The main finding of this study is that the serum ADMA levels
were significantly increased in MHT patients with DM compared to
normotensive diabetic subjects. ADMA levels, BMI, and low HDL
levels were independent predictors of MHT in patients with DM.
ADMA levels positively correlated with ABPM measurements,
especially daytime measurements, but were not related to office BP
measurements. ADMA levels may play a role in prediction, with a
good sensitivity and negative predictive value but poor specificity
and positive predictive value. To the best of our knowledge, this is
the first study to examine the relationship between ADMA and
MHT in the current literature.
Ng et al. studied in a total of 133 DM patients, 18% of whom had
MHT. It was reported that MHT is associated with a higher prevalence
of albuminuria, left ventricular diastolic dysfunction, and
hypertrophy compared with normotensive DM . Also, the
prevalence of target organ damage was comparable in the MHT
group with sustained hypertension in this study. Eguchi et al. reported
MHT prevalence of 46.7% among 81 clinically normotensive
Japanese diabetic persons. In this study, MHT was related to
significantly increased incidence of silent brain infarcts and albuminuria
. In another cross-sectional study enrolling a total 135
normotensive patients with type 2 diabetes, the prevalence of MHT
was reported as 30% . Based on the current literature, MHT
prevalence was higher in type 2 DM subjects and is correlated with
target organ damage relative to normotensive diabetics. Therefore,
these subjects may have an increased risk of cardiovascular events.
However, the value of cardiovascular risk markers to determine
MHT has not been well studied.
ADMA has been shown to inhibit endothelial NOS in vitro, in
animals, and in the human forearm arterial bed . Surdacki et al.
also suggested that increased serum ADMA levels may lead to
increased vascular resistance and elevated BP via a decrease in NO
bioavailability . In a well designed study, intravenously
administered suppressor doses of ADMA resulted in increased
arterial stiffness and decreased cerebral blood flow in young
healthy men . In another elegant human trial, Achan et al.
demonstrated that ADMA infusion increases systemic vascular
resistance by 24%, and mean arterial BP by 6% in healthy subjects
and that a bolus dose of ADMA decreases cardiac output by 15%
. In a second part of that study, it was shown that a handgrip
maneuver increased cardiac output in control subjects by 96%, but
in subjects given ADMA, cardiac output increased by only 35%.
ADMA concentration 30 min after the infusion was 2.6 mol/L,
however, the baseline value was not provided. In addition, several
studies have shown that serum ADMA levels are increased in...