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


METHOD
Testing 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.


RESULTS
In 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).


CONCLUSION
In 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.
['Yeboah|Kwame|K|http://orcid.org/0000-0001-5240-0645', 'Antwi|Daniel A|DA|', 'Gyan|Ben|B|', 'Govoni|Virginia|V|', 'Mills|Charlotte E|CE|', 'Cruickshank|J Kennedy|JK|', 'Amoah|Albert G B|AG|']
D000328:Adult D000368:Aged D055109:Ankle Brachial Index D062186:Arterial Pressure D003924:Diabetes Mellitus, Type 2 D005260:Female D005869:Ghana D006801:Humans D006973:Hypertension D008297:Male D008875:Middle Aged D063177:Pulse Wave Analysis D059289:Vascular Stiffness
Arterial stiffness Hypertension Diabetes Ghana Cardio-ankle vascular index Aortic pulse wave velocity