Refractory and resistant hypertension in patients with type 2 diabetes mellitus: differences in metabolic profile and endothelial function

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Abstract

Aim. To determine the prevalence of refractory hypertension (RfH) in patients with and without type 2 diabetes mellitus (DM), as well as to evaluate whether diabetic patients with RfH significant differ from those with uncontrolled resistant hypertension (RH) in clinical phenotype, metabolic profile and endothelial function.

Materials and methods. The study included 193 patients with RH: RH 74 patients with diabetes and 119 patients without DM. Uncontrolled RH and RfH were defined by the presence of uncontrolled blood pressure – BP (≥140 and/or 90 mm Hg) despite the use of >3 but <5 antihypertensive drugs (for RH) and ≥5 antihypertensive drugs, including a mineralocorticoid receptor antagonist (for RfH). Clinical examination, lab tests were performed. Flow-mediated dilation (FMD) and vasoreactivity of middle cerebral artery (MCA) using both breath-holding and hyperventilation test were measured by high-resolution ultrasound.

Results. The prevalence of refractory hypertension in patients with and without DM was similar (30% vs 28%, respectively). No differences in BP levels, data of echocardiography and clinical phenotype were found between the diabetic groups, but value of HOMA index, plasma resistin level and postprandial glycaemia were higher in patients with RfH. FMD and MCA reactivity to the breath-holding test were worse in patients with RfH, and they had a more pronounced vasoconstrictor response of MCA to the hyperventilation test compared to patients with RH.

Conclusion. The prevalence of RfH is the same in patients with and without diabetes. Diabetic patients with refractory hypertension have a more unfavorable metabolic profile and greater impairment of endothelial function than patients with uncontrolled resistant hypertension.

About the authors

Alla Y. Falkovskaya

Cardiology Research Institute, Tomsk National Research Medical Center

Author for correspondence.
Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0002-5638-3034

к.м.н., ст. науч. сотр. отд-ния артериальных гипертоний

Russian Federation, Tomsk

Victor F. Mordovin

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0002-2238-4573

д.м.н., проф., рук. отд-ния артериальных гипертоний

Russian Federation, Tomsk

Stanislav E. Pekarskiy

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0002-4008-4021

д.м.н., вед. науч. сотр. отд-ния хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции

Russian Federation, Tomsk

Tatiana M. Ripp

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0001-5898-0361

д.м.н., вед. науч. сотр. отд-ния артериальных гипертоний

Russian Federation, Tomsk

Mushegh A. Manukyan

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0003-3577-1895

аспирант отд-ния артериальных гипертоний

Russian Federation, Tomsk

Valeria A. Lichikaki

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0003-4066-869X

к.м.н., науч. сотр. отд-ния артериальных гипертоний

Russian Federation, Tomsk

Irina V. Zyubanova

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0001-6995-9875

к.м.н., мл. науч. сотр. отд-ния артериальных гипертоний

Russian Federation, Tomsk

Ekaterina S. Sitkova

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0002-0988-3642

к.м.н., врач отд-ния хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции

Russian Federation, Tomsk

Anna M. Gusakova

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0002-3147-3025

к.м.н., науч. сотр. отд-ния функциональной и лабораторной диагностики

Russian Federation, Tomsk

Tamara R. Ryabova

Cardiology Research Institute, Tomsk National Research Medical Center

Email: alla@cardio-tomsk.ru
ORCID iD: 0000-0001-8573-5695

к.м.н., ст. науч. сотр. отд-ния функциональной и лабораторной диагностики

Russian Federation, Tomsk

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Supplementary files

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2. Fig. 1. Block diagram of the study. Note. PA - renal arteries.

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3. Fig. 2. Metabolic parameters in diabetic patients with refractory hypertension and uncontrolled RAH. Note. HOMA-IR - insulin resistance index. Here and below in Fig. 3, 4: p - level of significance; Student's t-test.

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4. Fig. 3. Indicators of the test with the brachial artery hyperemia in diabetic patients with refractory hypertension and uncontrolled RAH.

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5. Fig. 4. Indicators of cerebrovascular reactivity in diabetic patients with refractory hypertension and uncontrolled RAH. Note. K (+) is the coefficient of MCA reactivity to hypercapnia in the breath hold test, K (-) is the coefficient of MCA reactivity to hypocapnia in the hyperventilation test.

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