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Coexistence of hypertension and diabetes mellitus (DM) increases the risk of cardiovascular disease. However, factors associated with future development of DM have not been well elucidated in patients already having essential hypertension. This study prospectively included 168 patients (mean age 41 ± 7 years, 112 men) with essential hypertension. All patients did not have DM and vascular or renal complications initially. Baseline demographic data, blood pressure, body mass index, and antihypertensive agents were carefully evaluated and serum high-sensitivity C-reactive protein (hsCRP) was measured at the beginning of the study. All of the patients were followed for at least 6 months. The study endpoint was occurrence of new DM. After a mean follow-up period of 32 ± 10 months, 22 subjects (13.1%) developed new DM. Patients with new DM had higher baseline glucose (105.2 ± 11.8 vs 94.2 ± 8.0 mg/dl, P < 0.001), triglyceride level (213.7 ± 112.4 vs 155.6 ± 83.2 mg/dl, P = 0.04), log hsCRP (0.31 ± 0.44 vs 0.19 ± 0.25 mg/dl, P = 0.016), and lower high-density lipoprotein (40.2 ± 7.8 vs 46.6 ± 14.4 mg/dl, P = 0.045). Total cholesterol, low-density lipoprotein, homeostasis model assessment index, and adiponectin were not different in patients with or without new DM. Among antihypertensive agents, only use of β-blocker was significantly associated with new DM ( P = 0.008). Multivariate Cox regression analysis showed log hsCRP (hazard ratio [HR] 9.77, 95% confidence interval [CI] 2.97-32.10, P < 0.001), age (HR 1.21, 95% CI 1.06–1.38, P = 0.004), and baseline glucose level (HR 1.11, 95% CI 1.06–1.15, P < 0.001) to be independent predictors for occurrence of new DM. High-sensitivity CRP was an independent factor for future development of DM in essential hypertensive patients. Increased inflammation might have a key role in the pathogenesis of DM in hypertension. [ABSTRACT FROM AUTHOR]

Objective: Global longitudinal strain is not well illustrated for the prognostic value in hypertension. This observational study investigated the prognostic value of global longitudinal strain, subendocardial longitudinal strain, and subepicardial (EpiLS) longitudinal strain in regularly treated hypertensive patients., Methods: Ninety-five hypertensive study participants (60.0% men, age 65.5 ± 12.0 years) were regularly treated for more than 1 year. We performed a two-dimensional echocardiographic study and obtained global peak systolic left ventricular longitudinal strain of subendocardial myocardium and the subepicardium (defined as subendocardial longitudinal strain and EpiLS, respectively). Cardiovascular events included cardiovascular death and any admission for stroke, acute coronary syndrome, or heart failure., Results: After a follow-up period of 7.3 ± 2.0 years, 20 (21%) study participants had cardiovascular events. Significant differences between study participants with and without cardiovascular events were noted in diuretic administration (75.0 vs. 93.3%, P = 0.018), age (71.0 ± 11.6 vs. 64.0 ± 11.8 years, P = 0.02) and EpiLS (-16.0 ± 2.0 vs. -17.7 ± 3.0%, P = 0.04). Using multivariate Cox regression analysis, EpiLS was the only independent prognostic factor (hazard ratio 1.449, 95% confidence interval 1.027-2.045, P = 0.035). Using the cut off value of -17.57% for EpiLS (median value of EpiLS), the Kaplan-Meier survival curve revealed a significant difference (P = 0.016) associated with cardiovascular outcome., Conclusion: EpiLS was the only independent prognostic factor in regularly-treated hypertensive patients. Our results indicated that involvement of subepicardial myocardium may infer worse prognosis of hypertensive heart disease.