Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes

BMC Cardiovascular Disorders, Feb 2014

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.biomedcentral.com/content/pdf/1471-2261-14-23.pdf

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 - 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)


This is a preview of a remote PDF: http://www.biomedcentral.com/content/pdf/1471-2261-14-23.pdf

Chan-Hee Jung, Sang-Hee Jung, Kyu-Jin Kim, Bo-Yeon Kim, Chul-Hee Kim, Sung-Koo Kang, Ji-Oh Mok. Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes, BMC Cardiovascular Disorders, 2014, pp. 23, 14, DOI: 10.1186/1471-2261-14-23