24-hour central aortic systolic pressure and 24-hour central pulse pressure are related to diabetic complications in type 1 diabetes – a cross-sectional study

Abstract

BackgroundNon-invasive measurements of 24 hour ambulatory central aortic systolic pressure (24 h-CASP) and central pulse pressure (24 h-CPP) are now feasible. We evaluate the relationship between 24 h central blood pressure and diabetes-related complications in patients with type 1 diabetes.MethodsThe study was cross-sectional, including 715 subjects: 86 controls (C), 69 patients with short diabetes duration (< 10 years), normoalbuminuria (< 30 mg/24 h) without receiving antihypertensive treatment (SN), 211 with longstanding diabetes (≥ 10 years) and normoalbuminuria (LN), 163 with microalbuminuria (30-299 mg/24 h) (Mi) and 186 with macroalbuminuria (> 300 mg/24 h) (Ma).24 h-CASP and 24 h-CPP was measured using a tonometric wrist-watch-like device (BPro, HealthStats, Singapore) and derived using N-point moving average.ResultsIn C, SN, LN, Mi and Ma mean ± SD 24 h-CASP was: 114 ± 17, 115 ± 13, 121 ± 13, 119 ± 16 and 121 ± 13 mmHg (p < 0.001); and 24 h-CPP: 38 ± 8, 38 ± 7, 44 ± 10, 46 ± 11 and 46 ± 11 mmHg, (p < 0.001).Following rigorous adjustment (24 h mean arterial pressure and conventional risk factors), 24 h-CASP and 24 h-CPP increased with diabetes, albuminuria degree, previous cardiovascular disease (CVD), retinopathy and autonomic dysfunction (p ≤ 0.031).Odds ratios per 1 standard deviation increase in 24 h-CASP, 24 h-CPP and 24 h systolic blood pressure (24 h-SBP) were for CVD: 3.19 (1.68-6.05), 1.43 (1.01-2.02) and 2.39 (1.32-4.33), retinopathy: 4.41 (2.03-9.57), 1.77 (1.17-2.68) and 3.72 (1.85-7.47) and autonomic dysfunction: 3.25 (1.65-6.41), 1.64 (1.12-2.39) and 2.89 (1.54-5.42).Conclusions24 h-CASP and 24 h-CPP was higher in patients vs. controls and increased with diabetic complications independently of covariates. Furthermore, 24 h-CASP was stronger associated to complications than 24 h-SBP.The prognostic significance of 24 h-CASP and 24 h-CPP needs to be determined in follow-up studies.Trial registrationClinicalTrials.gov ID NCT01171248.

Central Hemodynamics Are Associated With Cardiovascular Disease and Albuminuria in Type 1 Diabetes

“…16 We have previously found 24-hour measurements of CASP and CPP obtained with a different device (BPro, HealthStats, Singapore) to be associated with diabetic complications (albuminuria degree, presence of CVD, retinopathy, and autonomic dysfunction) in this cohort. 10 With this study, we found no association between central hemodynamics and retinopathy but a significant association with presence of autonomic neuropathy (heart rate variability during deep breathing; data not shown). Measurements with BPro during 24 hours may provide a more precise estimate of risk, as compared with office blood pressure, whereas office measurements with the SphygmoCor device, which has been tested much more, are faster to perform and provides the ability to estimate SEVR.…”

“…9 Recently, we demonstrated 24-hour values of central blood pressure measured with the BPro device (HealthStats, Singapore) to be associated with diabetic complications in our study cohort. 10 In this study, we expand these analyses to the cross-sectional relationship between presence of CVD or albuminuria at baseline and estimates of SEVR and central blood pressure measured in the office with the SphygmoCor device (Atcor Medical, Sydney, Australia). Moreover, we are the first to evaluate the prognostic value for development of end-stage renal disease (ESRD) and all-cause mortality in relation to office measurements of central hemodynamics in patients with type 1 diabetes.…”

Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications

“…In adult, T1DM patients from the STENO‐cohort DR was significantly related to 24 hours central aortic systolic pressure, 24 hours central PP, 24 hours SBP, and long diabetes duration. Arterial damage caused by diabetes seems to be a later complication not relevant before 10 years of diabetes duration which might explain the association between DR and lower PP in our patients.…”

The afterload-dependent peak efficiency of the isolated working rat heart is unaffected by streptozotocin-induced diabetes

“…Arterial stiffness is known to be higher in diabetic human tissue post-mortem [42] as well as in the arteries [43-45] and myocytes [44] of diabetic patients. These effects are commonly attributed to increased fibrosis [44], deposition of advanced glycation end-products [44,45], increased oxidative stress [45] or low-grade inflammation [43]. The absence of any difference of blood pressure indices between STZ and SHAM rat hearts probably reflects the difference between acute (present study) and chronic diabetes (human patients).…”