Contribution of Carbohydrate Metabolism Disorders to the Development of Target Organ Damage in Hypertensive Patients with Metabolic Syndrome

CLINICAL AND BASIC RESEARCH
Nigora Z. Srojidinova

Republican Specialized Center of Cardiology, Tashkent, Uzbekistan

*Corresponding author: Nigora Z. Srojidinova, PhD, Department of Arterial Hypertension, Republican Specialized Center of Cardiology, 4, Osiyo str., 100052, Tashkent, Uzbekistan. Tel: 998-97-1040112 E-mail: nigora_s@bcc.com.uz

Abstract: 

Objective: The relationship between glucose abnormality and cardiovascular and renal functions in hypertensive patients with metabolic syndrome (MetS) was examined in this study.

Methods: The population included 85 hypertensive patients with MetS. MetS is defined according to IDF, 2005 criteria. Metabolic measures included lipids, plasma insulin, glucose tolerance test, and insulin sensitivity by the homeostasis model assessment. M- and B-mode ultrasounds were used to determine left ventricular (LV) hypertrophy, endothelium-dependent vasodilation and intima media thickness.

Results: Hypertensive patients who have had either impaired glucose tolerance (IGT) and hyperinsulinemia or a combination of both have expressed a higher degree of LV hypertrophy, LV diastolic dysfunction, endothelium dysfunction and lipid disorders.

Conclusions: The presence of the IGT and hyperinsulinemia changes for the worse cardiovascular remodeling processes in hypertensive patients with MetS and it is association with high risk of target organ damage.

