Background:
@EN Hypertensive patients have an increased risk profile for cardiovascular disease even in the absence of diabetes mellitus. Much evidence exist to show that insulin resistance plays a key role in eliciting several metabolic and fibrinolytic
abnormalities in patients with hypertension. in patients with type 2 diabetes, the onset of hypertension is associated with obesity, advancing age, and the coexistence of essential hypertension. Much less is known about specific vascular
abnormalities
leading to thrombosis and the relationship between the hyperinsulinemia and thrombosis in diabetics. Therefore, we want to compare the fibrinolytic and metabolic profile between the type 2 diabetic patients with and without hypertension to
investigate
whether coexisting hypertension and diabetes act as additive risk factors to accelerate vascular complication. We also want to assess the relationship between levels of the regulators of fibrinolysis, serum lipid profiles including lipoprotein(a)
(Lp(a)) and plasma insulin levels.
@ES Methods:
@EN In thirty-four type 2 diabetic patients with hypertension and 32 type 2 diabetic patients without hypertension, we measured the levels of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1), the regulators
of
the
fibrinolysis, lipoprotein profile including serum Lp(a) level and the serum c-peptide concentration, as the degree of insulin resistance.
@ES Results:
@EN Type 2 diabetic patients with hypertension have increased levels of t-PA(p<0.05), PAI-1 (p<0.05), total cholesterol (p<0.05), and plasma Lp(a) (p<0.05) as compared with those without hypertension. A significant correlation between PAI-1
levels
and
body mass index (BMI) (r=0.3, p<0.05), fasting C-peptide levels (r=0.54, p<0.01) and serum triglyceride levels (r=0.28, p<0.05) was observed in the diabetic patients. But we could not find a significant association between either t-PA of PAI-1
levels
and Lp(a) levels in them. Stepwise forward regression analyses using BMI, fasting C-peptide level, age, systolic blood pressure, HbAlc, triglyceride, t-PA and PAI-1 level as independent variables showed that only the fasting C-peptide levels
correlated
with PAI-1 levels (F=5.61; p<0.05).
@ES Conclusion:
@EN These results suggest that the type 2 diabetic patients with hypertension seem to have lower fibrinolysis of higher Lp(a) levels than the normotensive diabetics. It might be possible that coexisting hypertension and diabetes act as additive
risk
factors to accelerate vascular complication by way of aggravating the level of insulin resistance, when we consider the strong association between the level of hypofibrinolysis and dyslipidemia and the hyperinsulinemia, a measure of insulin
resistance
in the diabetic patients.
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