Indian Write- Ups

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Hypertension and diabetes mellitus are well-established risk factors for development of cardiac complications1. Cardiac disease and elevated blood pressure frequently occur in type II diabetes (NIDDM)2-3. Type II diabetes is due to derangement in insulin secretion and insulin resistance, which is the common factor among obesity, glucose intolerance and hypertension4. Thus insulin plays a role in the pathogenesis of hypertension5. But hypertension is the prime cause or secondary to metabolic defect remains still unclear. Therefore the present study was undertaken to evaluate the fructosamine and FFA level in Hypertensive patients with Myocardial Infarction (MI) in non-insulin dependent diabetes mellitus (NIDDM).

The present study was conducted at Govt. Medical College, Nagpur. The study comprised of 60 hypertensive patients of both sexes between 35-70 years of age who had myocardial infarction and diabetes mellitus diagnosed by WHO criteria6. All the subjects subjected for study group were screened to exclude evidence of hypo or hyperparathyroidism, chronic renal failure and any other aliments. Group I comprised of 30 normal controls of same age and sex-matched individuals were also selected.

All the patients subjected for study were divided into group II and group III. All had an initial blood pressure above 150 mm Hg systolic and 100 mm Hg diastolic. Patients treated with enalipril group II required dose of 5 mg/day whereas patients treated with atenolol, group III required 20 mg/day.

Venous blood collected in hepatin bulb were obtained from all the 3 groups in fasting state before and after receiving 3 months treatment. Plasma separated from blood by centrifugation and fructosamine. FFA acid were estimated by well established method7-8.

The mean concentration of fructosamine and Free Fatty Acid (FFA) levels in plasma of untreated group of Hypertensive patients with MI in NIDDM differed significantly (P<0.0001) from those of control group I. In group II and group III plasma fructosamine was correlated with those of FFA. Patients treated with enalipril influence the fructosamine with significant change in Free Fatty Acid was observed. Whereas atenolol induced increase fructosamine level (P>0.001) with significant rise in FFA level (P>0.01). Fall in blood pressure occurred in both group of patients at the end of 3 months treatment.

Hypertension and blood pressure are closely related to diabetes mellitus9. Diabetic patients have an increased risk for hypertension and vascular consequences of high blood pressure10. Blood pressure is believed to be a common causative mechanism that linked hypertension pathogenetically to disorders in both carbohydrate and lipid metabolism. The results of present study in Table 1.

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