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Office and ambulatory pulse pressure—association with clinical characteristics and cardiovascular risk factors in normoalbuminuric patients with type 2 diabetes (ROADMAP study)

Journal of Human Hypertension volume 25, pages 679–685 (2011)Cite this article

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Abstract

To investigate the association of office and ambulatory 24-h pulse pressure (PP) with clinical characteristics and cardiovascular risk factors in normoalbuminuric type 2 diabetic patients enrolled to the Randomised Olmesartan and Diabetes Microalbuminuria Prevention study, 4449 patients (2054 male and 2395 female; mean age 57.7±8.7 years) with type 2 diabetes, normoalbuminuria and at least one additional cardiovascular risk factor were included into the analysis. After adjustment by age, there were significant correlations between office PP and presence of hypertension (r=0.24; P<0.001), presence of cardiac and vascular disorders (r=0.17; P<0.001), metabolic syndrome (r=0.10; P<0.001), duration of diabetes (r=0.09; P<0.001), fasting blood glucose (r=0.08; P<0.001), albumin/creatinine ratio (r=0.07; P<0.001), insulin treatment, glycosylated haemoglobin (HbA1c), male gender and current smoking. In the subgroup of 1234 patients with ambulatory blood pressure measurement performed, ambulatory PP adjusted for office PP correlated with fasting blood glucose (r=0.16; P<0.001), metabolic syndrome (r=0.14; P<0.001), albumin/creatinine ratio (r=0.11; P<0.001) and indices of glycemic control (HbA1c: r=0.11; P<0.001). In this group of normoalbuminuric type 2 diabetic patients, office and ambulatory PP were associated with duration of diabetes, indices of glycemic control and cardiovascular risk factors. There was relationship between office and ambulatory PP and albuminuria even within normal albuminuria range.

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References

  1. Chugh A, Bakris GL . Pulse pressure and arterial stiffness: an emerging renal risk predictor? J Hypertens 2007; 25: 1796–1797.

    Article  CAS  Google Scholar 

  2. Franklin SS . Do diabetes and hypertension interact to accelerate vascular ageing? J Hypertens 2002; 20: 1693–1696.

    Article  CAS  Google Scholar 

  3. Franklin SS, Khan SA, Wong ND, Larson MG, Levy D . Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study. Circulation 1999; 100: 354–360.

    Article  CAS  Google Scholar 

  4. O’Rourke M, Frohlich ED . Pulse pressure: is this a clinically useful risk factor? Hypertension 1999; 34: 372–374.

    Article  Google Scholar 

  5. Pessina AC . Target organs of individuals with diabetes caught between arterial stiffness and damage to the microcirculation. J Hypertens Suppl 2007; 25 (Suppl 1): S13–S18.

    Article  CAS  Google Scholar 

  6. Benetos A, Waeber B, Izzo J, Mitchell G, Resnick L, Asmar R, Safar M . Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am J Hypertens 2002; 15: 1101–1108.

    Article  Google Scholar 

  7. Giannattasio C, Failla M, Capra A, Scanziani E, Amigoni M, Boffi L et al. Increased arterial stiffness in normoglycemic normotensive offspring of type 2 diabetic parents. Hypertension 2008; 51: 182–187.

    Article  CAS  Google Scholar 

  8. Knudsen ST, Poulsen PL, Hansen KW, Ebbehoj E, Bek T, Mogensen CE . Pulse pressure and diurnal blood pressure variation: association with micro- and macrovascular complications in type 2 diabetes. Am J Hypertens 2002; 15: 244–250.

    Article  Google Scholar 

  9. Cockcroft JR, Wilkinson IB, Evans M, McEwan P, Peters JR, Davies S et al. Pulse pressure predicts cardiovascular risk in patients with type 2 diabetes mellitus. Am J Hypertens 2005; 18: 1463–1467; discussion 1468–1469.

    Article  Google Scholar 

  10. Schram MT, Kostense PJ, Van Dijk RA, Dekker JM, Nijpels G, Bouter LM et al. Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study. J Hypertens 2002; 20: 1743–1751.

    Article  CAS  Google Scholar 

  11. Strain WD, Chaturvedi N, Dockery F, Shiff R, Shore AC, Bulpitt CJ, Rajkumar C . Increased arterial stiffness in Europeans and African Caribbeans with type 2 diabetes cannot be accounted for by conventional cardiovascular risk factors. Am J Hypertens 2006; 19: 889–896.

    Article  Google Scholar 

  12. Ronnback M, Fagerudd J, Forsblom C, Pettersson-Fernholm K, Reunanen A, Groop PH . Altered age-related blood pressure pattern in type 1 diabetes. Circulation 2004; 110: 1076–1082.

