Pulse pressure and mortality in hypertensive type 2 diabetic patients. A cohort study

Mannucci, Edoardo; Lambertucci, L.; Monami, Matteo; Fedeli, A.; Chiasserini, Veronica; Marchionni, Niccolò; Masotti, Giulio; Ungar, Andrea

doi:10.1002/dmrr.598

Cited by 27 publications

(24 citation statements)

References 11 publications

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“…In keeping with our current observations, there was no significant interaction between the presence of diabetes and the 24-h systolic BP. 29 Several studies, [30][31][32] including a previous report from the IDACO consortium, 3 confirmed that the ambulatory BP is a better predictor of cardiovascular risk than Figure 2 10-year absolute risk of the composite cardiovascular end point associated with the 24-h systolic (a) and diastolic (b) blood pressures in patients with diabetes and non-diabetic subjects. The analysis was standardized to the distributions (mean or ratio) of cohort, age, sex, body mass index, smoking and drinking, treatment with antihypertensive drugs, history of cardiovascular disease and total serum cholesterol, and included an interaction term for diabetes and blood pressure.…”

Section: Discussionmentioning

confidence: 93%

Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Sehestedt

Hansen

et al. 2011

Hypertens Res

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It remains unknown whether diabetes and high blood pressure (BP) are simply additive risk factors for cardiovascular outcome or whether they act synergistically and potentiate one another. We performed 24-h ambulatory BP monitoring in 8494 subjects (mean age, 54.6 years; 47.0% women; 6.9% diabetic patients) enrolled in prospective population studies in 10 countries. In multivariable-adjusted Cox regression, we assessed the additive as opposed to the synergistic effects of BP and diabetes in relation to a composite cardiovascular endpoint by testing the significance of appropriate interaction terms. During 10.6 years (median follow-up), 1066 participants had a cardiovascular complication. Diabetes mellitus as well as the 24-h ambulatory BP were independent and powerful predictors of the composite cardiovascular endpoint. However, there was no synergistic interaction between diabetes and 24-h, daytime, or nighttime, systolic or diastolic ambulatory BP (P for interaction, 0.07pPp0.97). The only exception was a borderline synergistic effect between diabetes and daytime diastolic BP in relation to the composite cardiovascular endpoint (P¼0.04). In diabetic patients, with normotension as the reference group, the adjusted hazard ratios for the cardiovascular endpoint were 1.35 (95% confidence interval (CI), 0.87-2.11) for white-coat hypertension, 1.78 (95% CI, 1.22-2.60) for masked hypertension and 2.44 (95% CI, 1.92-3.11) for sustained hypertension. The hazard ratios for non-diabetic subjects were not different from those of diabetic patients (P-values for interaction, 0.09pPp0.72).In conclusion, in a large international population-based database, both diabetes mellitus and BP contributed equally to the risk of cardiovascular complications without evidence for a synergistic effect.

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Section: Discussionmentioning

confidence: 93%

Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Sehestedt

Hansen

et al. 2011

Hypertens Res

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“…There have been a few studies in diabetes patients, showing associations of ABP with cardiovascular outcomes 26 and all-cause mortality, 19,27 but they had significant limitations: in one study ABPM was performed in a hospital setting; 26 in another the study design was retrospective and the number of patients was small; 19 and in the third only clinic and ambulatory pulse pressures were used in the analysis, and the contributions of ambulatory awake/sleep pulse pressures and of ambulatory SBPs and DBPs were not analyzed. 27 As a result, the utility of ABPM in patients with diabetes is not yet accepted. In our study, although clinic SBP predicted Values are hazard ratios (95% confidence interval), per 10 mm Hg difference in SBP.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Blood Pressure Is a Better Marker Than Clinic Blood Pressure in Predicting Cardiovascular Events in Patients With/Without Type 2 Diabetes

Eguchi

Pickering

Hoshide

et al. 2008

American Journal of Hypertension

183

127

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“…[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.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Patients with type 2 diabetes mellitus are at increased risk of cardiovascular disease (CVD). We examined the predictive ability of 24-hour ambulatory pulse pressure (24-h PP), ambulatory arterial stiffness index (AASI) and diurnal blood pressure (BP) parameters for fatal and non-fatal CVD in patients with type 2 diabetes mellitus. A total of 108 patients with type 2 diabetes mellitus (mean duration 6.6 years) were followed for 9.5 (0.5-14.5) years. At baseline, all patients underwent ambulatory BP monitoring. During follow-up, 45 patients had cardiovascular (CV) events (35 non-fatal and 10 fatal). In bivariate analysis, events during follow-up were predicted by 24-h PP (Po0.01), AASI, 24-h systolic BP and systolic and diastolic night-day BP ratio (Po0.05 for all). In Cox regression analysis adjusted for established risk markers, only 24-h PP and systolic night-day BP ratio predicted CV events, Po0.05 for both. A significant interaction between the two parameters was found, Po0.05; thus, the higher the systolic night-day ratio, the greater the increase in hazard ratio (HR) per mmHg increase in 24-h PP and vice versa. A combined 10 mmHg increase in 24-h PP and 10%-point increase in systolic night-day ratio from the 25th percentile increased the adjusted HR (95% confidence interval) for CV events with 1.29 (0.53; 3.12), whereas a similar increase from the 75th percentile increased the HR with 4.2 (1.54; 11,51). Our study showed that 24-h PP and systolic night-day ratio interact as predictors of CV events in type 2 diabetes patients, and should be considered in conjunction when evaluating the risk of CVD.

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Pulse pressure and mortality in hypertensive type 2 diabetic patients. A cohort study

Abstract: High PP, assessed through office measurement or ABPM, was associated with increased mortality in hypertensive type 2 diabetic patients. In our sample, PP assessed with ABPM is a better predictor of mortality than office PP.

Cited by 27 publications

References 11 publications

Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Are blood pressure and diabetes additive or synergistic risk factors? Outcome in 8494 subjects randomly recruited from 10 populations

Ambulatory Blood Pressure Is a Better Marker Than Clinic Blood Pressure in Predicting Cardiovascular Events in Patients With/Without Type 2 Diabetes

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

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