PREDICTORS OF ARTERIAL HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN AZERBAIJAN POPULATION

The presented study in Azerbaijan is carried out for the first time within State Programs on fight against a type 2 diabetes mellitus (DM2) and other noninfectious diseases.

Aim. To define predictors of arterial hypertension (AH) in patients with DM2 in Azerbaijan population.

Material and methods. In the single-step clinical-epidemiology cohort study were included 528 patients with DM2 at the age of 30-69 (30,5% — men and 69,5% — women) who answered questions using “ARIC” questioner to define AH and its risk factors.

Results. The prevalence of AH in women (72,4%) was 2,6 times more than in men (27,6%) and the frequent occurrence of AH was at the age of 60-69 (respectively, 26,7±2,1% vs 9,6±2,9%, p<0,001). It was not determined remarkable differences between AH level and occupation status, alcohol consumption, low physical activity, feeding disorder of the patients, at the same time in patients with AH smoking frequency was about 2 times often than in others (respectively, 19,3±1,9% vs 10,6±3,0%, p<0,05). In parents of AH patients AH rates, in comparison with eutonics, were occurred like these: (respectively, in fathers 21,9±2,0% vs 12,5±3,2%, p<0,05; in mothers 42,2±2,4% vs 26,9±4,3%, p<0,01), in mothers DM2 (respectively, 33,7±2,3% vs 221 ±4,1 %, p<0,05), overweight and obesity were watched much more often (95,0±1,1% vs 88,5±3,1%, p<0,05), at the same time these patients were suffered from abdominal obesity (respectively, 96,5±0,9% vs 89,4±3,0%, p<0,01). The mean values of systolic and diastolic arterial pressure (respectively, 148,3±1,1 vs 119,8±1,3 Hg, p<0,001 and 85,9±0,5 vs 74,8±0,8 Hg, p<0,001) were often determined in patients with AH, and on the other hand in these patients were noted prevalence of anxious syndrome (respectively, 78,5±2,0% vs 72,1±4,4%, p<0,05) and depression (68,2±2,3% vs 62,5±4,7%, p>0,05). Regardless of AH level in all patients was noted stress (respectively, 99,8±0,2% vs 100,0±0,0%, p>0,05), which changed for the worse life quality of the patients with AH significantly (respectively, 1,0±2,2% vs 61,5±4,8%, p<0,05).

Conclusion. For patients with DM2 in Azerbaijan cohort female sex, increasing of the age, body mass index, abdominal obesity and anxious conditions are significant risk factors for AH. Presence of AH in both parents and DM2 in mothers increase this risk significantly, which decrease life quality of these patients.

1. International Diabetes Federation 2011. Global Burden: Prevalence and Projections, 2011 and 2030. Available from http://www.diabetesatlas.org/content/diabetes-and-impairedglucose-tolerance.

2. Touboul PJ, Hennerici MG, Meairs S. et al. Mannheim intima-media thickness consensus. Cerebrovasc Dis 2004; 18:346–349.

3. Muddu M, Mutebi E, Ssinabulya I. et al. Hypertension among newly diagnosed diabetic patients at Mulago National Referral Hospital in Uganda: a cross sectional study. Cardiovasc J Afr. 2018 Apr 20;29:1-7. doi: 10.5830/CVJA-2018-015.

4. Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart 2012; 98:177–184.

5. Zhang Y, Zhang X, Liu L, Zanchetti A. Is a systolic blood pressure target <140mmHg indicated in all hypertensives? Subgroup analyses of findings from the randomized FEVER trial. Eur Heart J 2011; 32:1500–1508.

6. 2018 ESC/ESH Guidelines for the management of arterial hypertension. EHJ 2018; 39:3021-3104. doi: org/10.1093/eurheartj/ehy339.

7. Kautzky-Willer A., Dorner A., Jensby A., Rieder A. Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS. BMC Public Health, 2012, 12:392.

8. Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012;55:1577–1596.

9. Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010;170:1566–1575.

10. Nield L, Moore HJ, Hooper L. et al. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2007;3:CD004097.

11. NICE Type 2 diabetes: the management of type 2 diabetes: NICE Clinical Guideline 87: National Institute for Health and Clinical Excellence 2009.

12. Sacks FM, Bray GA, Carey VJ. et al. Comparison of weight-loss diets with different compositions of fat, protein and carbohydrates. N Engl J Med 2009;360:859–873.

13. Okin PM, Devereux RB, Jern S. et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA 2004; 292:2343–2349.

14. Perk J, De Backer G, Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) // Eur Heart J 2012;33:1635–1701.

15. Sluik D, Buijsse B, Muckelbauer R. et al. Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-analysis. Arch Intern Med 2012:1–11.

16. Umpierre D, Ribeiro PA, Kramer CK. et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 2011;305:1790–1709.

17. Sigal RJ, Kenny GP, Boule NG. et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357–369.

18. Luft FC. Twins in cardiovascular genetic research. Hypertension 2001;37:350–356.

19. AlKhathami AD, Alamin MA, Alqahtani AM. et al. Depression and anxiety among hypertensive and diabetic primary health care patients. Could patients' perception of their diseases control be used as a screening tool? Saudi Med J. 2017 Jun;38(6):621-628. doi: 10.15537/smj.2017.6.17941.

20. Safar ME, Gnakaméné JB, Bahous SA. et al. Longitudinal Study of Hypertensive Subjects With Type 2 Diabetes Mellitus: Overall and Cardiovascular Risk // Hypertension, 2017 Jun;69(6):1029-1035. doi.10.1161/HYPERTENSION AHA.116.08962. Epub 2017 Apr 10.

21. Cederholm J, Gudbjornsdottir S, Eliasson B. et al. Blood pressure and risk of cardiovascular disease in type 2 diabetes: further findings from the Swedish National Diabetes Register (NDR-BP-II) // J Hypertens 2012; 30:2020–2030.

22. Perkovic V, Rodgers A. Redefining Blood-Pressure Targets - SPRINT Starts the Marathon. N Engl J Med. 2015;373(22):2175-2178. doi:10.1056/NEJMe151 3301.

23. Mancia G, Schumacher H, Redon J. et al. Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) // Circulation 2011; 124:1727–1736.

24. Ruggenenti P, Fassi A, Ilieva AP. et al. Effects of verapamil added-on trandolapril therapy in hypertensive type 2 diabetes patients with microalbuminuria: the BENEDICT-B randomized trial // J Hypertension, 2011; 29: 207–216.

25. Parving HH, Brenner BM, McMurray JJV. et al. Cardiorenal endpoints in a trial of aliskiren for type 2 diabetes // N Engl. J Med 2012;367:2204–2213.