Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes
BMC Cardiovascular Disorders
Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes
Chan-Hee Jung 1
Sang-Hee Jung 2
Kyu-Jin Kim 1
Bo-Yeon Kim 1
Chul-Hee Kim 1
Sung-Koo Kang 1
Ji-Oh Mok 1
0 170 Jomaru-ro , Wonmi-gu, Bucheon-si, Gyeonggi-do 420-767 , South Korea
1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine
2 Department of Obstetrics and Gynecology, Cha University School of Medicine , Bundang , Korea
Background: We examined the relationship between central blood pressure (BP), brachial BP with carotid atherosclerosis and microvascular complications in type 2 diabetes mellitus (T2DM). Methods: We recruited 201 patients who were evaluated for central BP, brachial BP, carotid ultrasonography, brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and microvascular complications. Central BP were calculated using a radial automated tonometric system. Results: Agreement between central BP and brachial BP was very strong (concordance correlation coefficient between central and brachial SBP = 0.889, between central and brachial PP = 0.816). Central pulse pressure (PP) was correlated with mean carotid intima-media thickness (CIMT), baPWV and ABI, whereas brachial PP was borderline significantly correlated with CIMT. The prevalence of nephropathy(DN) and retinopathy(DR) according to the brachial PP tertiles increased, the prevalences of microvascular complications were not different across central PP tertiles. In multivariate analysis, the relative risks (RRs) for the presence of DR were 1.2 and 4.6 for the brachial PP tertiles 2 and 3 when compared with the first tertile. Also, the RRs for the presence of DN were 1.02 and 3 for the brachial PP tertiles 2 and 3 when compared with the first tertile. Conclusions: Agreement of central BP and brachial BP was very strong. Nonetheless, this study showed that higher brachial PP levels are associated with increased probability for the presence of microvascular complications such as DR/DN. However, there are no associations with central SBP and central PP with microvascular complications. Central BP levels than brachial BP are correlated with surrogate marker of macrovascular complications.
Central blood pressure; Brachial blood pressure; Microvascular complications; Carotid atherosclerosis; Type 2 diabetes
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Background
Blood pressure (BP) management is important for the
prevention and management of cardiovascular disease
(CVD) and microvascular complications in T2DM [1].
Brachial BP remains the standard of reference for the
evaluation and management of BP, and has been a key
element in predicting target organ damage (TOD) and
CVD [2]. However, there is increasing evidence that central
BP may be a more sensitive indicator of CV risk than
brachial BP in specific groups [3-5]. In a study of American
Indians, central BP more strongly related to the extent
of carotid atherosclerosis, vascular hypertrophy and CV
events than brachial BP [4]. The Conduit Artery Function
Evaluation study demonstrated the superiority of central
BP to brachial BP as a CV predictor in hypertensive
patients [5]. In patients with T2DM, a few studies have
documented that increased augmentation of central BP
is associated with increases in CIMT [6,7]. However,
to our knowledge, no study has compared central BP
with brachial BP regarding to association with both
micro-and macrovascular complications in patients with
T2DM.
Pulse pressure (PP) is traditionally thought of as a
marker of arterial stiffness and has been suggested as an
independent CV risk factor [8,9]. Recent several studies
reported that brachial PP may be significantly associated
with CIMT [10,11]. Brachial PP is reportedly a better
predictor of coronary heart disease events than other BP
components in patients with T2DM [9]. However, the
significance of central PP versus brachial PP regarding
macrovascular complications in patients with diabetes
remains to be clarified. In addition, some authors
suggested that brachial PP is associated with microvascular
complications, although some authors disagree [12-14].
Central BP is most accurately measured by an invasive
method. It has been evaluated noninvasively by
mathematically transforming the radial artery pulse waveform to
the aortic pulse waveform recently [15,16]. Although a few
studies evaluated the relations of brachial and central
pressures to carotid atherosclerosis, no studies have
reported the relative importance of central and brachial BP in
to microvascular complications in patients with T2DM.
Therefore, the aim of this study was to evaluate the value
of central BP and brachial BP components in relation to
microvascular complications and surrogate markers of
macrovascular diseases (CIMT, baPWV and ABI), in
patients with T2DM.
Methods
Patients
We recruited 201 patients with T2DM who were (...truncated)