    Article  Google Scholar 

  13. Knudsen ST, Andersen NH, Mogensen CE . Ambulatory pulse pressure and progression of albuminuria in type 2 diabetes: evidence provided, new questions emerge. Hypertension 2006; 48: 207–208.

    Article  CAS  Google Scholar 

  14. Palmas W, Moran A, Pickering T, Eimicke JP, Teresi J, Schwartz JE et al. Ambulatory pulse pressure and progression of urinary albumin excretion in older patients with type 2 diabetes mellitus. Hypertension 2006; 48: 301–308.

    Article  CAS  Google Scholar 

  15. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421–426.

    Article  CAS  Google Scholar 

  16. Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 2003; 139: 901–906.

    Article  Google Scholar 

  17. Haller H, Viberti GC, Mimran A, Remuzzi G, Rabelink AJ, Ritz E et al. Preventing microalbuminuria in patients with diabetes: rationale and design of the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. J Hypertens 2006; 24: 403–408.

    Article  CAS  Google Scholar 

  18. Henry RM, Kostense PJ, Spijkerman AM, Dekker JM, Nijpels G, Heine RJ et al. Arterial stiffness increases with deteriorating glucose tolerance status: the Hoorn Study. Circulation 2003; 107: 2089–2095.

    Article  Google Scholar 

  19. Amar J, Ruidavets JB, Chamontin B, Drouet L, Ferrieres J . Arterial stiffness and cardiovascular risk factors in a population-based study. J Hypertens 2001; 19: 381–387.

    Article  CAS  Google Scholar 

  20. Benetos A, Rudnichi A, Safar M, Guize L . Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension 1998; 32: 560–564.

    Article  CAS  Google Scholar 

  21. Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Ducimetieere P, Guize L . Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension 1997; 30: 1410–1415.

    Article  CAS  Google Scholar 

  22. Cirillo M, Stellato D, Laurenzi M, Panarelli W, Zanchetti A, De Santo NG . Pulse pressure and isolated systolic hypertension: association with microalbuminuria. The GUBBIO Study Collaborative Research Group. Kidney Int 2000; 58: 1211–1218.

    Article  CAS  Google Scholar 

  23. van Dijk RA, van Ittersum FJ, Westerhof N, van Dongen EM, Kamp O, Stehouwer CD . Determinants of brachial artery mean 24 h pulse pressure in individuals with Type II diabetes mellitus and untreated mild hypertension. Clin Sci (Lond) 2002; 102: 177–186.

    Google Scholar 

  24. Tanaka M, Babazono T, Takeda M, Iwamoto Y . Pulse pressure and chronic kidney disease in patients with type 2 diabetes. Hypertens Res 2006; 29: 345–352.

    Article  Google Scholar 

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Acknowledgements

The ROADMAP study is supported by Daiichi-Sankyo Europe GmbH.

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Authors and Affiliations

  1. Department of Hypertension, Institute of Cardiology, Warsaw, Poland

    A Januszewicz

  2. Department of Nephrology, University of Heidelberg, Heidelberg, Germany

    E Ritz

  3. Division of Medicine, KCL Guy's Hospital, London, UK

    G Viberti

  4. Medicine Interne—Hypertension Arterielle CHU, Hospital Lapeyronie, Montpellier, France

    A Mimran

  5. Department of Nephrology and Hypertension, Leiden University Medical Center, Leiden, The Netherlands

    A J Rabelink

  6. Department of Internal Medicine/Nephrology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

    L C Rump

  7. Division of Hypertension, Hospital 12 de Octubre, Madrid, Spain

    L M Ruilope

  8. Department of Endocrinology and Diabetes, Faculty of Medicine, Saitama Medical University, Iruma, Japan

    S Katayama

  9. Division of Nephrology, Department of Clinical Medicine, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

    S Ito

  10. Department of Medicine, Erie County Medical Center, Buffalo, NY, USA

    J L Izzo Jr

  11. Department of Nephrology, Hannover Medical School, Hannover, Germany

    H Haller

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  1. A Januszewicz
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  2. E Ritz
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  7. S Katayama
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  9. J L Izzo Jr
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Correspondence to A Januszewicz.

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Competing interests

All steering committee members are consultants for Daiichi-Sankyo Europe GmbH for the ROADMAP study.

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Supplementary Information accompanies the paper on the Journal of Human Hypertension website

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Januszewicz, A., Ritz, E., Viberti, G. et al. Office and ambulatory pulse pressure—association with clinical characteristics and cardiovascular risk factors in normoalbuminuric patients with type 2 diabetes (ROADMAP study). J Hum Hypertens 25, 679–685 (2011). https://doi.org/10.1038/jhh.2010.111

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