Non-invasively estimated end-systolic elastance in patients with resistant hypertension and type 2 diabetes mellitus

Ventriculo-arterial coupling (VAC) has been shown to be impaired in patients with type 2 diabetes mellitus (type 2 DM) and hypertension, and to improve with antihypertensive treatment. We examined if VAC in patients with type 2 DM and hypertension improved after a period of intensified antihypertensive treatment. VAC was estimated as the ratio of effective arterial elastance (E A) to end-systolic elastance (E ES) using pressure and flow curves obtained non-invasively (applanation tonometry and echocardiography). Left ventricular (LV) systolic and diastolic functions were evaluated using LV volumes, ejection fraction (EF), mitral inflow pattern, and Doppler tissue mitral annulus velocities. In total, 180 patients were included and for 100 patients the data met the quality criteria. Patients were categorized as having controlled (CH, n = 34), uncontrolled (UH, n = 32) or resistant (RH, n = 34) hypertension. In patients with RH, EF at follow-up was reduced from 48 to 42% (p = 0.005) and E ES from 2.18 mmHg/ml to 1.47 mmHg/ml (p = 0.003). EES, however, was also reduced in patients with CH and UH (CH 2.41-2.26, p = 0.05, UH 2.51-2.04, p = 0.05). In the present study, intensified antihypertensive treatment did not improve VAC or LV function in patients with hypertension and type 2 DM despite better control of BP. We speculate whether this is due to a reduction in myocardial perfusion pressure or to a gradual progression of diabetic cardiomyopathy.