One-Hour Postload Plasma Glucose Levels and Diastolic Function in Hypertensive Patients

• Published in: Diabetes care Vol. 34; no. 10; pp. 2291 - 2296
• Main Authors: Sciacqua, Angela, Miceli, Sofia, Greco, Laura, Arturi, Franco, Naccarato, Paola, Mazzaferro, Deborah, Tassone, Eliezer J, Turano, Laura, Martino, Francesco, Sesti, Giorgio, Perticone, Francesco
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.10.2011
• Subjects: Adult; Aged; Anthropometry; Biological and medical sciences; blood; blood glucose; Blood Glucose - metabolism; Blood Glucose - physiology; Blood pressure; cardiomyopathy; Cardiovascular disease; Cholesterol; Dextrose; Diabetes; Diabetes. Impaired glucose tolerance; Echocardiography; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Family medical history; Female; Gastrointestinal diseases; Glucose; glucose tolerance; Glucose Tolerance Test; Glucose tolerance tests; Heart attacks; Hemodynamics; Humans; Hyperglycemia; Hypertension; Hypertension - blood; Hypertension - physiopathology; image analysis; insulin resistance; Male; Medical sciences; Metabolic diseases; metabolism; Middle Aged; Miscellaneous; Mortality; noninsulin-dependent diabetes mellitus; Original Research; patients; physiology; physiopathology; Plasma; Public health. Hygiene; Public health. Hygiene-occupational medicine; regression analysis; risk; Type 2 diabetes; Ventricular Dysfunction, Left; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - physiopathology; Human; Hypertension; Nutrition; Cardiovascular disease; Patient; Metabolic diseases; Glucose tolerance test; Glucose; Endocrinology; Glycemia
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc11-0879

OBJECTIVE: To address whether glucose tolerance status, and in particular 1-h postload plasma glucose levels, may affect diastolic function in 161 never-treated hypertensive white subjects. Impaired left ventricular relaxation, an early sign of diastolic dysfunction, represents the first manifestation of myocardial involvement in diabetic cardiomyopathy. A plasma glucose value ≥155 mg/dL for the 1-h postload plasma glucose during an oral glucose tolerance test (OGTT) is able to identify subjects with normal glucose tolerance (NGT) at high risk for type 2 diabetes and with subclinical organ damage. RESEARCH DESIGN AND METHODS: Subjects underwent OGTT and standard echocardiography. Diastolic function was assessed by pulsed Doppler transmitral flow velocity and tissue Doppler imaging. Insulin sensitivity was assessed by Matsuda index. RESULTS: Among the participants, 120 had NGT, 26 had impaired glucose tolerance (IGT), and 15 had type 2 diabetes. According to the 1-h postload plasma glucose cutoff point of 155 mg/dL, we divided NGT subjects as follows: NGT <155 mg/dL (n = 90) and NGT ≥155 mg/dL (n = 30). Those with NGT ≥155 mg/dL had higher left atrium dimensions (P < 0.0001) and isovolumetric relaxation time (IVRT) (P = 0.037) than those with NGT <155 mg/dL. By contrast, early/late transmitral flow velocity and all tissue Doppler parameters were significantly lower in those with NGT ≥155 mg/dL than in those with NGT<155 mg/dL. At multiple regression analysis, 1-h glucose was the major determinant of left atrium area, IVRT, septal e', septal e'-to-a' ratio, lateral e', and lateral e'-to-a' ratio. CONCLUSIONS: The main finding of this study is that 1-h postload plasma glucose is associated with left ventricular diastolic dysfunction. Subjects with NGT ≥155 mg/dL had significantly worse diastolic function than those with NGT<155 mg/dL.