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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

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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.

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Availability of Data and Material

The database of patients was under a registry which was accessed in a webpage: www.dicumap.org.

References

  1. Staneler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434–44.

    Article  Google Scholar 

  2. Hypertension in Diabetes Study (HDS): II. Increased risk of cardiovascular complications in hypertensive type 2 diabetic patients. J Hypertens. 1993;11:319–25.

    Article  Google Scholar 

  3. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974;34:29–34.

    Article  CAS  Google Scholar 

  4. Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, Deanfield J, Smeeth L, Timmis A, Hemingway H. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol. 2015;3:105–13.

    Article  Google Scholar 

  5. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.

    Article  CAS  Google Scholar 

  6. Tromp J, Tay WT, Ouwerkerk W, Teng TK, Yap J, MacDonald MR, Leineweber K, McMurray JJV, Zile MR, Anand IS, Richards AMR, Lam CSP, ASIAN-HF authors. Multimorbidity in patients with heart failure from 11 Asian regions: a prospective cohort study using the ASIAN-HF registry. PLoS Med. 2018;15:e1002541.

    Article  Google Scholar 

  7. Crespo-Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, Ferrari R, Piepoli MF, Delgado Jimenez JF, Metra M, Fonseca C, Hradec J, Amir O, Logeart D, Dahlström U, Merkely B, Drozdz J, Goncalvesova E, Hassanein M, Chioncel O, Lainscak M, Seferovic PM, Tousoulis D, Kavoliuniene A, Fruhwald F, Fazlibegovic E, Temizhan A, Gatzov P, Erglis A, Laroche C, Mebazaa A, Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2016;18:613–25.

    Article  Google Scholar 

  8. Kenchaiah S, Pfeffer MA. Cardiac remodeling in systemic hypertension. Med Clin North Am. 2004;88:115–30.

    Article  Google Scholar 

  9. Lindman BR, Dávila-Román VG, Mann DL, McNulty S, Semigran MJ, Lewis GD, de las Fuentes L, Joseph SM, Vader J, Hernandez AF, Redfield MM. Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study. J Am Coll Cardiol. 2014;64:541–9.

    Article  Google Scholar 

  10. ACC/AHA. Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. Circulation. 2005;2005(112):154–235.

    Google Scholar 

  11. Levey AS, Bosch JP, Lewis JB, Modification of diet in renal disease study group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130:461–70.

    Article  CAS  Google Scholar 

  12. Petersen PH, Stöckl D, Blaabjerg O, Pedersen B, Birkemose E, Thienpont L, Lassen JF, Kjeldsen J. Graphical interpretation of analytical data from comparison of a field method with reference method by use of difference plots. Clin Chem. 1997;43:2039–46.

    Article  CAS  Google Scholar 

  13. Heavens KR, Kenefick RW, Caruso EM, et al. Validation of equations used to predict plasma osmolality in a healthy adult cohort. Am J Clin Nutr. 2014;100:1252–6.

    Article  CAS  Google Scholar 

  14. Kaufman L, Rousseauw PJ. Finding groups in data: an introduction to cluster analysis. New York: Wiley-Interscience; 1990.

    Book  Google Scholar 

  15. Agrawal A, Naranjo M, Kanjanahattakij N, Rangaswami J, Gupta S. Cardiorenal syndrome in heart failure with preserved ejection fraction-an under-recognized clinical entity. Heart Fail Rev. 2019;24:421–37.

    Article  Google Scholar 

  16. Arévalo Lorido JC, Carretero Gómez J, Gómez Huelgas R, Quirós López R, Dávila Ramos MF, Serrado Iglesias A, Ruiz Laiglesia F, González Franco A, Cepeda Rodrigo JM, Montero-Pérez-Barquero M, Miembros del Registro RICA. Comorbidity in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction. Cluster analysis of the RICA registry. Opportunities for improvement. Rev Clin Esp. 2020. https://doi.org/10.1016/j.rce.2019.10.001.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Glasser SP, Halberg DL, Sands C, Gamboa CM, Muntner P, Safford M. Is pulse pressure an independent risk factor for incident acute coronary heart disease events? The REGARDS study. Am J Hypertens. 2014;27:555–63.

    Article  Google Scholar 

  18. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar M, London G. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99:2434–9.

    Article  CAS  Google Scholar 

  19. Safar ME, Nilsson PM, Blacher J, Mimran A. Pulse pressure, arterial stiffness, and end-organ damage. Curr Hypertens Rep. 2012;14:339–44.

    Article  Google Scholar 

  20. Knudsen ST, Laugesen E, Hansen KW, Bek T, Mogensen CE, Poulsen PL. Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients. Diabetologia. 2009;52:698–704.

