Blood pressure control and endothelial funtion in type 2 diabetes: importance of nutritional educational program
Maria Chiara Masoni, Lorenzo Ghiadoni, Claudio Scarpellini, Cristina Consani, Stefano Taddei, Elena Matteucci & Ottavio Giampietro
Background: Achievement of blood pressure (BP) control is an important target in type 2 diabetic patients (T2DM) to prevent microvascular and macrovascular complication. T2DM patients are characterized by endothelial dysfunction, which represents a key mechanism for the development of atherosclerotic disease.
Aim: The aim of this study is to evaluate the effect of a nutritional and dietary counseling on BP control and endothelial dysfunction in T2DM.
Methods: Nineteen T2DM patients (age 61±5 years, four females) were provided of a by a 2-day 24 h dietary recall at 1, 3, 6, 9 and 12 months. Blood pressure, endothelium-dependent (flow-mediated dilation, FMD, after 5 min of forearm ischemia) and independent (sublingual glycerol trinitrate, GTN, 25 μg) vasodilation by high resolution ultrasounds and computerized analysis of brachial artery diameter (maximal % increase) were assessed at baseline and after 12 months. Twenty age and gender matched healthy subjects were recruited as controls.
Results: At baseline T2DM had significantly (P<0.01) lower FMD (4.3±1.9%) and FMD/GTN ratio (0.61±0.15) as compared to controls (6.9±2.1% and 0.91±0.22, respectively). Response to GTN was similar in T2DM (7.8±2.4%) and controls (7.6±3.0%). After 12 months, there was a significant (P<0.01) reduction in systolic BP (from 145±17 to 133±8 mmHg) and a not significant reduction in diastolic BP (from 85±12 to 78±9 mmHg, P=0.06), HbA1c (from 7.7±17 to 7.1±0.8%, P=0.18) and plasma folate (from 6.1±8.4 to 11.4±8.5 mg/ml, P<0.001).
Number or dosage of antihypertensive drugs was increase in 25% of the studys patients.
FMD (5.9±2.9%) and FMD/GTN ratio (0.84±0.61), but not response to GTN (7.4±1.7%) were also significantly (P<0.05) improved. However, the improvement in FMD and FMD/GTN ratio was not related to changes in BP, metabolic control, plasma folate concentration or pharmacological treatment, but to sodium excretion reduction exclusively (r=0.51, P<0.005).
Conclusions: A long term nutritional and dietary counseling have positive effect on dietary behavior of T2DM patients resulting in a significant better BP control and an improvement of endothelial dysfunction.