title: Cumulative adverse effects of diabetes mellitus and hypertension on coronary flow velocity reserve.
abstract: BACKGROUND
  this study aimed to assess the hypothesis that essential hypertension (EH) may increase coronary microcirculation dysfunction in patients with type 2 diabetes mellitus (DM). Microvascular dysfunction has been reported in patients with DM or EH. Discordant results have been reported on cumulative adverse effects of the simultaneous presence of DM and EH on coronary flow velocity reserve (CFR).
  
  
  METHODS
  CFR were compared in 13 hypertensive diabetics (group 1), 12 normotensive diabetics (group 2), 11 hypertensive non diabetics (group 3) and 29 normotensive non diabetic patients (group 4). CFR was calculated using an intracoronary Doppler-tipped flow wire.
  
  
  RESULTS
  CFR was significantly lower in patients with both DM and EH (2.2 +/- 0.4 in group 1 vs 2.8 +/- 0.5, 2.8 +/- 0.6 and 2.9 +/- 0.7 in groups 2, 3 and 4 respectively, p<0.01). The presence of hypertension reduced CFR in diabetic patients with angiographically abnormal but unobstructed coronary arteries (2.1 +/- 0.3 in hypertensive vs 3.1 +/- 0.2 in normotensive diabetic patients, p<0.02). No cumulative adverse effect was observed in diabetics with angiographically normal coronary arteries (2.3 +/- 0.6 in hypertensive vs 2.6 +/- 0.5 in normotensive diabetic patients, NS). Multivariate analysis revealed that combination of DM and EH (p<0.007) was independently related to CFR.
  
  
  CONCLUSIONS
  the presence of hypertension appears to worsen coronary microangiopathy in diabetic patients with unobstructed coronary artery disease. The cumulative effect of EH and DM on CFR impairment has consequences for decision-making during coronary angioplasty and could identify patients at risk for cardiomyopathy.
authors.affiliation: Institut de cardiologie, Groupe hospitalier Pitié-Salpêtrière, Paris, France. claude.lefeuvre@psl.ap-hop-paris.fr
authors.forename: C
authors.initials: C
authors.lastname: Le Feuvre
authors.forename: F
authors.initials: F
authors.lastname: Raoux
authors.forename: F
authors.initials: F
authors.lastname: Beygui
authors.forename: G
authors.initials: G
authors.lastname: Helft
authors.forename: A
authors.initials: A
authors.lastname: Mogenet
authors.forename: D
authors.initials: D
authors.lastname: Dubois-Laforgue
authors.forename: J
authors.initials: J
authors.lastname: Timsit
authors.forename: J P
authors.initials: JP
authors.lastname: Metzger
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D014463:Ultrasonography