Central Pulse Pressure and Its Hemodynamic Determinants in Middle-Aged Adults With Impaired Fasting Glucose and Diabetes: The Asklepios study

• Published in: Diabetes care Vol. 36; no. 8; pp. 2359 - 2365
• Main Authors: CHIRINOS, Julio A, SEGERS, Patrick, GILLEBERT, Thierry C, DE BUYZERE, Marc L, VAN DAELE, Caroline M, KHAN, Zubair A, KHAWAR, Umair, DE BACQUER, Dirk, RIETZSCHEL, Ernst R
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-08-2013
• Subjects: Adult; Aorta - anatomy & histology; Biological and medical sciences; Blood Glucose - metabolism; Blood Pressure; Blood tests; Cardiovascular disease; Cardiovascular diseases; Complications and side effects; Diabetes; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Female; Glucose; Health aspects; Heart rate; Hemodynamics; Humans; Male; Medical sciences; Metabolic diseases; Middle age; Middle Aged; Miscellaneous; Original Research; Prediabetic State - physiopathology; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk factors; Type 2 diabetes; Vascular Stiffness; Belgium; United States; Endocrinopathy; Human; Systolic pressure; Middle age; Diastolic pressure; Nutrition; Diabetes mellitus; Determinant; Metabolic diseases; Adult; Arterial pressure; Hemodynamics; Impaired glucose tolerance; Differential pressure; Endocrinology
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc12-1463

Pulse pressure (PP), a strong predictor of cardiovascular events in type 2 diabetes, is a composite measure affected by several hemodynamic factors. Little is known about the hemodynamic determinants of central PP in type 2 diabetes or whether abnormalities in central pulsatile hemodynamics are already present in individuals with impaired fasting glucose (IFG). In a population-based study, we aimed to compare central PP and its hemodynamic determinants among adults with normal fasting glucose (n = 1654), IFG (n = 240), and type 2 diabetes (n = 33).
We measured carotid pressure, left ventricular outflow, aortic root diameter, carotid artery flow, and distension in order to measure various structural and hemodynamic arterial parameters.
IFG was associated with a greater mean arterial pressure (MAP) but was not associated with intrinsic aortic stiffening or abnormal aortic pulsatile indices after adjustment for MAP. After adjustment for age, sex, and MAP, type 2 diabetes was associated with a higher aortic root characteristic impedance (Zc), aortic root elastance-thickness product (Eh), and aortic root pulse wave velocity (but not aortic root diameter), a greater carotid-femoral pulse wave velocity, and lower total arterial compliance and wave reflection magnitude. Carotid size, Zc, distensibility, or Eh did not significantly differ between the groups.
Type 2 diabetes, but not IFG, is associated with greater large artery stiffness, without abnormalities in aortic root diameter or carotid stiffness. Subjects with type 2 diabetes demonstrate a decreased reflection magnitude, which may indicate an increased penetration of pulsatile energy to distal vascular beds.