Objective: To examine if ventriculo-vascular coupling (VVC) is impaired in patients with resistant hypertension (RH) and type-II-diabetes mellitus.

Methods: We included 87 patients. RH was defined according to guidelines from the American Heart Association.

Echocardiography was performed using GE Vivid 7and pulse wave analysis using Sphygmocor. All examinations were done under standardized conditions. All analyses were done blinded offline using Echopac and customized software.

VVC was estimated from stroke volume, end systolic pressure and –volume using the formula E_A/E_MAX.

Left ventricular chamber stiffness (K_LV) was estimated from mitral valve deceleration time (MV dect) using the formula 70(MV dect-20)^2.

All statistical analyses were adjusted for sex, age, length of disease and heart rate using multiple linear regression.

Results: 34 patients had RH and 24 had controlled hypertension (CH) leaving 29 with uncontrolled hypertension. See table 1 for patient characteristics. Patients were comparable with regards to age and BMI. Pulse pressure, mean arterial pressure and length of disease varied significantly between patients with RH and CH.

Patients with RH had higher E_A/E_MAX (P=0.005) and lower EF (P=0.001). They also had higher K_LV (P=0.04) and E/É (P=0.007) as well as higher characteristic impedance (P=0.045). Pulse wave velocity was not statistically significantly higher when adjusted for covariates (P=0.385).

Conclusion: Patients with resistant hypertension have dysfunctional VVC most likely due to stiffening of the left ventricle, which could be due to increased afterload and stiffness of the arterial system.