title: A prognostic role of mean 24-h pulse pressure level for cardiovascular events in type 2 diabetic subjects under 60 years of age.
abstract: OBJECTIVE
  To assess the prognostic role of ambulatory 24-h pulse pressure (PP) on various vascular events in relatively young type 2 diabetic subjects under 60 years of age.
  
  
  METHODS
  In this prospective study, 237 type 2 diabetic subjects without any history of vascular complications were analyzed. After excluding 9 dropout subjects, 228 subjects (mean age, 46 years; 69% men; mean follow-up period, 100 months) entered the study.
  
  
  RESULTS
  Distribution of 24-h PP for all subjects showed left skewed data, indicating that there may be a diabetic subgroup that had a wide PP. Therefore, further analysis was performed by stratifying the diabetic subjects by quartile of 24-h PP. Outcomes for the widest quartile (n = 58; cut point = 53.3 mmHg) was then compared with those from the other narrower quartiles (n = 170). In the diabetic subjects with a wide PP, cardiovascular events occurred more frequently than those in the diabetic subjects with a narrow one (20.7 vs. 4.1%; P < 0.001), resulting in the significant difference in the cumulative incidence of cardiovascular events (P < 0.001, log-rank test), but not cerebrovascular events, between the two subgroups. The Cox model revealed that a wide 24-h PP at baseline independently predicted subsequent cardiovascular events but not cerebrovascular events. By contrast, only duration of diabetes was the risk factor for cerebrovascular events.
  
  
  CONCLUSIONS
  This study showed that a wide 24-h PP is predictive for cardiovascular events in relatively young diabetic subjects.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Kanazawa Medical University, Uchinada, Ishikawa, Japan. nakano-s@kanazawa-med.ac.jp
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakano
authors.forename: Kazunori
authors.initials: K
authors.lastname: Konishi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Furuya
authors.forename: Keigo
authors.initials: K
authors.lastname: Uehara
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishizawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kigoshi
authors.forename: Kenzo
authors.initials: K
authors.lastname: Uchida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011674:Pulse; D013997:Time Factors