COMPARISON OF URINARY ACE 2 LEVELS IN HYPERTENSIVE AND TYPE 2 DIABETIC PATIENTS VS HYPERTENSIVE NON-DIABETICS

Abstract

Angiotensin-converting enzyme 2 (ACE2), which is the necessary component of the renin-angiotensin system (RAS), influences the level of metabolic activity and the tone of the vascular smooth muscle. ACE2 acts out allying hypertension and Type 2 Diabetes Mellitus (T2DM), which are two diseases that are not only correlated but mostly are condemnably in opposition to cardiovascular and renal risks. The study aimed at comparing the urinary ACE2 levels in diabetic hypertonic, with non-diabetic hypertonic patients to ascertain its worth as a non-invasive biomarker for monitoring metabolic vascular disorder.

Methods: A comparative cross-sectional study was done on 280 participants grouped into two categories they included hypertensives with T2DM and hypertensives without diabetes. The data were collected on the premises of demographic, clinical, and biochemical parameters, including blood pressure, fasting blood sugar (FBS), HbA1c, weight, and height. ELISA was used to determine the urinary level of ACE2. The presented statistical analyses were: the Shapiro-Wilk test to evaluate the normality, the Cronbach Alpha to evaluate the internal consistency, the KMO test and Bartlett test to evaluate the validity, the Independent samples t-test, ANOVA, Kruskal-Wallis, and Chi-square tests to compare the groups, and Pearson correlation and multiple regression analysis to evaluate the relationship and predictor.

Results: Data were normally distributed (p > 0.05), highly reliable ( 0.7 0.7), and well-sampled in terms of adequate validity (KMO = 0.76; Bartlett p 0.05). The t-test and ANOVA showed a significant difference in the level of urinary ACE2 in hypertensive diabetics and non-diabetics (p < 0.05). Kruskal-Wallis and Chi-Square tests verified the existence of significant distribution and categorical differences. According to Pearson correlation, systolic BP, diastolic BP, and FBS and HbA1c had strong positive relationships (r = 0.49-0.65). Regression analysis revealed FBS ( -0.356, p = -0.001) and HbA1c ( -0.298, p = -0.001) had the highest predictive ability of systolic BP.

Discussion: The results indicate that the levels of urinary ACE2 are affected by the presence of hypertension and diabetes, and diabetics demonstrate a change in the patterns of ACE2 excretion. The favorable correlations between glycemic and cardiovascular variables can demonstrate that metabolic dysregulation promotes vascular stress using the ACE2-mediated processes. These findings agree with the previous research indicating that ACE2 is compensatory against the effect of angiotensin II mishaps to the vascular system.

Conclusion: Urinary ACE2 may be used as a possible non-invasive biomarker, which is capable of reflecting metabolic and vascular changes of hypertensive diabetic patients. The strong correlation and predictive associations of FBS, HbA1c, and ACE2 highlight the need to observe glycemic control as an effort to reduce complications linked with hypertension. The findings demonstrate the clinical insensitivity of ACE2 as a linking factor between diabetes, hypertension, and the regulation of renal functions.