title: Endothelial dysfunction and C-reactive protein are risk factors for diabetes in essential hypertension.
abstract: OBJECTIVE
  Type 2 diabetes and essential hypertension are major risk factors for cardiovascular diseases. Endothelial dysfunction is an early step in the development of atherosclerosis and has been demonstrated in hypertensive and diabetic patients.
  
  
  METHODS
  We designed this study to determine whether forearm endothelial dysfunction is an independent predictor of type 2 diabetes in patients with essential hypertension. We enrolled 400 white never-treated hypertensive outpatients, free of type 2 diabetes at the time of the first evaluation. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine. Insulin resistance was estimated by homeostasis model assessment.
  
  
  RESULTS
  During the follow-up (4.5 +/- 1.6 years), 44 patients developed type 2 diabetes. The event rate was 2.4 events/100 patient-years. In a multivariate Cox regression analysis, the peak percentage increase in acetylcholine-stimulated forearm blood flow (hazard ratio [HR] 0.77 [95% CI 0.61-0.99]; P = 0.04) and C-reactive protein (1.16 [1.03-1.32]; P = 0.01) resulted in the only independent predictors of type 2 diabetes.
  
  
  CONCLUSIONS
  An impaired vasodilatory response to acetylcholine predicts development of type 2 diabetes in patients with essential hypertension. Present data also extend recent findings regarding a possible inflammatory pathogenesis of type 2 diabetes and suggest a new approach in treatment of essential hypertension.
authors.affiliation: Department of Experimental and Clinical Medicine G. Salvatore, University Magna Graecia of Catanzaro, Catanzaro, Italy. perticone@unicz.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
authors.forename: Raffele
authors.initials: R
authors.lastname: Maio
authors.forename: Angela
authors.initials: A
authors.lastname: Sciacqua
authors.forename: Francesco
authors.initials: F
authors.lastname: Andreozzi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Iemma
authors.forename: Maria
authors.initials: M
authors.lastname: Perticone
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Giorgio
authors.initials: G
authors.lastname: Sesti
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein