Pulmonary hypertension found in one in eight people with type 2 diabetes


By Mardi Chapman

18 Oct 2021

Clinically significant pulmonary hypertension (PH) is relatively common in type 2 diabetes according to a WA study  – strengthening the case for consideration of PH in the routine assessment of people with type 2 diabetes.

The study of 1430 participants in the Fremantle Diabetes Study Phase 2 found 42% also had data recorded in the National Echocardiographic Database of Australia (NEDA).

Since echocardiography was performed for clinical indications such as dyspnoea, PH was assumed absent in participants who did not undergo echocardiography.

The study found that the prevalence of echocardiographically identified PH was 6.3% at the estimated right ventricular systolic pressure (eRVSP) threshold of >30 mmHg or 2.5% at >40 mm Hg.

“The 92 and 37 participants identified with PH at these thresholds were more likely to be older, have longer diabetes duration, have higher a body shape index (ABSI) as a marker of visceral obesity, be taking antihypertensive medications and have lower serum total cholesterol than the remaining 1338 and 1393 participants, respectively, with confirmed type 2 diabetes.”

“Those participants with prevalent PH also had more AF, cerebrovascular disease, heart failure, higher NT-proBNP, peripheral sensory neuropathy, cardiac valvular disease, history of COPD and obstructive sleep apnea.”

The study, published in the Journal of Clinical Medicine, found a 9.2% incident rate of PH at an eRVSP >30 mmHg during 9162 person-years of follow-up and a 5.0% IR at eRVSP >40 mmHg during 8660 person-years of follow-up.

“In bivariable analyses, the participants with incident PH at both thresholds of eRVSP were more likely to be older, have longer duration of diabetes, be treated for hypertension and to be taking aspirin.”

“These prevalence and incidence data suggest that clinically significant PH is relatively common in type 2 diabetes,” the study authors said.

“Although the classification of PH into etiologic sub-groups was beyond the scope of the present study, a range of readily accessible independent variables were associated with prevalent and incident PH.”

For example, an increase in plasma NT-proBNP was independently associated with PH in all multivariable analyses.

“Its strong predictive value in incident PH in the present study support its suggested use as a screening tool.”

“The only diabetes–specific risk factor was duration of disease with an increase of 3–4%/year in incident PH for each year increase in duration, regardless of eRVSP threshold.”

“In addition to easily accessible demographic and clinical variables as risk factors, the present study adds weight to the potential of biomarkers such as NT-proBNP and hsCRP in predicting the emergence of PH in people with type 2 diabetes,” they added.

The authors concluded that with one in eight people with T2D having PH, “its presence should be considered as part of regular clinical assessment of individuals with type 2 diabetes.”

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