ARTERIAL STIFFNESS AND ENDOTHELIAL DYSFUNCTION ARE THE MAIN DETERMINANTS OF ALBUMINURIA IN PATIENTS WITH DIABETES AND HYPERTENSION: 5A.07:

Background: Patients with type II diabetes and associated arterial hypertension have increased arterial stiffness due mainly to endothelial dysfunction. Meanwhile, they usually have microalbuminuria, also as a result of diffuse endothelial dysfunction. We hypothesized that these markers of subclinical organ damage are related and, therefore, we assessed the strength of correlation and the influence of other parameters. Methods: We evaluated 53 patients (57 ± 9 years, 28 males), with mild to moderate hypertension (mean ABPM values: 146/93 mmHg) and type II diabetes (mean duration of 3.6 ± 5 years). Arterial function was assessed by e-tracking and wave intensity analysis, at the level of the RCCA, with measurements of intima-media thickness (IMT), beta index (β2), elastic module (Ep), carotid wave speed (WS), and arterial compliance (AC). Endothelial function was assessed by flow mediated dilation (FMD) at the level of the right brachial artery. Albuminuria was measured by an imunoturbidic method. Results: IMT and arterial stiffness parameters (β2, Ep, WS, and AC) were at the upper limit of normal. FMD was slightly decreased, indicating mild endothelial dysfunction. Proteinuria was into the limits for microalbuminuria (table). Proteinuria correlated positively with arterial stiffness parameters (r = 0.45 for β2, r = 0.50 for Ep, both p < 0.01, and r = 0.36 for WS, p < 0.05). By stepwise multiple regression analysis (using a model including age, duration of hypertension, duration of diabetes, ABPM values, HbA1c values, and all arterial function parameters), best determinants of albuminuria were indices of arterial stiffness (beta index and arterial compliance) and of endothelial dysfunction (FMD): r = 0.64, r2 = 0.40, p = 0.001. Conclusion: Arterial stiffness and endothelial dysfunction, but not duration of disease and blood pressure or diabetes control, are the main determinants of albuminuria in patients with mild to moderate hypertension and type 2 diabetes mellitus. This should be considered when new targets for preventive treatment are implemented.