Comparative Study of Intrarenal Vascular Impedance Among Hypertensive Diabetics and Normotensive Type 2 Diabetics In South Western Nigeria
Diabetes is a serious health problem with staggering morbidity and mortality rates documented to be rising at an alarming rate worldwide, more so in low income countries. The uncontrolled effect of high blood glucose and disease complications have protean multisytemic consequences. Concomitant Diabetes Mellitus (DM) and hypertension accelerates the progression of micro and macro vascular complications including nephropathy. In this prospective comparative study amongst Diabetic hypertensives, normotensive Diabetics and healthy non-diabetic normotensive controls, we evaluated the effect of co-existing hypertension with diabetes and normotensive DM on renal vascular impedance. Demographic, clinico-laboratory data and Duplex ultrasound impedance of the renal interlobar arteries were documented and data analyzed using Statistical Package for Social Sciences (SPSS) version 23 computer software. The Intra-renal Resistive index (RI) among Diabetic hypertensives (Mean = 0.72 ± 0.15), normotensive DM patients (Mean = 0.69±0.08) and control (Mean = 0.63 ± 0.08) were statistically significant, F (2, 89) = 10.94, p <0.001. The intra renal Doppler RI showed significant correlations with age (r = 0.236, p=0.019) and duration of diabetes (r = 0.333, p=0.003). The Pulsatility index showed statistical significant associations with age (r = 0.370, p<0.001), duration of diabetes (r = 0.338, p = 0.002) and serum creatinine (r = 0.208, p = 0.039). A unit increase in mean arterial blood pressure increases the risk of concomitant hypertension in DM patients by about 3% (AOR= 1.03, 95% CI 1.10; 1.33, p <0.001). Also, an increase by 1mg/dl in cholesterol level increases the risk of concomitant hypertension in DM patients by about 1% (AOR= 1.01, 95% CI 1.00; 1.02, p = 0.044). Altogether concomitant hypertension with DM causes slightly high renal vascular impedance, particularly the RI as well as mild renal dysfunction than in normotensive persons with diabetes. Particularly among cases with clinico-laboratory evidence of good glycaemic control as well as blood pressure management. The arterial blood pressure and cholesterol levels are predictors of concomitant Hypertensive Diabetic status in this study.
Ademola Joseph Adekanmi,
Comparative Study of Intrarenal Vascular Impedance Among Hypertensive Diabetics and Normotensive Type 2 Diabetics In South Western Nigeria, Clinical Medicine Research.
Vol. 7, No. 1,
2018, pp. 30-39.
WHO Mortality Database [online database]. Geneva: World Health Organization; (http://apps.who.int/healthinfo/statistics/mortality/causeofdeath_query/).
IDF Diabetes Atlas, 6th ed. Brussels, International Diabetes Federation; 2013.
World Health Assembly. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Geneva: World Health Organization; 2013.
Akinkugbe OO (Editor). Non communicable diseases in Nigeria: national survey (final report) on hypertension, coronary heart disease, diabetes mellitus, G6PD deficiency and anaemia. National Expert Committee on Non-Communicable Disease. Federal Ministry of Health and Social Services, Lagos, 1997.
Chinenye S, Ogbera AO. Socio-cultural aspects of diabetes mellitus in Nigeria. J Soc Health Diabetes. 2013; 1(1): 15-21.
Nyenwe EA, Odia OJ, Ihekwaba AE, Ojule A, Babatunde S. Type 2 diabetes in adult Nigerians: a study of its prevalence in Port Harcourt, Nigeria. Diabetes Res Clin Pract. 2003; 62: 177-185.
Okafor, C., Fasanmade, O. A. and Oke, D. A. (2008) Pattern of Dyslipidaemia among Nigerians with Type 2 DiabetesMellitus. Nigerian Journal of Clinical Practice, 11, 25-31.
Piette JD, Kerr EA (2006). The Impact of Comorbid Chronic Conditions on Diabetes Care. Diabetes Care; 29: 725-731.
Sowers JR. Recommendations for special populations: diabetes mellitus and the metabolic syndrome. Am J Hypertens. 2003; 16 (11 Pt 2):41S–5S.
American Diabetes Association (ADA). Treatment of Hypertension in Adults With Diabetes. Diabetes Care, VOLUME 26, SUPPLEMENT 1, JANUARY 2003.
