Pulse pressure and mortality in hypertensive type 2 diabetic patients. A cohort study.
OBJECTIVE
Hypertension is a well-known cardiovascular risk factor in type 2 diabetic patients. It has been suggested that pulse pressure (PP) could be an independent cardiovascular risk factor in the general population, particularly in the elderly. An association between office PP and cardiovascular mortality has been previously reported in diabetic patients, while the relationship between ambulatory measurements of PP and all-cause mortality has not been assessed so far.


OBJECTIVE
To assess the relationship between ambulatory PP and all-cause mortality in diabetic patients with hypertension.


METHODS
A cohort study was performed on a consecutive series of 435 diabetic outpatients. All patients underwent office blood pressure measurement (OBP) and 24-h ambulatory blood pressure monitoring (ABPM). Mortality was assessed through queries at the Registry Offices of the city of residence for each patient. Mean follow-up was 3.8 +/- 1.2 years.


RESULTS
Fifty-eight patients (13.3%) died during the follow-up. Mortality was significantly (p < 0.05) higher in patients in the highest quartile and lower in patients in the lowest quartile, when compared to the intermediate quartiles, both for office and ABPM-PP. In a multivariate analysis, after adjustment for numerous variables (including current hypoglycaemic, antihypertensive statin and aspirin treatment), mortality was increased by 3.1 and 5.3% for each incremental mmHg of office PP (p < 0.05) and ABPM-PP (p < 0.001) respectively.


CONCLUSIONS
High PP, assessed through office measurement or ABPM, was associated with increased mortality in hypertensive type 2 diabetic patients. In our sample, PP assessed with ABPM is a better predictor of mortality than office PP.
Mannucci
Edoardo
E
Geriatric Unit, Department of Critical Care, University of Florence Medical School, Florence, Italy. edmannu@tin.it
Lambertucci
Lorella
L
Monami
Matteo
M
Fedeli
Angela
A
Chiasserini
Veronica
V
Marchionni
Niccolò
N
Masotti
Giulio
G
Ungar
Andrea
A
D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011674:Pulse; D016019:Survival Analysis