was slightly higher than lipid indicators, in Group I the difference was 2.79% for TC, TG - 29.5%, LDL – 3.77%, VLDL – 16.7% (p<0.01). Due to the complete lack of information, we could not determine the indicators of the coefficient of complete atherogenicity in patients.

Table 1.

Indicator by lipid Spectra (X)

In order to determine the indicators of damage to target cells, the results of echocardiography (ECHOCG) performed on patients were studied (Table – 2) . In patients with AG + DM, the frequency of left ventricular occurrence was noted – 20.12%, diffuse hypokinesis -50.18%, local hypokinesis-28.43%, akinesis-10.54%, EF -12.7%, ESV - 21.26%, EDV-11.21% (p<0.01).

Table 2.

 The main differences according to ECHOCG (X)

According to the SCORE scale[14](approved by the ESC organization), which helps to assess the 10 – year risk of death, data on blood pressure, cholesterol, and age characteristics were collected, based on which the SCORE scale value among Group I men was 3.37±1.25%, in women – 2.95±0.92%, in Group II Men - 2.58±1.1%, in women - 2.16±0.78% and was determined as a moderate risk group (Figure - 2).

Figure 3. Indicator on the average value of the SCORE scale (%)

Table 3.

 Average daily SBP and DBP average in hospital (%)

In patients of both groups, according to the degree of arterial hypertension, the average results of daily SBP / DBP were revealed. As is known, in patients of group I SBPday. the level is 164.56±14.37., DBPday.-96.32±4.57, this indicator is in group II SBPday.-155.21±11.41, DBPday.-91.09±3.94 (Table 3). In patients with AH+ DM, the results for day and night blood pressure were similar.

Discussion. Thus, according to the results of our study, the high risk of cardiovascular diseases in DM confirmed that it develops due to several conditions.  Factors such as obesity, hypertension and dyslipidemia may play a crucial role in the development of diabetes complications associated with atherosclerosis. Thus, every second patient with diabetes is diagnosed with dyslipidemia, and almost all patients in this category are overweight.

Arterial hypertension is observed in approximately 75-80% of patients with type II diabetes and is the cause of death in more than 50% of patients [9].  Their frequent association contributes to the interaction of common hereditary factors and risk factors. Among them, the most important are: genetic predisposition to high blood pressure and diabetes; sodium retention in the body can also cause or worsen angiopathy and nephropathy, obesity (especially abdominal cavity), insulin resistance, which contributes to increased blood pressure and the development of diabetes.

This was the case against the background of metabolic disorders, the average level of systolic and diastolic blood pressure is determined during the day, day and night. Another feature of the daily blood pressure profile in patients with DM is the increased variability of systolic and diastolic blood pressure during the day and at night. Patients with type II diabetes mellitus and arterial hypertension are also characterized by the large size and speed of the morning increase in blood pressure. On the other hand, diabetes (despite arterial hypertension and obesity) is associated with hypertrophy of the myocardium of the left ventricle of the heart and an increase in the stiffness of the artery wall.

Cardiovascular complications should be considered as the main cause of death in patients with type II diabetes. The reason is that diabetes is a risk factor for the development of atherosclerosis and, accordingly, coronary heart disease (CHD). In this group of patients, the prevalence of coronary heart disease is 25 times higher than in the general population, and, according to some studies, it is more common in 70% of patients with type II diabetes and in women than in men.

Conclusion: Patients suffering from diabetes and hypertension belong to the group with a very high cardiovascular risk. Both diabetes and hypertension affect each other and often coexist with other components of the metabolic syndrome. In order to avoid complications on the part of the heart and kidneys, it is necessary to monitor lipid and carbohydrate metabolism, functional kidney function, blood pressure levels daily and in dynamics.

References:

1. World Health Organization // Hypertension. - 2019. https://www.who.int.
2. World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risk Factors. - 2021. https://www.paho.org.
3. John R.P., Tomasz J.G., Rhian M.T. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms // Can J Cardiol. – 2017. - № 34(5). – Р. 575-584.
4. Guanghong J., James R.S. Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease // Hypertension. – 2021. - № 78 (5). – Р. 1197-1205. 5. Dianna J. Magliano, Co-chair, Edward J. Boyko, Co-chair; IDF Diabetes Atlas 10th edition scientific committee, 2021.
5. World Health Organization. The top 10 causes of death: World Health Organization. https://www.who.int.
6. Alexandra K., Konstantinos I., Konstantinos S., Alexandros S., Michalis D., Vasilios G.A.  Treatment strategies for hypertension in patients with type 1 diabetes // Expert OpinPharmacother/  - 2020. - № 21 (10). – Р. 1241-1252.
7. Mitsuru O. Hypertension with diabetes mellitus: physiology and pathology // Hypertens Res. – 2018. - № 41 (6). – Р. 389-393.
8. Aladeen A., Abdulmoneam S., Ibrahim A. Hypertension and diabetes mellitus as a predictive risk factors for stroke // Diabetes MetabSyndr.  – 2018. - № 12 (4). – Р. 577-584.
9. Agnieszka P., Weronika B., Andrzej P. Hypertension and Type 2 Diabetes-The Novel Treatment Possibilities //  Int J Mol Sci. – 2022. - № 23(12). - Р. 6500.
10. Robert W.S, Raymond O.E., Philip S.M., William R.H. Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial // Nat Clin Pract Nephrol. – 2007. - № 3 (8). – Р. 428-438.
11. Yan M., Stefan A.O., Goos D. L.,  et al.Effect of a reduction in uric acid on renal outcomes during losartan treatment: a post hoc analysis of the reduction of endpoints in non-insulin-dependent diabetes mellitus with the Angiotensin II Antagonist Losartan Trial //  Hypertension. – 2011. - № 58 (1). – Р. 2-7.
12. Han H., Yaying C., Chengwu F., Yan Z., Klodian D., Shu Z.,  et al.Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank // Diabetes Care. – 2022. - № 45 (2). – Р. 319-329.
13. 2018 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension //J.Hypertens. -2018;