Pulse Pressure Predicts Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus

Cockcroft, John R.; Wilkinson, Ian B.; Evans, Marc; McEwan, P.; Peters, John R.; Davies, Sara; Scanlon, M. F.; Currie, Craig John

doi:10.1016/j.amjhyper.2005.05.009

Cited by 90 publications

(74 citation statements)

References 29 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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Aims/hypothesis We followed type 2 diabetic patients over a long period to evaluate the predictive value of ambulatory pulse pressure (PP) and decreased nocturnal BP reduction (non-dipping) for nephropathy progression. Methods Type 2 diabetic patients (n=112) were followed for an average of 9.5 (range 0.5-14.5) years. At baseline, all patients underwent 24 h ambulatory BP measurement. Urinary albumin excretion rate was evaluated by three urinary albumin:creatinine ratio measurements at baseline and follow-up. Results At baseline, patients who subsequently progressed to a more advanced nephropathy stage (n=35) had reduced diastolic night/day BP variation and higher 24 h systolic BP and PP values; they also had more advanced nephropathy and were more likely to smoke than those with no progression of nephropathy (n=77). In a Cox regression analysis, independent predictors of nephropathy progression were 24 h PP (p<0.01), diastolic night:day BP ratio (p=0.02) and smoking (p=0.02). The adjusted hazards ratio (95% CI) for each mmHg increment in 24 h PP was 1.04 (1.01-1.07), whereas the adjusted hazards ratio (95% CI) for each 1% increase in diastolic night:day BP ratio was 1.06 (1.01-1.11). Only one of 33 patients (3.0%) with both a diastolic night:day BP ratio and a 24 h PP below the median progressed, whereas 17 of 32 patients (53.1%) with both a diastolic night:day BP ratio and a 24 h PP equal to or above the median progressed to a more advanced nephropathy stage (p<0.001). Conclusions/interpretation Ambulatory PP, impaired nocturnal BP decline and smoking are strong, independent predictors of nephropathy progression in type 2 diabetic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…6): these increases are further amplified in the presence of micro-and macrovascular complications [61][62][63]. Importantly, the increased pulse pressure observed in type 2 diabetic patients has been found to be predictive of future cardiovascular mortality [60,64].…”

Section: Estimates Of Arterial Stiffnessmentioning

confidence: 99%

Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease

2008

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Increased arterial stiffness associated with diabetes and the metabolic syndrome may in part explain the increased cardiovascular disease risk observed in these conditions. Arterial stiffness can be estimated by quantifying pulse pressure but is better described by distensibility and compliance coefficients, pulse wave velocity and wave reflection. The most common non-invasive methodologies used to quantify these estimates of arterial stiffness (e.g. ultrasonography and applanation tonometry) are also described. We then review and summarise the current data on the associations between diabetes, the metabolic syndrome and insulin resistance on the one hand and greater arterial stiffness on the other, and identify and discuss some unresolved issues such as differential stiffening of central vs peripheral arterial segments, the impact of sex, and the pathobiology of increased arterial stiffness in diabetes and the metabolic syndrome. Finally, some considerations with regard to treatment options are presented.At present the most powerful therapy available for reducing arterial stiffness is to vigorously treat hypertension using pharmacological agents. New pharmacological strategies to reduce arterial stiffness are likely to be especially relevant to individuals with diabetes.

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“…9 The relationship between age and PP was stronger in diabetic subjects than in non-diabetic individuals. 10 This baseline assessment of the ROADMAP study showed office PP correlations with indices of glycemic control being in a good agreement with the evidences that the metabolic alterations in type 2 diabetes are associated with increased arterial stiffness.…”

Section: Discussionmentioning

confidence: 96%

“…8 It has also been reported that PP is independently associated with cardiovascular mortality in individuals with type 2 diabetes and PP is a better predictor of coronary heart disease (CHD) events than systolic blood pressure (SBP). [9][10][11] The results of the FinnDiane Study showed that early age-related rise in office PP was more pronounced in subjects with diabetic nephropathy, but was also evident in diabetic subjects with normal albumin excretion. 12 Recent studies indicate that ambulatory PP may provide additional information to predict progression of albuminuria in elderly diabetic subjects, above and beyond office PP.…”

Section: Introductionmentioning

confidence: 99%

Office and ambulatory pulse pressure—association with clinical characteristics and cardiovascular risk factors in normoalbuminuric patients with type 2 diabetes (ROADMAP study)

et al. 2010

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To investigate the association of office and ambulatory 24-h pulse pressure (PP) with clinical characteristics and cardiovascular risk factors in normoalbuminuric type 2 diabetic patients enrolled to the Randomised Olmesartan and Diabetes Microalbuminuria Prevention study, 4449 patients (2054 male and 2395 female; mean age 57.7 ± 8.7 years) with type 2 diabetes, normoalbuminuria and at least one additional cardiovascular risk factor were included into the analysis. After adjustment by age, there were significant correlations between office PP and presence of hypertension (r ¼ 0.24; Po0.001), presence of cardiac and vascular disorders (r ¼ 0.17; Po0.001), metabolic syndrome (r ¼ 0.10; Po0.001), duration of diabetes (r ¼ 0.09; Po0.001), fasting blood glucose (r ¼ 0.08; Po0.001), albumin/creatinine ratio (r ¼ 0.07; Po0.001), insulin treatment, glycosylated haemoglobin (HbA1c), male gender and current smoking. In the subgroup of 1234 patients with ambulatory blood pressure measurement performed, ambulatory PP adjusted for office PP correlated with fasting blood glucose (r ¼ 0.16; Po0.001), metabolic syndrome (r ¼ 0.14; Po0.001), albumin/ creatinine ratio (r ¼ 0.11; Po0.001) and indices of glycemic control (HbA1c: r ¼ 0.11; Po0.001). In this group of normoalbuminuric type 2 diabetic patients, office and ambulatory PP were associated with duration of diabetes, indices of glycemic control and cardiovascular risk factors. There was relationship between office and ambulatory PP and albuminuria even within normal albuminuria range.

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Pulse Pressure Predicts Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus

Abstract: In summary, PP is a better predictor of CHD events than SBP in persons with type 2 diabetes, but the converse is true for CVD and PVD.

Cited by 90 publications

References 29 publications

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

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

Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease

Office and ambulatory pulse pressure—association with clinical characteristics and cardiovascular risk factors in normoalbuminuric patients with type 2 diabetes (ROADMAP study)

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