ASSOCIATION OF AMBULATORY BLOOD PRESSURE PARAMETERS WITH CAROTID DAMAGE IN PATIENTS WITH TYPE-2 DIABETES/PRE-DIABETES AND HYPERTENSION

Abstract

Objective: This study investigated the association between ambulatory blood pressure (ABP) parameters and carotid damage in patients with type-2 diabetes/pre-diabetes and hypertension. Design and method: Adults with hypertension and type-2 diabetes/prediabetes were subjected to (i) 24-hour ABP monitoring (20 min intervals, Microlife WatchBPO3) and (ii) estimation of preclinical carotid damage (ultrasound carotid intima-media thickness [cIMT] and carotid plaque score [CPS]). BP variability was quantified using the standard deviation (SD) and coefficient of variation (CV). Results: Seventy individuals were analyzed [age 65.2±9.7 years, 47 men, body mass index (BMI) 31.6±4.8 kg/m2, HbA1c 6.6±0.8%, 86% diabetics, average 24-hour ABP (systolic/diastolic) 123±12/69±7 mmHg, cIMT 0.8±0.2 mm, CPS 5.4±4.7 mm]. There was a significant correlation between 24-hour/daytime systolic ABP and cIMT (r = 0.34/0.34 respectively, p<0.01) and CPS (r = 0.26/0.25 respectively, p<0.05). 24-hour/daytime/nighttime pulse pressure was associated with cIMT (r = 0.39/0.41/0.28 respectively, p<0.05) and CPS (r = 0.26/0.28/0.23, p< = 0.05). No significant association was found between indices of carotid damage and SD or CV of systolic ABP. Stepwise multivariable regression analysis with age, sex, BMI, smoking and daytime pulse pressure as independent variables, revealed that cIMT was determined by the daytime pulse pressure and age (R2 = 0.27), whereas CPS was determined by daytime pulse pressure and smoking (R2 = 0.23). Conclusions: These preliminary data suggest that in patients with type-2 diabetes/pre-diabetes and hypertension ambulatory pulse pressure might have a critical role in the development of carotid damage.