Abstract
BackgroundWe examined the relationship between central blood pressure (BP), brachial BP with carotid atherosclerosis and microvascular complications in type 2 diabetes mellitus (T2DM).MethodsWe recruited 201 patients who were evaluated for central BP, brachial BP, carotid ultrasonography, brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and microvascular complications. Central BP were calculated using a radial automated tonometric system.ResultsAgreement between central BP and brachial BP was very strong (concordance correlation coefficient between central and brachial SBP = 0.889, between central and brachial PP = 0.816). Central pulse pressure (PP) was correlated with mean carotid intima-media thickness (CIMT), baPWV and ABI, whereas brachial PP was borderline significantly correlated with CIMT. The prevalence of nephropathy(DN) and retinopathy(DR) according to the brachial PP tertiles increased, the prevalences of microvascular complications were not different across central PP tertiles. In multivariate analysis, the relative risks (RRs) for the presence of DR were 1.2 and 4.6 for the brachial PP tertiles 2 and 3 when compared with the first tertile. Also, the RRs for the presence of DN were 1.02 and 3 for the brachial PP tertiles 2 and 3 when compared with the first tertile.ConclusionsAgreement of central BP and brachial BP was very strong. Nonetheless, this study showed that higher brachial PP levels are associated with increased probability for the presence of microvascular complications such as DR/DN. However, there are no associations with central SBP and central PP with microvascular complications. Central BP levels than brachial BP are correlated with surrogate marker of macrovascular complications.
Highlights
We examined the relationship between central blood pressure (BP), brachial BP with carotid atherosclerosis and microvascular complications in type 2 diabetes mellitus (T2DM)
To the contrary, central BP levels rather than brachial BP are correlated with surrogate marker of macrovascular complications
The present study revealed that central pulse pressure (PP) is significantly correlated with carotid intima-media thickness (CIMT) and brachial PP values showed positive, but weaker, correlation than central PP
Summary
We examined the relationship between central blood pressure (BP), brachial BP with carotid atherosclerosis and microvascular complications in type 2 diabetes mellitus (T2DM). Blood pressure (BP) management is important for the prevention and management of cardiovascular disease (CVD) and microvascular complications in T2DM [1]. In a study of American Indians, central BP more strongly related to the extent of carotid atherosclerosis, vascular hypertrophy and CV events than brachial BP [4]. The Conduit Artery Function Evaluation study demonstrated the superiority of central BP to brachial BP as a CV predictor in hypertensive patients [5]. To our knowledge, no study has compared central BP with brachial BP regarding to association with both micro-and macrovascular complications in patients with T2DM
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