title: Effect of diabetes and hypertension on left ventricular diastolic function in a high-risk population without evidence of heart disease.
abstract: OBJECTIVE
  To assess the independent and combined effects of diabetes and hypertension on left ventricular (LV) diastolic function in a community-based cohort at high cardiovascular risk.
  
  
  RESULTS
  Two-dimensional echocardiography was performed in 708 subjects from the Cardiac Abnormalities and Brain Lesions (CABL) study. Peak diastolic early (E) and late (A) transmitral flow, and tissue Doppler-derived early mitral annulus velocity (E') were recorded, and E/A and E/E' ratios were calculated. The population was divided into four groups: those without hypertension or diabetes (HT-/DM-), those with only hypertension (HT), only diabetes (DM), and with hypertension plus diabetes (HT + DM). In multivariate analysis, hypertension and diabetes were independent predictors of worse diastolic function. The coexistence of hypertension and diabetes was associated with greater impairment of diastolic function (higher E/E' ratio than HT-/DM-, HT, or DM, all P < 0.05), independent of covariates. The negative, synergistic effect of hypertension and diabetes on LV diastolic function was present both in lean participants and in overweight/obese ones. An E/E' ratio >15, suggestive of increased LV filling pressure, was found in 2.2% of HT-/DM-, 8.9% of HT, 5.9% of DM, and 14.7% of HT + DM (P < 0.01).
  
  
  CONCLUSIONS
  Hypertension and diabetes are independently associated with impaired LV diastolic function, independent of the effect of overweight/obesity and other covariates. Their coexistence results in a negative synergistic effect on LV diastolic mechanics and is associated with higher LV filling pressures than either condition alone.
authors.affiliation: Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH3-342 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging; D015994:Incidence; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016277:Ventricular Function, Left