Zigzagged Augmentation Index in Diabetes

Abstract

Although the patients with diabetic nephropathy suffered high cardiovascular risk, augmentation index (AI) in diabetic nephropathy has been poorly characterized. Cross-sectional studies were performed on 26 diabetic and 27 nondiabetic nephropathic patients. Home blood pressure was examined. In addition, blood pressure, pulse rate, and AI were measured in both supine and sitting positions. Patient backgrounds such as age, sex, sitting blood pressure, and pulse rate were similar between two groups. Circadian variations of home blood pressure were preserved in nondiabetic patients, but disappeared in diabetes. Changing from supine to sitting position induced greater decrements of systolic blood pressure (DeltaSBP -9 +/- 8 mmHg) and AI (DeltaAI -7 +/- 10) in the diabetic group than in nondiabetic patients (DeltaSBP -4 +/- 12 mmHg, DeltaAI -2 +/- 9). Multivariate regression analysis revealed that AI in a sitting position correlated positively to SBP and inversely to pulse rate. Of interest, AI in supine position related positively to age, the presence of diabetes and SBP, and inversely to pulse rate. The present data indicate autonomic dysfunction in patients with diabetic nephropathy. Furthermore, our findings provide the evidence that autonomic dysfunction elicits an inadequate physiological arterial contraction in response to postural change, thereby reducing AI that results in the fall of SBP. Finally, the present results suggest that AI in supine, but not sitting position, is suited for detecting cardiovascular risk in diabetes.

Height Constitutes an Important Predictor of Mortality in End-Stage Renal Disease

“…ASCOT-CAFÉ study demonstrated the advantage of lower AI for better cardiovascular outcomes in hypertensive patients [9]. As discussed (bide infra), AI measured in the sitting position, however, may be inappropriately low in diabetic group possibly due to the presence of neuropathy [14]. Taken together, these observations could account for that the shortness of height, an important determinant of AI, but not AI itself, was picked up as a risk factor of mortality.…”

“…Our previous data demonstrated that AI positively correlated to left ventricular mass Index in patients with nondiabetic CKD [27]. Our recent data demonstrated that patients with diabetic nephropathy manifested greater decreases in AI, brachial and central blood pressures when their postures alter from supine to sitting position than those with nondiabetic CKD [14]. The patient with diabetic nephropathy commonly suffers neuropathy as well [37].…”

“…Collectively, variations in these factors may elicit changes in AI. Indeed, we have demonstrated that AI in diabetes shows abnormal regulations following acute postural changes [14]. …”

Sodium–glucose co-transporter type 2 inhibitors reduce evening home blood pressure in type 2 diabetes with nephropathy

“…Clinical parameters including estimated glomerular filtration rate (eGFR), albuminuria, and home blood pressure were analysed over 6 months. 2 We welcome the patients to take breakfast on visiting day. The study was approved by the ethical committees of International University of Health and Welfare (No.…”

Paradoxical Distribution of Augmentation Index Level in Chronic Kidney Diseases

“…3 Our recent data also showed that drops in radial AI are greater in patients with diabetic nephropathy when posture was changed from a supine to a sitting position than those for non-diabetics. 4 We have previously demonstrated that PWV correlated to AI in stage 1-3 non-diabetic chronic kidney disease (CKD) patients. 5 PWV is known to rise as the stage of CKD advances.…”