pulsatile stress; Type 1 diabetes; type 2 diabetes mellitus; pulse pressure; arterial stiffneww; Finapres
Abstract :
[en] AbstractBackground: Arterial pulse pressure (PP) is considered as an independent cardiovascular risk factor. We compared PP during an active orthostatic test in middle-aged patients with type 1 diabetes and with type 2 diabetes, and corresponding nondiabetic controls. Methods: 40 patients with type 1 diabetes (mean age 50 years, diabetes duration 23 years, BMI 23.0 kg/m(2)) were compared to 40 non hypertensive patients with type 2 diabetes (respectively, 50 years, 8 years, 29.7 kg/m(2)). Patients taking antihypertensive agents or with renal insufficiency were excluded. All patients were evaluated with a continuous noninvasive arterial blood pressure monitoring (Finapres(R)) in standing (1 min), squatting (1 min) and again standing position (1 min). Patients with type 1 or type 2 diabetes were compared with two groups of 40 age-, sex- and BMI-matched healthy subjects. Results: Patients with type 1 diabetes and patients with type 2 diabetes showed significantly higher PP, heart rate (HR) and PPxHR double product (type 1 : 5263 vs 4121 mmHg/min, p=0.0004; type 2 : 5359 vs 4321 mmHg, p=0.0023) levels than corresponding controls. There were no significant differences between patients with type 1 diabetes and type 2 diabetes regarding PP (59 vs 58 mmHg), HR (89 vs 88/min), and PPxHR product (5263 vs 5359 mmHg/min). Conclusion: Patients with type 1 diabetes have comparable increased levels of peripheral PP, an indirect marker of arterial stiffness, and PPxHR, an index of pulsatile stress, as non-hypertensive patients with type 2 diabetes at similar mean age of 50 years.
Disciplines :
Cardiovascular & respiratory systems Endocrinology, metabolism & nutrition
Author, co-author :
Philips, Jean-Christophe ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Marchand, Monique ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Language :
English
Title :
Pulsatile stress in middle-aged patients with Type 1 or Type 2 diabetes compared to nondiabetic controls.
Publication date :
2010
Journal title :
Diabetes Care
ISSN :
0149-5992
eISSN :
1935-5548
Publisher :
American Diabetes Association, Alexandria, United States - Virginia
Schram MT, Kostense PJ, Van Dijk RA, Dekker JM, Nijpels G, Bouter LM, Heine RJ, Stehouwer CD. Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study. J Hypertens 2002;20:1743-1751
Nilsson PM, Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Gudbjörnsdóttir S, Swedish National Diabetes Register (NDR). Pulse pressure strongly predicts cardiovascular disease risk in patients with type 2 diabetes from the Swedish National Diabetes Register (NDR). Diabetes Metab 2009;35:439-446
Rönnback M, Fagerudd J, Forsblom C, Pettersson-Fernholm K, Reunanen A, Groop PH, Finnish Diabetic Nephropathy (FinnDiane) Study Group. Altered age-related blood pressure in type 1 diabetes. Circulation 2004;110:1076-1082 (Pubitemid 39319005)
Schram MT, Chaturvedi N, Fuller JH, Stehouwer CD, EURODIAB Prospective Complications Study Group. Pulse pressure is associated with age and cardiovascular disease in type 1 diabetes: the Eurodiab Prospective Complications Study. J Hypertens 2003;21:2035-2044 (Pubitemid 38296864)
Soedamah-Muthu SS, Chaturvedi N, Witte DR, Stevens LK, Porta M, Fuller JH, EURODIAB Prospective Complications Study Group. Relationship between risk factors and mortality in type 1 diabetic patients in Europe: the EURODIAB Prospective Complications Study (PCS). Diabetes Care 2008;31:1360-1366
Benetos A. Pulse pressure and arterial stiffness in type 1 diabetic patients. J Hypertens 2003;21:2005-2007 (Pubitemid 38296857)
