METHODS: A cross-sectional multicentric study was conducted on 192 consecutive outpatients, aged ≥ 55 years, with hypertension or high-normal BP, referred to three diabetology units. NT-proBNP was collected before starting new anti-diabetic therapy. Patients with known HF were excluded, and participants were classified based on the age-adjusted NT-proBNP cut-points.
RESULTS: Mean age: 70.3 ± 7.8 years (67.5% males). Patients with obesity (BMI ≥ 30 Kg/m2): 63.8%. Median NT-proBNP: 96.0 (38.8-213.0) pg/mL. Prevalence of chronic kidney disease (CKD, eGFR < 60 mL/min/1.73m2): 32.1%. Mean arterial BP: 138.5/77.0 ± 15.8/9.9 mmHg. The NT-proBNP values, according to the proposed age-adjusted cut-points, classified 28.6% of patients as \"HS likely\" (organize elective echocardiography and specialist evaluation), 43.2% as \"HS not likely\" (a grey area, repeat NT-proBNP at six months) and 28.2% as \"very unlikely HS\" (repeat NT-proBNP at one year). The presence of CKD and the number of anti-hypertensive drugs, but not glycemic parameters, were independently associated with HS.
CONCLUSIONS: According to NT-proBNP, over a quarter of T2DM patients with hypertension/high-normal BP, among those eligible for SGLT2i and/or GLP1-RA, were already at risk of cardiac damage, even subclinical. Most would receive an indication to echocardiogram and be referred to a specialist, allowing the early implementation of effective strategies to prevent or delay the progression to advanced stages of cardiac disease and overt HF.
方法:对192名连续门诊患者进行了一项横断面多中心研究,年龄≥55岁,高血压或正常血压较高,提到了三个糖尿病科。在开始新的抗糖尿病治疗之前收集NT-proBNP。已知HF患者被排除在外,参与者根据年龄校正的NT-proBNP临界点进行分类.
结果:平均年龄:70.3±7.8岁(男性占67.5%)。肥胖患者(BMI≥30Kg/m2):63.8%。NT-proBNP中位数:96.0(38.8-213.0)pg/mL。慢性肾脏病(CKD,eGFR<60mL/min/1.73m2):32.1%。平均动脉血压:138.5/77.0±15.8/9.9mmHg。NT-proBNP值,根据拟议的年龄调整后的切入点,将28.6%的患者归类为“HS可能”(组织选择性超声心动图和专家评估),43.2%为“HS不太可能”(灰色区域,6个月时重复NT-proBNP)和28.2%为“极不可能HS”(一年时重复NT-proBNP)。CKD的存在和抗高血压药物的数量,但不是血糖参数,与HS独立相关。
结论:根据NT-proBNP,超过四分之一的T2DM患者患有高血压/正常血压高,在符合SGLT2i和/或GLP1-RA资格的人中,已经有心脏损伤的危险,甚至亚临床。大多数人会收到超声心动图的指示,并转诊给专家,允许早期实施有效的策略,以防止或延迟进展到晚期的心脏疾病和明显的HF。