Despite adequate glycemic and blood pressure (BP) control, diabetic hypertensives remain at increased cardiovascular (CV) risk. Aortic stiffness and pulse pressure (PP) amplification may provide complementary information to correct CV risk. We aim to determine whether these hemodynamic parameters are interrelated or not and to explore the factors related to pressure pulsatility.Design and method:
A cross-sectional study was conducted in 351 patients, involving controls, hypertensives without diabetes and diabetic patients with or without hypertension. Hemodynamic parameters were determined by applanation tonometry. Multivariate regression analyses evaluated the interest of therapeutic strategies. The study cohort was composed of 351 patients, 205 men (43% with diabetes) and 146 women (47% with diabetes). Previous CV events were present in 76 patients, involving at least one vascular site: coronary heart disease in 52 (15%) patients, peripheral vascular disease in 21 (6%) patients and cerebro-vascular disease in 12 (3%) patients.Results:
Although disproportionately increased aortic stiffness in diabetic hypertensives (p < 0.001), no difference was found for PP amplification (Figure 1). The present dissociation between these two hemodynamic parameters may be related to the effect of increased heart rate (p < 0.001) in the presence of diabetes, in men and women. In diabetic hypertensives, aortic stiffness was correlated with glycated hemoglobin level (p = 0.04), but not with blood pressure or heart rate. Aortic stiffness and PP amplification were not interrelated (p = 0.32) in multivariate-adjusted analysis and were both independently associated with previous CV events. Antihypertensive and statin treatments were correlated with PP amplification but not with aortic stiffness.Conclusions:
Aortic stiffness and PP amplification were not interrelated, suggesting that these markers may provide complementary information for CV risk. New therapeutic strategies targeting pressure pulsatility should take into account the impact of hyperglycemia and increased heart rate in diabetic hypertensives. Gender influence on the role of autonomic nervous system in attenuating pressure wave reflections remains to be further established.