Pulse pressure is independently associated with sensorimotor peripheral neuropathy in patients with type 2 diabetes

Abstract

Abstract. Jarmuzewska EA, Mangoni AA (University of Milan, Milan, Italy; and Flinders University, Adelaide, Australia). Pulse pressure is independently associated with sensorimotor peripheral neuropathy in patients with type 2 diabetes. J Intern Med 2005; 258: 38-44.Objectives. The mechanisms responsible for the onset and progression of sensorimotor peripheral neuropathy (SMPN) in type 2 diabetes remain largely unknown. Although a link between hypertension and SMPN has been observed, it is not clear which blood pressure (BP) component (i.e. systolic, SBP; diastolic, DBP; or pulse pressure, PP) is primarily involved. We sought to determine the relationship between BP components and parameters of nerve function in type 2 diabetes. Design. Cross-sectional study. Setting. Academic medical centre. Subjects. A total of 55 consecutive ambulatory patients with type 2 diabetes (age 62.6 ± 8.0 years, mean ± SD). Interventions. Measurement of clinic BP and 10 neurophysiological parameters: motor nerve conduction velocity (NCV; median, ulnar, posterior tibial and peroneal nerve), sensory amplitude (AMP) and latency (LAT; median, ulnar and sural nerve). Results. Univariate analysis showed that age, diabetes duration, SBP and PP were negatively correlated with nerve function. Regression analysis showed that, after correcting for age, duration of diabetes, glycated haemoglobin, body mass index, microalbuminuria and SBP, PP was independently and negatively associated with NCV (median, P ¼ 0.011; ulnar, P ¼ 0.001; peroneal, P ¼ 0.006 and posterior tibial, P ¼ 0.005) and signal AMP (ulnar, P ¼ 0.027; sural, P ¼ 0.055), and positively associated with signal LAT (median, P ¼ 0.083; sural, P ¼ 0.021). SBP was negatively associated with signal AMP (median, P ¼ 0.012) and positively associated with LAT (ulnar, P ¼ 0.018). By contrast, DBP failed to show any significant correlation with nerve function. Conclusions. The PP is strongly associated with neurophysiological parameters of nerve function in patients with type 2 diabetes. This relationship is independent of traditional risk factors and other BP components.

Cutaneous sensibility and peripheral nerve function in patients with unmedicated essential hypertension

“…Treatment with angiotensin converting enzyme inhibitors, which reduce blood pressure by vasodilatation, improved nerve conduction velocities in diabetics (Malik et al, 1998; Reja, Tesfaye, Harris, & Ward, 1995). Further, pulse pressure has been reported to be a strong independent predictor of nerve conduction velocity in patients with diabetes mellitus (Jarmuzewska & Mangoni, 2005).…”

Auditory Brainstem Responses & Nerve Conduction Velocity in Essential Hypertension

“…Increase in nerve conduction velocity by lisinopril has also been demonstrated in streptozotocin-diabetic rats [18,19]. Further, pulse pressure has been shown to be independently associated with peripheral neuropathy in patients of diabetes mellitus [7].…”

“…Improvement of nerve conduction velocity in diabetics by the use of angiotensin converting enzyme (ACE) inhibitors again suggests the role of essential hypertension in diabetic neuropathy [5,6]. Moreover, nerve conduction velocity has also been independently related to pulse pressure in diabetes mellitus [7]. Data on nerve conduction velocity in patients of essential hypertension, without diabetes mellitus, is inconsistent.…”

Association of arterial stiffness and neuropathy in diabetes: a systematic review and meta-analysis

“…In total, 60 studies were included in the systematic review,26–85 with 43 of those studies including at least one arterial stiffness measurement suitable for meta-analysis 29–31 33–35 37–39 41 42 46 47 52 53 55 57 59–77 79–85. Although various studies adjusted for age, sex, diabetes duration, or SBP in data analysis, the values used in the meta-analyses were not adjusted for, other than those studies that only included participants of one sex 65 75.…”