Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study

Schram, Miranda T.; Kostense, Pieter J.; Dijk, R.A.J.M. van; Dekker, Joost; Nijpels, Giel; Bouter, Lex M.; Heine, Robert J.; Stehouwer, Coen D.A.

doi:10.1097/00004872-200209000-00017

Cited by 170 publications

(148 citation statements)

References 45 publications

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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. 18 The present study in normoalbuminuric patients with type 2 diabetes revealed an association between office PP and selected cardiovascular risk factors, including age (455 years), hypertension, abdominal obesity and metabolic syndrome, as well as cardiac and vascular disorders.…”

Section: Discussionsupporting

confidence: 85%

“…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%

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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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Section: Discussionsupporting

confidence: 85%

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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“…Arterial stiffening has been associated with hypertension, dyslipidemia, diabetes mellitus, and atherosclerosis 29, 30, 31, 32, 33. The buffering action of the systemic arterial system is reduced with rAC.…”

Section: Discussionmentioning

confidence: 99%

“…The buffering action of the systemic arterial system is reduced with rAC. rAC is a major contributor to the development of systolic hypertension, contributing to LV afterload and decreased coronary flow during diastole, and it has been shown to be a strong predictor of LV dysfunction and adverse events 30, 31, 32, 33, 34. Patients with AS already have increased LV afterload because of valvular stenosis, and it has been demonstrated that rAC has a significant additive effect and contributes to LV dysfunction and occurrence of adverse outcomes 22, 35.…”

Section: Discussionmentioning

confidence: 99%

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

Côté

Simard

Zenses

et al. 2017

JAHA

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BackgroundAbout 50% of normal‐flow/low‐gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements.Methods and ResultsDoppler‐echocardiography was performed in 4 sheep with experimentally induced severe and critical AS at: (1) normal aortic pressure, (2) during hypertension, and (3) with rAC. Hypertension and rAC induced a substantial decrease in MG/Vpeak compared with normal stage (both P≤0.03) despite a stable transvalvular flow (P>0.16). Hypertension and rAC resulted in a greater reduction of MG in critical (−42%) compared with severe (−35%) AS (P˂0.0001). Comprehensive Doppler‐echocardiography and computed tomography were performed in 220 AS patients (mean age: 69±13 years; MG 29±18 mm Hg) with normal flow. The population was divided in 3 groups according to the presence of hypertension and rAC. The slope of the linear association between MG/Vpeak and aortic valve calcification divided by the cross‐sectional area of the aortic annulus was significantly reduced in patients with hypertension and/or rAC compared with normotensive/normal AC patients (P<0.01). Accordingly, patients with normal‐flow/low‐gradient and severe aortic valve calcification density were more frequent in hypertension and rAC groups compared with the normotensive/normal‐AC group (16% and 12% compared with 2%; P=0.03).ConclusionsHypertension and rAC are associated with a substantial reduction in MG/Vpeak for similar aortic valve calcification (ie, similar AS anatomic severity), which may lead to underestimation of AS hemodynamic severity.

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“…6 The same authors in an other study found that in type II diabetes, PP is positively associated with cardiovascular mortality. 7 PP can be considered as a marker of an ageassociated increase in arterial stiffness, manifested by an increase in systolic (SBP) with parallel decrease in diastolic blood pressure (DBP). 8 Miwa et al 9 reported that PP is an independent and the most powerful predictor of all pressure components of the progress of aortic calcification.…”

Section: Introductionmentioning

confidence: 99%

Differential pulse pressure response to various antihypertensive drug families

et al. 2006

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Pulse pressure (PP) is emerging as a major pressure predictor of cardiac disease. The study comprised 10 185 untreated patients with essential hypertension. A total of 5395 men and 4790 women 56713 years old, with uncomplicated essential hypertension, after a 15-day washout period and after 6 months of antihypertensive monotherapy were included. All patients included in the final cohort were responders and had normalized their blood pressure. PP was decreased least with diuretics (À5 mm Hg) and most with angiotensin II receptor blockers (ARBs) and calcium antagonists (À15 mm Hg), followed by angiotensin-converting enzyme inhibitors (ACEI) (À12 mm Hg) a-and b-blockers (À10 and À9 mm Hg), differentiating among antihypertensive classes (Po0.001). The magnitude of PP fall was related to the degree of left ventricular (LV) mass reduction (Po0.001), seen best with ARBs (r ¼ 0.42) and least with ACEIs (r ¼ 0.18). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists, whereas diuretics confer poor response. PP was decreased least with diuretics (À5 mm Hg) and most with ARBs and calcium channel blockers (À15 mm Hg), followed by ACEI (À12 mm Hg) a-and b-blockers (À10 and À9 mm Hg), differentiating among antihypertensive classes (Po0.001). Of the antihypertensive medications used in everyday practice, PP decrease may be achieved best with ARBs and calcium antagonists.

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Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study

Cited by 170 publications

References 45 publications

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

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

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

Differential pulse pressure response to various antihypertensive drug families

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