Arterial stiffness in hypertensive and type 2 diabetes patients in Ghana: comparison of the cardio-ankle vascular index and central aortic techniques

Abstract

BackgroundDiabetes and hypertension increase arterial stiffness and cardiovascular events in all societies studied so far; sub-Saharan African studies are sparse. We investigated factors affecting arterial function in Ghanaians with diabetes, hypertension, both or neither.MethodTesting the hypothesis that arterial stiffness would progressively increase from controls to multiply affected patients, 270 participants were stratified into those with diabetes or hypertension only, with both, or without either. Cardio-ankle vascular index (CAVI), heart–ankle pulse wave velocity (haPWV), aortic PWV (PWVao) by Arteriograph, aortic and brachial blood pressures (BP), were measured.ResultsIn patients with both diabetes and hypertension compared with either alone, values were higher of CAVI (mean ± SD, 8.3 ± 1.2 vs 7.5 ± 1.1 and 7.4 ± 1.1 units; p < 0.05), PWVao (9.1 ± 1.4 vs 8.7 ± 1.9 and 8.1 ± 0.9 m/s; p < 0.05) and haPWV (8.5 ± 1 vs 7.9 ± 1 and 7.2 ± 0.7 m/s; p < 0.05) respectively. In multivariate analysis, age, having diabetes or hypertension and BMI were independently associated with CAVI in all participants (β = 0.49, 0.2, 0.17 and -0.2 units; p < 0.01, respectively). Independent determinants of PWVao were heart rate, systolic BP and age (β = 0.42, 0.27 and 0.22; p < 0.01), and for haPWV were systolic BP, age, BMI, diabetes and hypertension status (β = 0.46, 0.32, -0.2, 0.2 and 0.11; p < 0.01).ConclusionIn this sub-Saharan setting with lesser atherosclerosis than the western world, arterial stiffness is significantly greater in patients with coexistent diabetes and hypertension but did not differ between those with either diabetes or hypertension only. Simple, reproducibly measured PWV/CAVI may offer effective and efficient targets for intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0135-5) contains supplementary material, which is available to authorized users.

Relationships Among Conventional Cardiovascular Risk Factors and Lifestyle Habits With Arterial Stiffness in Type 2 Diabetic Patients

“…While previous reports demonstrated that BMI was positively associated with arterial stiffness [ 5 , 20 , 24 , 25 ], BMI was inversely associated with arterial stiffness in this study, consistent with a previous report in non-T2DM patients [ 26 ]. The exact explanation for the conflicting results is unknown; however, a previous study showed higher baPWV levels in T2DM patients with normal BMI and increased visceral adiposity compared to those with higher BMI and normal visceral adiposity [ 27 ].…”

Adiposity measures and arterial stiffness in primary care: the MARK prospective observational study

“…BMI shows a negative association in children, 54 and in patients with hypertension and in subjects with diabetes in Ghana. 55 Similarly, the waist circumference has a negative relationship in subjects with metabolic syndrome. 26 56 …”

Arterial Stiffness Is Associated with Peripheral Sensory Neuropathy in Diabetes Patients in Ghana

“…Diabetes patients in Ghana have abnormalities in arterial function that can be measured using aortic pulse wave velocity (PWVao) or cardio-ankle vascular index (CAVI) [ 7 , 8 ]. Both PWVao and CAVI measure arterial stiffness, with CAVI assessing the stiffness in long range of arterial segment (from the aortic root to the ankle arteries), as opposed to PWVao, which assesses the stiffness in the descending aorta, from the aortic root to the bifurcation.…”