Blood Pressure, Congestion and Heart Failure with Preserved Ejection Fraction Among Patients with and Without Type 2 Dia
- PDF / 854,864 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 69 Downloads / 181 Views
ORIGINAL ARTICLE
Blood Pressure, Congestion and Heart Failure with Preserved Ejection Fraction Among Patients with and Without Type 2 Diabetes Mellitus. A Cluster Analysis Approach from the Observational Registry DICUMAP José Carlos Arévalo‑Lorido1 · J. Carretero‑Gómez1 · O. Aramburu‑Bodas2 · J. Grau‑Amoros3 · G. Torres‑Cortada4 · M. Camafort‑Babkowski5 Received: 24 May 2020 / Accepted: 1 August 2020 © Italian Society of Hypertension 2020
Abstract Introduction The association of patients with heart failure (HF) and preserved ejection fraction (HFpEF) and with type 2 diabetes mellitus (T2DM) is strong and related additionally to blood pressure (BP). Aims To analyze distinctive clinical profiles among patients with HFpEF both with and without T2DM. Methods The study was based on a Spanish National Registry (multicenter and prospective) of patients with HF (DICUMAP), that enrolled outpatients with HF who underwent an ambulatory BP monitoring (ABPM) and then were followed-up for 1 year. We categorized patients according to the presence/absence of T2DM then building different clusters based on K-medoids algorithm. Results 103 patients were included. T2DM was present in 44.7%. The patients with T2DM were grouped into two clusters and those without T2DM into three. All patients with T2DM had kidney disease and anemia. Among them, cluster 2 had higher systolic blood pressure and pulse pressure (PP) with a bad outcome (p = 0.03) regarding HF mortality and readmissions, influenced by eGFR (HR 0.93, 95% CI 0.97–0.87, p = 0.04), and hemoglobin (HR 0.65, 95% CI 0.71–0.63, p = 0.03). Among those without T2DM, cluster 3 had a pathological ABPM pattern with the highest PP, cluster 4 was slightly similar to cluster 2, and cluster 5 expressed a more benign pattern without differences on both, HF mortality and readmissions. Conclusions Patients with HFpEF and T2DM expressed two different profiles depending on neurohormonal activation and arterial stiffness with prognostic implications. Patients without T2DM showed three profiles depending on ABPM pattern, kidney disease and PP without prognostic repercussion. Keywords Heart failure with preserved ejection fraction · Type 2 diabetes mellitus · Ambulatory blood pressure monitoring · Pulse pressure
1 Introduction Hypertension is a more common comorbidity among patients with type 2 diabetes mellitus (T2DM) than in the general population [1]. Blood pressure (BP) level is a major determinant of cardiovascular morbidity and mortality in Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40292-020-00405-x) contains supplementary material, which is available to authorized users. * José Carlos Arévalo‑Lorido [email protected] Extended author information available on the last page of the article
individuals with T2DM conferring an age-adjusted 82% increase in the risk of diabetes-related death [2]. Epidemiological studies presently suggest a strong association between T2DM and heart failure (HF) [3]. Indeed, in people with T2D
Data Loading...
