Type 2 diabetes mellitus worsens arterial stiffness in hypertensive patients through endothelial dysfunction

Endothelium-derived factors are thought to be physiological modulators of large artery stiffness. The aim of the study was to investigate whether endothelial function could be a determinant of arterial stiffness in essential hypertensive patients, in relation with the concomitant presence of type 2 diabetes mellitus. The study included 341 participants (84 hypertensive patients with and 175 without type 2 diabetes mellitus, 82 matched controls). Brachial artery endothelium-dependent flow-mediated dilation (FMD) was determined by high-resolution ultrasound and computerised edge detection system. Applanation tonometry was used to measure carotid-femoral pulse wave velocity (PWV). Hypertensive patients with diabetes had higher PWV (10.1 +/- 2.3 m/s vs 8.6 +/- 1.4 m/s, < 0.001) and lower FMD (3.51 +/- 2.07 vs 5.16 +/- 2.96%, < 0.001) than non-diabetic hypertensive patients, who showed impaired vascular function when compared with healthy participants (7.9 +/- 1.6 m/s and 6.68 +/- 3.67%). FMD was significantly and negatively correlated to PWV only in hypertensive diabetic patients ( = -0.456, < 0.001), but not in hypertensive normoglycaemic patients ( = -0.088, = 0.248) or in healthy participants ( = 0.008, = 0.946). Multivariate analysis demonstrated that, in the diabetic group, FMD remained an independent predictor of PWV after adjustment for confounders ( (2) = 0.083, = 0.003). Subgroup analysis performed in non-diabetic hypertensive patients revealed that neither obesity nor the metabolic syndrome affected the relationship between FMD and PWV. Endothelial dysfunction is a determinant of aortic stiffness in hypertensive diabetic patients but not in hypertensive patients without diabetes. These results suggest that type 2 diabetes mellitus on top of hypertension might worsen arterial compliance by endothelium-related mechanisms.