Central hemodynamic modifications in diabetes mellitus.
Arterial stiffness in hypertension is markedly influenced by age, mean arterial pressure (MAP) and heart rate, whereas factors influencing this parameter in diabetes mellitus are not yet fully understood. The aim of our study was to compare central hemodynamics in diabetics (n = 126) versus non-diabetic controls (n = 203), most of whom were hypertensive, and with similar MAP. Anthropometric, laboratory and clinical measurements were collected. Hemodynamic parameters (central blood pressure, aortic pulse wave velocity [PWV], augmentation index [AIx] and pulse pressure amplification [PPA]) were measured using applanation tonometry. PWV and AIx were significantly higher in diabetics, after adjustment for age, gender, MAP, and heart rate. After further adjustment for metabolic syndrome, only the difference in PWV persisted (P < 0.0001). PPA was marginally altered though not significantly. In diabetics, PWV did not correlate with MAP, suggesting that other structural alterations, resulting from insulin resistance, may account for diabetic arterial stiffening to a greater extent than, and independently of, blood pressure. Chronic treatment with insulin was associated with increased PWV, independently of blood pressure, diabetes control and duration, or other common confounding variables. In conclusion, hypertensive diabetics had greater arterial stiffness than hypertensive controls. In diabetes, multiple factors affect arterial stiffening independently of hemodynamic status. Notably, insulin therapy (IT) is associated with more severe arterial stiffness, suggesting a consistent relationship between these parameters. It remains to be determined whether IT should be considered as a marker of diabetes severity that leads to increased arterial stiffness, or whether it has a direct/indirect effect on arterial wall modifications.
Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, 1 place du Parvis Notre Dame, 75004 Paris, France; Department of Internal Medicine, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
Davide
D
Agnoletti
Ari
A
Lieber
Yi
Y
Zhang
Athanase D
AD
Protogerou
Claudio
C
Borghi
Jacques
J
Blacher
Michel E
ME
Safar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension; D007249:Inflammation; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D059289:Vascular Stiffness; D055815:Young Adult
D007328:Insulin
Arterial stiffness; Central hemodynamics; Diabetes mellitus; Insulin therapy; Pulse pressure amplification; Pulse wave velocity