Centers for Disease Control and Prevention. 2007 National diabetes fact sheet. http://www.cdc.gov/diabetes/pubs/estimates07.htm#8. Accessed November 13, 2010.
Colosia AD, Palencia R, Khan S (2013). Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: A systematic literature review. Dovepress; 6: 327-338.
Unadike B C, Eregie A, Ohwovoriole A E. Prevalence of hypertension amongst persons with diabetes mellitus in Benin City, Nigeria. Niger J Clin Pract [serial online] 2011[cited 2017 Aug 8]; 14:300-2. Available from: http://www.njcponline.com/text.asp?2011/14/3/300/86772
Adogu, P O U, Chineke H N, Ewuzie M U, Enwere O O, Egenti N B. (2015) The Prevalence and Presentation Pattern of Diabetes Mellitus in Patients at Imo State University Teaching Hospital (IMSUTH) Orlu and Imo State Specialist Hospital (IMSSH) Umuguma Owerri (A 10-Year Retrospective Study: 1st November 2004 to 31st October 2013). Journal of Diabetes Mellitus, 5, 49-57. http://dx.doi.org/10.4236/jdm.2015.52006.
Fillenbaum G, Pieper C, Cohen H, Cornoni-Huntley J, Guralnik J. Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality. J Gerontol A Biol Sci Med Sci 2000; 55: M84–89.
UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes BMJ 1998; 317:703-13.
Nelson RG, Bennett PH, Beck GJ, Tan M, Knowler WC, Mitch WE, et al. Development and progression of renal disease in Pima Indians with noninsulin-dependent diabetes mellitus. N Engl J Med 1996; 335:1636-42.
Amanda N. Long, DO and Samuel Dagogo-Jack, MD. The Comorbidities of Diabetes and Hypertension: Mechanisms and Approach to Target Organ Protection. J Clin Hypertens (Greenwich). 2011 April; 13(4): 244–251.
American Diabetes Association (ADA). Standards of Medical Care in Diabetes- 2015. http://care.diabetesjournals.org/content/suppl/2014/12/23/38.Supplement_1.DC1/January_Supplement_Combined_Final.6-99.pdf.
Raymond Townsend, MD. April 2007 Issue of renal and urology news: Mechanism of Diabetic nephropathy. 2007; 1-4.
Carmine PK.: The renal vascular response to diabetes. Current Opinion in Nephrology and Hypertension. 2010 Jan; 19(1): 85-90:10.1097/MNH.0b013e32833240fc.
UK Prospective Diabetes Study Group: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321:412–9.
Lorenzo E. Derchi, Giovanna Leoncini, Denise Parodi, Francesca Viazzi, Carlo Martinoli, Elena Ratto, Simone Vettoretti, Valentina Vaccaro, Valeria Falqui, Cinzia Tomolillo, Giacomo Deferrari, and Roberto Pontremoli. Mild Renal Dysfunction and Renal Vascular Resistance in Primary Hypertension. AJH 2005; 18:966–971.
Naïke Bigé, Pierre Patrick Lévy, Patrice Callard, Jean-Manuel Faintuch, Valérie Chigot, Virginie Jousselin, Pierre Ronco, and Jean-Jacques Boffa. Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease. BMC Nephrology 2012, 13:139. http://www.biomedcentral.com/1471-2369/13/139.
Richard J MacIsaac, Merlin C Thomas, Sianna Panagiotopoulos, Trudy J Smith, Huming Hao, D Geoffrey Matthews, George Jerums, Louise M Burrell and Piyush M Srivastava. Association between intrarenal arterial resistance and diastolic dysfunction in type 2 diabetes. Cardiovascular Diabetology 2008, 7:15 doi:10.1186/1475-2840-7-15.
R. M. Bruno, A. Salvati, M. Barzacchi, K. Raimo, S. Taddei, L. Ghiadoni and A. Solini. Predictive value of dynamic renal resistive index (drin) for renal outcome in type 2 diabetes and essential hypertension: a prospective study. Cardiovascular Diabetology (2015) 14:63. DOI 10.1186/s12933-015-0227-y
Ishimura E, Nishizawa Y, Kawagishi T, Okuno Y, Kogawa K, Fukumoto S, Maekawa K, Hosoi M, Inaba M, Emoto M, Morii H. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int 1997;51:1920-1927.