Keywords: 
hypertension, metabolic syndrome.
References: 
  1. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome–a new worldwide definition. Lancet 2005; 366:1059-1062.
  2. Balkau B. The DECODE study. Diabetes epidemiology: collaborativeanalysis of diagnostic criteria in Europe. Diabetes Metab 2000; 26(4):282-286.
  3. Barkris GL. Microalbuminuria: what is it? Why is it important? What should be done about it? J Clin Hypertens 2001; 3: 99-102.
  4. Bindraban NR, van Valkengoed I, Mairuhu  G, Koster RW, Holleman F, Hoekstra JB, Koopmans RP, Stronks K.  A new tool, a better tool? Prevalence and performance of the International Diabetes Federation and the National Cholesterol Education Program criteria for metabolic syndrome in different ethnic groups. Eur J Epidemiol 2008; 23:37–44.
  5. Biology of obesity, p 467. In Harrison’s principles of internal medicine Edited by: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL. 2008; 17:462-469.
  6. Burchfiel CM, Skelton TN, Andrew MJ, Garrison RJ, Arnett DK, Jones DW, Taylor HA. Metabolic syndrome and echocardiographic left ventricular mass in blacks: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2005;112:819–827.
  7. Celermajer DS, Soronsen KE, Gooch VM et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340:1111-1115.
  8. Chinali M, Devereux RB, Howard BV, Roman MJ, Bella JN, Liu JE, Resnick HE, Lee ET, Best LG, de Simone G. Comparison of cardiac structure and function in American Indians with and without the metabolic syndrome (the Strong Heart Study). Am J Cardiol 2004;93:40–44.
  9. Cuspidi C, Meani S, Fusi V, Severgnini B, Valerio C, Catini E, Leonetti G, Magrini F, Zanchetti A. Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens 2004;22:1991–1998.
  10.  de Simone G, Palmieri V, Bella JN, Celentano A, Hong Y, Oberman A, Kitzman DW, Hopkins PN, Arnett DK, Devereux RB. Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study. J Hypertens 2002;20:323–331.
  11.  Dell’Omo G, Penno G, Pucci L, Mariani M, Del Prato S, Pedrinelli R. Abnormal capillary permeability and endothelial dysfunction in hypertension with comorbid metabolic syndrome. Atherosclerosis 2004;172: 383–389.
  12.  Di Bello V, Santini F, Di Cori A et al. Obesity cardiomyopathy: Is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr 2006; 19: 1063–1071.
  13.  Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 2005; 28:2745–2749.
  14.  Gimeno-Orna JA, Molinero-Herguedas E, Sanchez-Vano R, Lou-Arnal L.M, Boned-Juliani B, Castro-Alonso FJ. Microalbuminuria presents the same vascular risk as overt CVD in type 2 diabetes. Diabetes Res Clin Pract 2006; 74:103-109.
  15.  Grandi AM, Maresca AM, Giudici E, Laurita E, Marchesi C, Solbiati F, Nicolini E, Guasti L, Venco A. Metabolic syndrome and morphofunctional characteristics of the left ventricle in clinically hypertensive nondiabetic subjects. Am J Hypertens 2006; 19:199 –205.
  16.  Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart  Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112:2735–2752.
  17.  Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008; 28:629-636.
  18.  Haffner S, Taegtmeyer H. Epidemic obesity and the metabolic syndrome. Circulation 2003; 108:1541–1545.
  19.  Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24:683-689.
  20.  Jansson PA. Endothelial dysfunction in insulin resistance and type 2 diabetes. J Intern Med 2007; 262:173-83.
  21.  Kawamoto R, Tomita H, Ohtske N, Inone A, Kamitani A. Metabolic syndrome and subclinical atherosclerosis assessed by carotid intima- media thickness. J Atheroscler Thromb 2007; 14:78-85.
  22.  Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114:345–352.
  23.  Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709–2716.
  24.  Leoncini G, Ratto E, Viazzi F, Vaccaro V, Parodi D, Parodi A, Falqui V, Tomolillo C, Deferrari G, Pontremoli R. Metabolic syndrome is associated with early signs of organ damage in nondiabetic, hypertensive patients. J Intern Med 2005;257:454–460.
  25.  Lerman A, Zeiher AM. Endothelial function: cardiac events. Circulation 2005; 111:363–368.
  26.  Lind L. Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis 2007; 27:27.
  27.  Ljungman S, Wikstrand J, Hartford M, Berglund G. Urinary albumin excretion — a predictor of risk of cardiovascular disease: a prospective 10-year follow-up of middle-aged nondiabetic normal and hypertensive men. Am J Hypertens 1996; 9: 770-778.
  28.  Lteif AA, Han K, Mather KJ. Obesity, insulin resistance, and the metabolic syndrome: determinants of endothelial dysfunction in whites and blacks. Circulation. 2005; 112:32–38.
  29.  Mancia G, Bombelli M, Corrao G, Facchetti R, Madotto F, Giannattasio C, Trevano FQ, Grassi G, Zanchetti A, Sega R. Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension 2007;49:40 – 47.
  30.  Mancia G, de Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM. et al. 2007 Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J  Hypertens 2007; 25:1105–1187.
  31.  Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28:412– 419.
  32.  Miranda PJ, De Fronzo RA, Califf RM, Guyton JR. Metabolic syndrome: definition, pathophysiology, and mechanisms. Am Heart J 2005; 149:33-45.
  33.  Mule G, Cottone S, Nardi E et al. Metabolic syndrome in subjects with essential hypertension: relationship with subclinical cardiovascular and renal damage. Minerva Cardioangiol 2006.54:173–94.
  34.  Mule G, Nardi E, Cottone S, Cusimano P, Volpe V, Piazza G, Mongiovi R, Mezzatesta G, Andronico G, Cerasola G. Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005;257:503–513.
  35.  Muniyappa R, Quon MJ. Insulin action and insulin resistance in vascular endothelium. Curr Opin Clin Nutr Metab Care 2007;10:523-30.
  36.  Nesto RW. The relation of insulin resistance syndromes to risk of cardiovascular disease. Rev Cardiovasc Med 2003; 4 (Suppl 6):S11-S18.
  37.  Oberman A, Prineas RJ, Larson JC, La Croix A, Lasser NL. Prevalence and determinants of electrocardiographic left ventricular hypertrophy among a multiethnic population of postmenopausal women. Am J Cardiol 2006; 97:512–519.
  38.  Palaniappan L, Carnethon M, Fortmann SP. Association between microalbuminuria and the metabolic syndrome: NHANES III. Am J Hypertens 2003; 16:952–958.
  39.  Paternostro G, Pagano D, Gnecchi-Ruscone T, Bonser RS, Camici PG. Insulin resistance in patients with cardiac hypertrophy. Cardiovasc Res1999; 42: 246–253.
  40.  Peterson LR, Herrero P, Schechtman KB et al. Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Circulation 2004; 109: 2191–2196.
  41.  Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: An 8 years follow-up of 14,719 initially healthy American women. Circulation 2003; 107:391-397.
  42.  Ruggenenti P, Remuzzi G. Time to abandon microalbuminuria? Kindney Int 2006; 70: 1214-1222.
  43.  Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000; 101:1899–1906.
  44.  Schillaci G, Pirro M, Pucci G, Mannarino MR, Gemelli F, Siepi D, Vaudo G, Mannarino E. Different impact of the metabolic syndrome on left ventricular structure anf function in hypertensive men and women. Hypertension 2006; 47:881– 886.
  45.  Schillaci G, Pirro M, Vaudo G, Gemelli F, Marchesi S, Porcellati C, Mannarino E. Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol 2004; 43:1817–1822.
  46.  Schillaci G, Verdecchia P, Porcellati C, Cuccurullo O, Cosco C, Perticone F. Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension 2000; 35:580 –586.
  47.  Stehouwer CD, Smulders YM. Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms. J Am Soc Nephrol 2006; 17: 2106-2111.
  48.  Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 2000; 101:948–954.
  49.  Taddei S, Salvetti A. Endothelial dysfunction in essential hypertension: clinical implications. J Hypertens 2002; 20:1671–1674.
  50.  Wong CY, O’Moore-Sullivan T, Leano R, Byrne N, Beller E, Marwick TH. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 2004; 110:3081–3087.
  51.  Yanai H, Tomono Y Ito K, Furutani N, Yoshida H, Tada N. The underlying mechanisms for development of hypertension in the metabolic syndrome. Nutrition Journal 2008; 7(10):1475-2891.

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Int J Biomed. 2011; 1(3):132-38. © 2011 International Medical Research and Development Corporation. All rights reserved.