    Article  CAS  Google Scholar 

  21. Knudsen ST, Jeppesen P, Frederiksen CA, Andersen NH, Bek T, Ingerslev J, Mogensen CE, Poulsen PL. Endothelial perturbation: a link between non-dipping and retinopathy in type 2 diabetes? J Am Soc Hypertension. 2007;1:208–15.

    Article  Google Scholar 

  22. Miller WL. Assessment and management of volume overload and congestion in chronic heart failure: can measuring blood volume provide new insights? Kidney Dis (Basel). 2017;2:164–9.

    Article  Google Scholar 

  23. Dart AM, Kingwell BA. Pulse pressure—a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37:975–84.

    Article  CAS  Google Scholar 

  24. Kario K, Ishikawa J, Eguchi K, Morinari M, Hoshide S, Ishikawa S. Sleep pulse pressure and awake mean pressure as independent predictors for stroke in older hypertensive patients. Am J Hypertens. 2004;17:439–45.

    Article  Google Scholar 

  25. Tadic M, Cuspidi C, Majstorovic A, Pencic B, Mancia G, Bombelli M, Grassi G, Kocijancic V, Djukic V, Celic V. The association between 24-h blood pressure patterns and left ventricular mechanics. J Hypertens. 2020;38:282–8.

    Article  CAS  Google Scholar 

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Acknowledgements

All the investigators from DICUMAP registry. Our thanks to the Registry Coordinating Center DICUMAP “S&H Medical Science Service” for its work in quality, control of data and administrative support. There has been no duplicate publication or submission elsewhere of any part of the work (excluding abstracts).

Author information

Authors and Affiliations

  1. Internal Medicine Department, Zafra County Hospital, Ctra Badajoz-Granada s/n, 06300, Zafra, Badajoz, Spain

    José Carlos Arévalo-Lorido & J. Carretero-Gómez

  2. Internal Medicine Department, University Hospital “Virgen Macarena”, Avd. Doctor Fedriani, 3, 41071, Seville, Spain

    O. Aramburu-Bodas

  3. Internal Medicine Department, Badalona Serveis Assistencials, Via Augusta, 9-13, 08911, Badalona, Spain

    J. Grau-Amoros

  4. Internal Medicine Department, “Santa María” Hospital, Avd. Alcalde Rovira Roure, 44, 25198, Lleida, Spain

    G. Torres-Cortada

  5. Internal Medicine Service, University Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain

    M. Camafort-Babkowski

Authors
  1. José Carlos Arévalo-Lorido
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  2. J. Carretero-Gómez
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  3. O. Aramburu-Bodas
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  4. J. Grau-Amoros
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  5. G. Torres-Cortada
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  6. M. Camafort-Babkowski
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Contributions

All authors contributed to the study conception and design. Material preparation, and data collection were performed by all authors, formal analysis and investigation were performed by José Carlos Arévalo-Lorido. The first draft of the manuscript was written by José Carlos Arévalo-Lorido and Juana Carretero Gómez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to José Carlos Arévalo-Lorido.

Ethics declarations

Funding

The present research had not any funding.

Conflicts of interest/Competing interests

The authors declare not having any conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the hospital “Mora D’Ebre”, Tarragona, Spain.

Consent to participate

An informed consent was obtained from all patients prior to inclusion in the registry.

Consent for publication

All authors have revised and agree for the final version of this manuscript and to publish it.

Electronic supplementary material

Below is the link to the electronic supplementary material.

40292_2020_405_MOESM1_ESM.tif

Fig 1 (Suppl): Matrix of dissimilarity and figure of clusters based on medoids in patients with and without diabetes mellitus. In the matrix square, the color level is proportional to the similarity value between the observations. If it is red, the distance between the variables is 0 (high similarity) and if it is green, the distance is the highest (low similarity)

Appendix 1

Appendix 1

Membership of DICUMAP registry: Miguel Camafort Babkowski; José Carlos Arévalo Lorido; Luis Manzano Espinosa; Javier Sobrino Martínez; José Luis Arias Jiménez; Jorge Francisco Gómez Cerezo; Jesús Díez Manglano; Oscar Aramburu Bodas; Jordi Grau Amorós; Joan Carles Trullás Vila; Manuel Montero Pérez-Barquero; Gerard Torres Cortada; José Manuel Varela Aguilar; Gonzalo Martínez De las Cuevas; Manuel Méndez Bailón; Nuria Ribas Pizá; Fernando Salgado Ordóñez; Francesc Formiga; Antoni Castro Salomó.

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Arévalo-Lorido, J.C., Carretero-Gómez, J., Aramburu-Bodas, O. et al. 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. High Blood Press Cardiovasc Prev 27, 399–408 (2020). https://doi.org/10.1007/s40292-020-00405-x

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