Cvitkoviæ Kuzmiæ A, Brkljaèiæ B, Ivankoviæ D, Galešiæ K. Doppler sonographic renal resistance index in healthy children. Eur Radiol 2000; 10:1644-1648.
Francesca Viazzi, Giovanna Leoncini, Lorenzo E. Derchi, and Roberto Pontremoli Ultrasound Doppler renal resistive index: a useful tool for the management of the hypertensive patient. Journal of Hypertension 2014, 32:149–153.
World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia. http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf
Giles TD, Materson BJ, Cohn JN, Kostis JB. Definition and classification of hypertension: an update. J Clin Hypertens (Greenwich). 2009; 11: 611–4.
Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016). Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomarker Insights, 11, 95–104. http://doi.org/10.4137/BMI.S38440
Gillett MJ. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009; 32: 1327–34].
Katzmarzyk, P. T., Hu, G., Cefalu, W. T., Mire, E., & Bouchard, C. (2013). The Importance of Waist Circumference and BMI for Mortality Risk in Diabetic Adults. Diabetes Care, 36(10), 3128–3130. http://doi.org/10.2337/dc13-0219.
American Diabetes Association Standards of medical care in diabetes—2013. Diabetes Care 2013;36 (Suppl. 1):S11–S66 [PMC free article] [PubMed]
Kodama S, Horikawa C, Fujihara K, et al. Comparisons of the strength of associations with future type 2 diabetes risk among anthropometric obesity indicators, including waist-to-height io: a meta-analysis. Am J Epidemiol 2012; 176:959–969 [PubMed].
Ishimura E, Nishizawa Y, Kawagishi T, Okuna Y, Kogawa K, Fukumoto S, et al. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. kidney Int. 1997;51:1920-1927.
Dawha S, Ayoola OO, Ibitoye BO, Ikem RT, Arogundade FA. An assessment of factors influencing resistivity and pulsatility indices in diabetes mellitus Trop J Nephrol. 2014; 9: 15-22.
Nejad MN, Jafari B, Alipour P. Arterial resistive index (RI) in type 2 Diabetic Nephropathy Stages and Healthy Controls. Iran J Radiol. 2009; 6(1):29-32.
Thukral A, Mishra M, Srivastava V, kumar H, Dhar Dwivedi AN, Shukla RC et al. Determinants of intravascular resistance in Indian diabetic nephropathy patients: A Hospital based study. Int J vasc Med. 2011; 2011:656030.
Bouissou H, Pieraggi MT, Julian M. Age related morphological changes of the arterial wall. In: Camilleri JP, Berry CL, Fiessinger JN, Barriety J, editors. Disease of the arterial wall. Berlin. Springer-Verlag 1989: 71–78).
Nejad MN, Jafari B, Alipour P. Arterial resistive index (RI) in type 2 Diabetic Nephropathy Stages and Healthy Controls. Iran J Radiol. 2009; 6(1):29-32).
Panaritis, A.V. Kyriakidis, M. Pyrgioti, L. Raffo, E. Anagnostopoulou, G. Gourniezaki, E. Koukou et al. Pulsatility Index of Temporal and Renal Arteries as an Early Finding of Arteriopathy in Diabetic Patients. Annals of Vascular Surgery, 19, (1): 80–83.
Murray Epstein and James R. Sowers. Hypertension 1992; 19:403-418.
Elkayam U, Weber L, Campese VM, Massry SG, Rahimtoola SH. Renal hemodynamic effects of vasodilation with nifedipine and hydralazine in patients with heart failure. J Am Coll Cardiol. 1984 Dec; 4(6):1261-7.
Licata, G., Scaglione, R., Ganguzza, A. et al. Eur J Clin Pharmacol (1993) 45: 307. https://doi.org/10.1007/BF00265946.
Lorenzo E. Derchi, Giovanna Leoncini, Denise Parodi, Francesca Viazzi, Carlo Martinoli, Elena Ratto, Simone Vettoretti, Valentina Vaccaro, Valeria Falqui, Cinzia Tomolillo, Giacomo Deferrari, and Roberto Pontremoli. Mild Renal Dysfunction and Renal Vascular Resistance in Primary Hypertension. Am J Hypertens 2005; 18: 966–971.