Effect of type 2 diabetes mellitus on left ventricular geometry and systolic function in hypertensive subjects - Hypertension genetic epidemiology network (HyperGEN) study

Background-Type 2 diabetes is a cardiovascular risk factor. It remains to b e elucidated in a large, population-based sample whether diabetes is associ ated with changes in left ventricular (LV) structure and systolic function independent of obesity and systolic blood pressure (BP). Methods and Results-Among 1950 hypertensive participants in the HyperGEN St udy without overt coronary heart disease or significant valve disease, 20% (n=386) had diabetes. Diabetics were more likely to be women, black, older, and have higher BMI and waist/hip ratio than were nondiabetics. After adju stment for age and sex, diabetics had higher systolic BP, pulse pressure, a nd heart rate; lower diastolic BP; and longer duration of hypertension than nondiabetics. LV mass and relative wall thickness were higher in diabetic than nondiabetic subjects independent of covariates. Compared with nondiabe tic hypertensives, diabetics had lower stress-corrected midwall shortening, independent of covariates, without difference in LV EF. Insulin levels and insulin resistance were higher in non-insulin-treated diabetics (n=195) th an nondiabetic (n=1439) subjects (both P<0.01). Insulin resistance positive ly but weakly related to LV mass and relative wall thickness. Conclusions-In a relatively healthy, population-based sample of hypertensiv e adults, type 2 diabetes was associated with higher LV mass, more concentr ic LV geometry, and lower myocardial function, independent of age, sex, bod y size, and arterial BP.