Philips JC, Marchand M, Scheen AJ. Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes. Diabetes Metab Res Rev 2009; 25:442-451
Philips JC, Marchand M, Scheen AJ. Squatting amplifies pulse pressure increase with disease duration in patients with type 1 diabetes. Diabetes Care 2008; 31:322-324 (Pubitemid 351213344)
Rickards CA, Newman DG. A comparative assessment of two techniques for investigating initial cardiovascular reflexes under acute orthostatic stress. Eur J Appl Physiol 2003;90:449-457 (Pubitemid 37508847)
Marfella R, Giugliano D, di Maro G, Acampora R, Giunta R, D'Onofrio F. The squatting test. A useful tool to assess both parasympathetic and sympathetic involvement of the cardiovascular autonomic neuropathy in diabetes. Diabetes 1994;43:607-612
Marfella R, Salvatore T, Giugliano D, Di Maro G, Giunta R, Torella R, Juchmes J, Scheen A, Lefebvre PJ. Detection of early sympathetic cardiovascular neuropathy by squatting test in NIDDM. Diabetes Care 1994;17:149-151 (Pubitemid 24035312)
Nakagawa M, Shinohara T, Anan F, Yufu K, Takahashi N, Okada N, Hara M, Yoshimatsu H, Saikawa T. New squatting test indices are useful for assessing baroreflex sensitivity in diabetes mellitus. Diabet Med 2008;25:1309-1315
Imholz BP, Wieling W, van Montfrans GA, Wesseling KH. Fifteen years experience with finger arterial pressure monitoring: assessment of the technology. Cardiovasc Res 1998;38:605-616 (Pubitemid 28319870)
Nakayama Y, Ueda H, Tsumura K, Yoshimaru K, Hayashi T. Ascending fractional pulse pressure closely relating to large artery function. J Hum Hypertens 2002;16: 243-247 (Pubitemid 34441159)
Baumann M, Pan CR, Roos M, von Eynatten M, Sollinger D, Lutz J, Heemann U. Pulsatile stress correlates with (micro-)albuminuria in renal transplant recipients. Transpl Int 2010;23:292-298
Thomas F, Bean K, Provost JC, Guize L, Benetos A. Combined effects of heart rate and pulse pressure on cardiovascular mortality according to age. J Hypertens 2001;19:863-869 (Pubitemid 32436949)
Schram MT, Schalkwijk CG, Bootsma AH, Fuller JH, Chaturvedi N, Stehouwer CD, EURODIAB Prospective Complications Study Group. Advanced glycation end products are associated with pulse pressure in type 1 diabetes: the EURODIAB Prospective Complications Study. Hypertension 2005;46:232-237
Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553-1579
Ahlgren AR, Sundkvist G, Wollmer P, Sonesson B, Länne T. Increased aortic stiffness in women with type 1 diabetes mellitus is associated with diabetes duration and autonomic nerve function. Diabet Med 1999;16:291-297
Mattace-Raso FU, van den Meiracker AH, Bos WJ, van der Cammen TJ, Westerhof BE, Elias-Smale S, Reneman RS, Hoeks AP, Hofman A, Witteman JC. Arterial stiffness, cardiovagal baroreflex sensitivity and postural blood pressure changes in older adults: the Rotterdam Study. J Hypertens 2007;25:1421-1426 (Pubitemid 46918829)
Witte DR, Tesfaye S, Chaturvedi N, Eaton SE, Kempler P, Fuller JH, EURODIAB Prospective Complications Study Group: Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus. Diabetologia 2005;48:164-171 (Pubitemid 40174669)
Prince CT, Secrest AM, Mackey RH, Arena VC, Kingsley LA, Orchard TJ. Cardiovascular autonomic neuropathy, HDL cholesterol, and smoking correlate with arterial stiffness markers determined 18 years later in type 1 diabetes. Diabetes Care 2010;33:652-657
Meyer C, Milat F, McGrath BP, Cameron J, Kotsopoulos D, Teede HJ. Vascular dysfunction and autonomic neuropathy in type 2 diabetes. Diabet Med 2004;21:746-751 (Pubitemid 38916220)
Eckert S, Horstkotte D. Comparison of Portapres non-invasive blood pressure measurement in the finger with intra-aortic pressure measurement during incremental bicycle exercise. Blood Press Monit 2002;7: 179-183 (Pubitemid 35001782)
