A Prognostic Role of Mean 24-h Pulse Pressure Level for Cardiovascular Events in Type 2 Diabetic Subjects Under 60 Years of Age

Abstract

OBJECTIVE -To assess the prognostic role of ambulatory 24-h pulse pressure (PP) on various vascular events in relatively young type 2 diabetic subjects under 60 years of age.RESEARCH DESIGN AND METHODS -In this prospective study, 237 type 2 diabetic subjects without any history of vascular complications were analyzed. After excluding 9 dropout subjects, 228 subjects (mean age, 46 years; 69% men; mean follow-up period, 100 months) entered the study.RESULTS -Distribution of 24-h PP for all subjects showed left skewed data, indicating that there may be a diabetic subgroup that had a wide PP. Therefore, further analysis was performed by stratifying the diabetic subjects by quartile of 24-h PP. Outcomes for the widest quartile (n ϭ 58; cut point ϭ 53.3 mmHg) was then compared with those from the other narrower quartiles (n ϭ 170). In the diabetic subjects with a wide PP, cardiovascular events occurred more frequently than those in the diabetic subjects with a narrow one (20.7 vs. 4.1%; P Ͻ 0.001), resulting in the significant difference in the cumulative incidence of cardiovascular events (P Ͻ 0.001, log-rank test), but not cerebrovascular events, between the two subgroups. The Cox model revealed that a wide 24-h PP at baseline independently predicted subsequent cardiovascular events but not cerebrovascular events. By contrast, only duration of diabetes was the risk factor for cerebrovascular events.CONCLUSIONS -This study showed that a wide 24-h PP is predictive for cardiovascular events in relatively young diabetic subjects. Diabetes Care 28:102-107, 2005T here is now increasing evidence that wide pulse pressure (PP), which is an indicator of large arterial stiffness, is an independent predictor for cardiovascular disease in elderly subjects with essential hypertension (1,2). A prognostic role for PP has been extended to an unselected general population, including relatively young aged (3,4) and normotensive subjects (5). Furthermore, the Atherosclerosis Risk in Communities study (6) and the Hoorn study (7) demonstrated that type 2 diabetic subjects have stiffer arteries than individuals with normal glucose tolerance, which was confirmed using ambulatory 24-h monitoring of PP by van Dijk et al. (8). Recently, Domanski et al. (9) and Miyagi et al. (10) pointed out that a cardiovascular risk in subjects with a wide PP increased with the presence of diabetes. On the other hand, previous studies suggest that in subjects with essential hypertension, ambulatory PP not only correlates with organ damage (11) but also independently predicts cardiovascular events more precisely than clinic PP does (12,13). However, there is little information concerning PP of relatively young type 2 diabetic subjects, and the predictive value of ambulatory 24-h PP among these subjects has not been previously reported.The aim of this present study was to assess a prognostic role of ambulatory 24-h PP on various vascular events in type 2 diabetic subjects Ͻ60 years of age.RESEARCH DESIGN AND METHODS -The blood pressure (BP) monitoring progra...

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

“…Although the crosssectional design did not allow any firm conclusions regarding causality, we hypothesised that PP could be a risk factor for the progression of albuminuria in this patient group. Subsequently, several studies have associated an elevated PP with both micro- [3,5] and macrovascular [6][7][8] complications in diabetic patients.…”

“…An elevated pulse pressure (PP) is strongly associated with micro- [1][2][3][4][5] as well as macrovascular [1,[6][7][8] complications in type 2 diabetic patients. In a large observational study including 954 elderly type 2 diabetic patients [9], ambulatory PP was a strong and independent predictor of progression of nephropathy during a 2 year follow-up period.…”

Pulse pressure and systolic night–day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

“…12,14,15,24 Nakano et al 15 reported the highest quartile of 24-h PP to predict cardiac, but not cerebral, events in a cohort of 228 young (mean age 46 years) Japanese type 2 diabetic patients without a history of CVD. However, the ABPM measurements were performed during hospitalisation, thus raising the possibility of selection bias and limiting the reproducibility of the findings in a general setting.…”

“…[10][11][12][13][14][15][16] However, only a few BP parameters were evaluated in each of these studies and the potential interaction between BP parameters were not examined. Moreover, some studies report the association with total mortality, not with CV mortality.…”

“…Moreover, some studies report the association with total mortality, not with CV mortality. 10,11 In addition, the general applicability of some of the reported associations is limited owing to methodological characteristics of the individual studies, as they are either cross-sectional; 12 the study-populations consist of older patients with a long duration of diabetes; 13,14 ABPM was performed in hospitalised patients 15 or in a mixed cohort of type 1 and 2 diabetes patients. 16 Hence, despite these previous studies, several questions remain unresolved, particularly if 24-h PP, AASI and diurnal BP parameters obtained from ambulatory measurement in the early course of the disease predict future CV events above other BP parameters, after adjustment for well-established CV risk markers.…”