Pulse pressure and diurnal blood pressure variation: association with micro- and macrovascular complications in type 2 diabetes

Knudsen, Søren Tang; Poulsen, Per Løgstrup; Hansen, Klavs Würgler; Ebbehøj, Eva; Bek, Toke; Mogensen, Carl Erik

doi:10.1016/s0895-7061(01)02281-6

Cited by 94 publications

(84 citation statements)

References 30 publications

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“…It was also recently shown that in patients with reduced renal function, BP remains high for a longer period of time after going to bed compared with patients with normal renal function [20]. Previous investigators have also found that a blunted diurnal BP pattern is associated with the prevalence of nephropathy in patients with type 2 diabetes [21]. In the light of these findings, we find it noteworthy that in our cohort of clinically normotensive patients, nocturnal systolic BP was independently associated with aortic PWV after adjustments for age, sex, BMI, HbA 1c and blood pressure-lowering medication, but that this association did not remain significant after further adjustments for creatinine levels.…”

Section: Discussionmentioning

confidence: 97%

Masked nocturnal hypertension—a novel marker of risk in type 2 diabetes

et al. 2009

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Aims/hypothesis This study was designed to evaluate the prevalence of masked nocturnal hypertension (MNHT) and its impact on arterial stiffness and central blood pressure in patients with type 2 diabetes. Methods Middle-aged patients (n=414) with type 2 diabetes underwent clinic and ambulatory BP measurements and applanation tonometry. Results MNHT (clinic BP<130/80 mmHg and night-time BP≥120/70 mmHg) was found in 7.2% of patients (n=30). Compared with patients with both clinical and nocturnal normotension (n=70), patients with MNHT had higher aortic pulse wave velocity (PWV) (10.2±1.8 m/s vs 9.4±1.7 m/s; p=0.03) and higher central BP (117.6±13.9/74.0±9.1 mmHg vs 110.4±16.4/69.7±9.6 mmHg, p=0.04). In patients with clinical normotension, night-time systolic BP correlated significantly with PWV. Conclusions/interpretation Thirty per cent of patients with clinical normotension had nocturnal hypertension. This was accompanied by increased arterial stiffness and higher central BP. We conclude that in clinically normotensive patients with type 2 diabetes, ambulatory BP measurement may help clinicians to identify patients with increased cardiovascular risk.

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Section: Discussionmentioning

confidence: 97%

Masked nocturnal hypertension—a novel marker of risk in type 2 diabetes

et al. 2009

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“…Other data from this cohort have previously been reported. 12,17 Patients were followed for a mean of 9.5 (range 0.5-14.5) years until death or until 1 April 2008. Follow-up data were available for 108 patients, as 10 patients were excluded due to incomplete 24-h ABPM measurements (three patients), migration (two patients) or incomplete records on CV outcomes (five patients).…”

Section: Methodsmentioning

confidence: 99%

“…[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%

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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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“…6,7 In patients with type 2 diabetes with micro-and macrovascular complications PP is higher than in those without complications. 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.…”

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 and diurnal blood pressure variation: association with micro- and macrovascular complications in type 2 diabetes

Abstract: Increased PP and blunted diurnal BP variation are hemodynamic abnormalities associated with micro- and macrovascular complications in type 2 diabetes.

Cited by 94 publications

References 30 publications

Masked nocturnal hypertension—a novel marker of risk in type 2 diabetes

Masked nocturnal hypertension—a novel marker of risk in type 2 diabetes

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

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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