One-hour postload plasma glucose levels and left ventricular mass in hypertensive patients
Angela Sciacqua1, Sofia Miceli, Giuseppe Carullo
1Department of Experimental and Clinical Medicine G. Salvatore, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Insights
Elevated 1-hour postload glucose in normal glucose tolerance (NGT) identifies individuals with increased left ventricular mass and hypertrophy risk, similar to impaired glucose tolerance or diabetes.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular morbidity and mortality.
- Identifying early markers for LVH in hypertension is crucial for risk stratification.
- A 1-hour postload plasma glucose ≥155 mg/dL during an oral glucose tolerance test (OGTT) indicates high risk for type 2 diabetes.
Purpose of the Study:
- To investigate the impact of glucose tolerance status, specifically 1-hour postload glucose levels, on left ventricular mass (LVM) and cardiac geometry in essential hypertension.
- To determine if elevated 1-hour postload glucose in individuals with normal glucose tolerance (NGT) is associated with increased left ventricular mass index (LVMI) and LVH prevalence.
Main Methods:
- Enrolled 767 never-treated hypertensive subjects (mean age 49.6 years).
- Performed OGTT to assess glucose tolerance and standard echocardiography to calculate LVM index (LVMI).
- Categorized participants into NGT, impaired glucose tolerance (IGT), and type 2 diabetes groups, and further divided NGT subjects based on 1-hour postload glucose (<155 mg/dL vs. ≥155 mg/dL).
Main Results:
- Subjects with NGT and 1-hour postload glucose ≥155 mg/dL exhibited worse insulin sensitivity compared to those with <155 mg/dL.
- Men with NGT ≥155 mg/dL showed significantly higher LVMI and LVH prevalence than men with NGT <155 mg/dL.
- 1-hour postload glucose was identified as the primary determinant of LVMI across normotolerant, IGT, and diabetic groups.
Conclusions:
- Individuals with NGT and a 1-hour postload glucose ≥155 mg/dL demonstrate elevated LVMI and LVH prevalence.
- These findings suggest that even in the presence of normal glucose tolerance, a higher 1-hour postload glucose level is associated with adverse cardiac remodeling.
- The results highlight the importance of 1-hour postload glucose as a risk marker for cardiac changes in hypertensive individuals.
Objective:
Left ventricular hypertrophy (LVH), an independent risk factor for cardiovascular (CV) morbidity and mortality, recognizes a multifactorial pathogenesis. A plasma glucose value ≥155 mg/dL for the 1-h postload plasma glucose during an oral glucose tolerance test (OGTT) identifies subjects with normal glucose tolerance (NGT) at high risk for type 2 diabetes. We addressed the question if glucose tolerance status, particularly 1-h postload plasma glucose levels, affects left ventricular mass (LVM) and cardiac geometry in essential hypertension.
Research Design And Methods:
We enrolled 767 never-treated hypertensive subjects, 393 women and 374 men (mean age 49.6 ± 8.5 years). All patients underwent an OGTT for the evaluation of glucose tolerance and standard echocardiography. LVM was calculated using the Devereux formula and normalized by body surface area (LVM index [LVMI]). Insulin sensitivity was assessed by the Matsuda index. Among all participants, 514 had NGT, 168 had impaired glucose tolerance (IGT), and 85 had type 2 diabetes. According to the 1-h postload plasma glucose cutoff point of 155 mg/dL, we divided normotolerant subjects into two groups: NGT <155 mg/dL (n = 356) and NGT ≥155 mg/dL (n = 158).
Results:
Subjects in the NGT ≥155 mg/dL group had worse insulin sensitivity than subjects in the NGT <155 mg/dL group (Matsuda index 63.9 vs. 88.8; P < 0.0001). Men with NGT ≥155 mg/dL had a higher LVMI than men with NGT <155 mg/dL (126.6 vs. 114.3 g/m(2); P = 0.002) and a different LVH prevalence (41.1 vs. 25.8%; P < 0.0001). At multiple regression analysis, 1-h glucose resulted in the major determinant of LVMI in normotolerant, IGT, and diabetic groups.
Conclusions:
These data show that NGT ≥155 mg/dL subjects, compared with NGT <155 mg/dL subjects, have a higher LVMI and a greater prevalence of LVH similar to that of IGT and diabetic patients.
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