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Effect of hypertension and diabetes on subclinical left ventricular systolic dysfunction in a predominantly elderly population-based cohort

Hypertension (HTN) and diabetes are main risk factors for the development of heart failure and their management is especially crucial in the elderly, who have high prevalence of both conditions. HTN and diabetes are associated with left ventricular systolic dysfunction (LVSD), often in the absence of heart failure symptoms. LV global longitudinal strain (GLS), a measure of myocardial systolic deformation over the longitudinal axis, has proven effective in the early detection of LVSD, when LV ejection fraction (LVEF) is still preserved, and in predicting outcome. Although information is available on the association of HTN and diabetes with subclinical LVSD, little is known in population settings, and especially in the elderly, which represent the subgroup at higher risk of heart failure. We examined the association of HTN, diabetes and their combination with subclinical LVSD in a predominantly elderly cohort. We examined 729 participants (mean age 71 9 years, 60.5% women) with LVEF 50% from the community-based Cardiac Abnormalities and Brain Lesions (CABL) study. HTN was defined as systolic blood pressure (BP) 140mmHg or diastolic BP 90mmHg (mean of two readings), or history of antihypertensive medications. Diabetes was defined as fasting blood glucose 126mg/dL or history of diabetes medications. Overall, 384 participants (52.7%) had HTN alone, 20 (2.7%) had diabetes alone, 185 (25.4%) had both. Speckle-tracking analysis was performed using a commercially available software (Philips QLAB, version 8.1). GLS was calculated by averaging 12 LV segments from the apical fourand two-chamber views. Cutoff value for abnormal GLS was –14.7%, 95th percentile of GLS distribution in normotensive, non-diabetic participants in CABL. Abnormal GLS was found in 146 participants (20.0%); its frequency was significantly higher in participants with HTN (20.3%) or diabetes (25%) than in those with neither (5.7%); GLS reduction frequency was greatest in those with both (29.7%; p-value for the trend:< 0.001). The independent association of abnormal GLS with diabetes and HTN was then tested in two logistic regression models (Figure 1) that included: (1) HTN and diabetes separately; (2) HTN, HTNþdiabetes and other significant clinical and echocardiographic covariates (identified by p< 0.05 in univariable analyses). In Model 1, HTN and diabetes were independently associated with reduced GLS (odds ratios (ORs) 3.05 and 1.84, respectively). In the fully adjusted model (Model 2), HTN plus diabetes carried an increased risk of abnormal GLS (OR 3.70) over HTN alone (OR 2.41); similar results were obtained with BP cutoff for HTN diagnosis lowered to 130/ 80mmHg (OR 3.57 and 2.22, respectively). LV mass,