title: Zigzagged augmentation index in diabetes.
abstract: Although the patients with diabetic nephropathy suffered high cardiovascular risk, augmentation index (AI) in diabetic nephropathy has been poorly characterized. Cross-sectional studies were performed on 26 diabetic and 27 nondiabetic nephropathic patients. Home blood pressure was examined. In addition, blood pressure, pulse rate, and AI were measured in both supine and sitting positions. Patient backgrounds such as age, sex, sitting blood pressure, and pulse rate were similar between two groups. Circadian variations of home blood pressure were preserved in nondiabetic patients, but disappeared in diabetes. Changing from supine to sitting position induced greater decrements of systolic blood pressure (DeltaSBP -9 +/- 8 mmHg) and AI (DeltaAI -7 +/- 10) in the diabetic group than in nondiabetic patients (DeltaSBP -4 +/- 12 mmHg, DeltaAI -2 +/- 9). Multivariate regression analysis revealed that AI in a sitting position correlated positively to SBP and inversely to pulse rate. Of interest, AI in supine position related positively to age, the presence of diabetes and SBP, and inversely to pulse rate. The present data indicate autonomic dysfunction in patients with diabetic nephropathy. Furthermore, our findings provide the evidence that autonomic dysfunction elicits an inadequate physiological arterial contraction in response to postural change, thereby reducing AI that results in the fall of SBP. Finally, the present results suggest that AI in supine, but not sitting position, is suited for detecting cardiovascular risk in diabetes.
authors.affiliation: Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38 Moro-Hongo Moroyama, Iruma, Saitama, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takenaka
authors.forename: Takahiko
authors.initials: T
authors.lastname: Sato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hoshi
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kato
authors.forename: Keita
authors.initials: K
authors.lastname: Sueyoshi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takane
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kanno
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ohno
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D015992:Body Mass Index; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D007674:Kidney Diseases / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011187:Posture; D012044:Regression Analysis; D016683:Supine Position; D013599:Systole