Article
American Journal of Hypertension (2008); 21, 6, 715–721. doi:10.1038/ajh.2008.166
Patients With Type 2 Diabetes Have Exaggerated Brachial and Central Exercise Blood Pressure: Relation to Left Ventricular Relative Wall Thickness
James A. Scott1, Jeff S. Coombes1, Johannes B. Prins2, Rodel L. Leano3, Thomas H. Marwick3 and James E. Sharman1,3
- 1School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia
- 2Centre for Diabetes and Endocrine Research, University of Queensland, Brisbane, Queensland, Australia
- 3School of Medicine, University of Queensland, Brisbane, Queensland, Australia
Correspondence: James E. Sharman, (j.sharman@uq.edu.au)
Received 27 November 2007; Revised 23 December 2007; Accepted 16 March 2008; Published online 17 April 2008.
Abstract
Background
A hypertensive response to exercise has prognostic significance. Patients with type 2 diabetes have vascular abnormalities which may predispose to exaggerated brachial and central blood pressure (BP) during exercise. This study aimed to test this hypothesis and to determine the clinical significance of high exercise BP by examining its relation to left ventricular (LV) mass.
Methods
Brachial and central BP were recorded at rest and in response to maximal exercise in 73 diabetic patients (aged 54 
10 years) and 73 controls (aged 53 12 years). Brachial BP was recorded using mercury sphygmomanometry and LV mass using 2D-
echocardiography. Central BP was estimated by radial tonometry using an exercise-
validated generalized transfer function.
Results
At rest there were no significant (P > 0.05) differences between groups in brachial or central BP. The diabetic patients had significantly increased exercise brachial systolic BP (SBP: 199 25 mm Hg vs. 185 21 mm Hg; P = 0.002) and central SBP (158 17 mm Hg vs. 149 15 mm Hg; P = 0.002). There was a significantly higher prevalence of an exaggerated exercise BP response (
210/105 mm Hg; men and 190/105 mm Hg; women) in the diabetic patients (51%
vs. 22%
; P < 0.01). Compared with those with normal exercise BP, LV relative wall thickness (RWT) was significantly higher (0.41 0.09 vs. 0.36 0.08; P < 0.05) and LV hypertrophy was more prevalent (35%
vs. 16%
; P < 0.05) in those with a hypertensive response. After accounting for other confounding variables, exercise central SBP remained independently associated with LV RWT (
= 0.22; P = 0.006).
Conclusion
Diabetic patients are more likely to exhibit exaggerated exercise BP. Regardless of disease status, high exercise central SBP may contribute to cardiovascular risk via adverse cardiac remodeling.
American Journal of Hypertension (2008) doi:10.1038/ajh.2008.166