title: Differential associations of central and brachial blood pressure with carotid atherosclerosis and microvascular complications in patients with type 2 diabetes.
abstract: BACKGROUND
  We examined the relationship between central blood pressure (BP), brachial BP with carotid atherosclerosis and microvascular complications in type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  We recruited 201 patients who were evaluated for central BP, brachial BP, carotid ultrasonography, brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and microvascular complications. Central BP were calculated using a radial automated tonometric system.
  
  
  RESULTS
  Agreement between central BP and brachial BP was very strong (concordance correlation coefficient between central and brachial SBP = 0.889, between central and brachial PP = 0.816). Central pulse pressure (PP) was correlated with mean carotid intima-media thickness (CIMT), baPWV and ABI, whereas brachial PP was borderline significantly correlated with CIMT. The prevalence of nephropathy(DN) and retinopathy(DR) according to the brachial PP tertiles increased, the prevalences of microvascular complications were not different across central PP tertiles. In multivariate analysis, the relative risks (RRs) for the presence of DR were 1.2 and 4.6 for the brachial PP tertiles 2 and 3 when compared with the first tertile. Also, the RRs for the presence of DN were 1.02 and 3 for the brachial PP tertiles 2 and 3 when compared with the first tertile.
  
  
  CONCLUSIONS
  Agreement of central BP and brachial BP was very strong. Nonetheless, this study showed that higher brachial PP levels are associated with increased probability for the presence of microvascular complications such as DR/DN. However, there are no associations with central SBP and central PP with microvascular complications. Central BP levels than brachial BP are correlated with surrogate marker of macrovascular complications.
authors.forename: Chan-Hee
authors.initials: CH
authors.lastname: Jung
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Jung
authors.forename: Kyu-Jin
authors.initials: KJ
authors.lastname: Kim
authors.forename: Bo-Yeon
authors.initials: BY
authors.lastname: Kim
authors.forename: Chul-Hee
authors.initials: CH
authors.lastname: Kim
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Kang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, #170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-767, South Korea. hanna@schmc.ac.kr.
authors.forename: Ji-Oh
authors.initials: JO
authors.lastname: Mok
mesh_terms: D055109:Ankle Brachial Index; D062186:Arterial Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008365:Manometry; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D063177:Pulse Wave Analysis; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors