Meta-analysis of the quantitative relation between pulse pressure and mean arterial pressure and cardiovascular risk in patients with diabetes mellitus.
Results of epidemiologic studies that investigated the significance of pulse pressure (PP) and mean arterial pressure (MAP) in terms of risk of cardiovascular disease (CVD) in patients with diabetes mellitus are inconsistent. We performed a quantitative meta-analysis to estimate CVD risk in relation to PP or MAP. Electronic literature search was conducted for prospective studies providing data on CVD risk for an increment in baseline MAP or PP in patients with diabetes mellitus. The pooled CVD risk for a 10-mm Hg increase in each blood pressure (BP) index was estimated with a random-effects model. There were 17 eligible studies consisting of 52,647 patients and 5,112 CVD cases. The pooled relative risk (95% confidence interval) of CVD for an increment of 10 mm Hg was 1.10 (1.04 to 1.16) for PP and 1.09 (0.98 to 1.21) for MAP. Significant between-study heterogeneity was observed (I(2) [p value]; 76.5% [p <0.001] for PP, 67.8% [p = 0.005] for MAP). In studies concurrently investigating CVD risk for the 4 indexes (i.e., PP, MAP, systolic BP, and diastolic BP), the pooled relative risk (95% confidence interval) was 1.17 (1.09 to 1.26) for PP, 1.11 (1.06 to 1.15) for MAP, 1.14 (1.06 to 1.22) for systolic BP, and 1.06 (0.94 to 1.19) for diastolic BP. In conclusion, the current meta-analysis suggested that PP was the strongest indicator among the 4 commonly used BP indexes. However, the large heterogeneity urged cautious interpretation of the study results.
Department of Health Management Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan; Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Satoru
S
Kodama
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Chika
C
Horikawa
Department of Health Management Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan; Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan; Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Ibaraki, Japan.
Kazuya
K
Fujihara
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Sakiko
S
Yoshizawa
Department of Faculty of Health and Nutrition, Yamanashi Gakuin University, Kōfu, Yamanashi, Japan.
Yoko
Y
Yachi
Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Kyoto, Japan.
Shiro
S
Tanaka
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Nobumasa
N
Ohara
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Satoshi
S
Matsunaga
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Takaho
T
Yamada
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan.
Osamu
O
Hanyu
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Niigata, Japan. Electronic address: sone@med.niigata-u.ac.jp.
Hirohito
H
Sone
D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology*; D014943:Global Health; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012307:Risk Factors; D013599:Systole