Elevated MAP was consistently associated with CVD risk in individuals with diabetes, while PP variability offered additional prognostic information, and integrated monitoring of MAP levels and PP variability may help refine vascular risk stratification, pending external validation.
Abstract
Cardiovascular disease (CVD) risk is elevated in diabetes, but the contributions of mean arterial pressure (MAP), pulse pressure (PP), and their long-term variability remain unclear.
We analyzed 1,065 individuals with diabetes from the nationally representative CHARLS cohort (2011–2020). PP and MAP, plus BP variability metrics, were evaluated for incident CVD using logistic and Cox models, with subgroup, spline, and sensitivity analyses. BP variability was assessed using repeated measurements of PP and MAP in 2011, 2013, and 2015, with within-participant indices including mean, standard deviation (SD), coefficient of variation (CV), average real variability (ARV), root mean square of successive differences (RMSSD), range, variance (PV), and variability independent of the mean (VIM).
Over a median 9-year follow-up, 256 (24.0%) participants developed CVD. Baseline MAP was consistently associated with CVD risk (per SD: hazard ratio [HR] 1.28, 95% CI: 1.08–1.52). PP-CVD associations weakened after adjustment. BP variability analyses showed no significant associations for MAP variability, whereas higher PP SD, ARV, RMSSD, range, and variance were associated with 18–25% higher CVD risk in fully adjusted models.
Elevated MAP was consistently associated with CVD risk in individuals with diabetes, while PP variability offered additional prognostic information. Integrated monitoring of MAP levels and PP variability may help refine vascular risk stratification, pending external validation.
Not applicable.
This study aimed to compare the strengths of association and predictive performance of systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse pressure index (PPI), and the SBP/DBP ratio for incident diabetes among Chinese adults with elevated BP.
This retrospective cohort study included 29,377 adults with elevated BP from a large Chinese health examination database. Cox proportional hazards models were used to estimate hazard ratios (HRs), and restricted cubic spline analyses were applied to evaluate non-linear associations.
During a median follow-up of 2.98 years, 1,550 participants (5.28%) developed diabetes. After multivariable adjustment, SBP (HR: 1.09, 95% CI 1.05–1.13), MAP (HR 1.07, 95% CI 1.02–1.13), PP (HR 1.06, 95% CI 1.03–1.10), PPI (HR 2.47, 95% CI 1.36–4.46), and the SBP/DBP ratio (HR 1.38, 95% CI 1.13–1.70) were significantly associated with incident diabetes. Restricted cubic spline analyses revealed significant non-linear relationships for SBP, DBP, MAP, and the SBP/DBP ratio. Among all BP parameters, SBP demonstrated the highest predictive performance.
Among Chinese adults with elevated BP, several BP parameters were associated with incident diabetes, and significant non-linear dose–response relationships were observed for SBP, DBP, MAP, and the SBP/DBP ratio. SBP showed the highest predictive performance, suggesting that BP parameters may provide simple supplementary information for diabetes risk stratification in this high-risk population.
Qiaofeng Wu, Yuting Gao, An-Wen Yu et al.· Frontiers in Endocrinology· 0 citations
INTRODUCTION
Central arterial stiffness and pressure pulsatility are key measures of arterial health and cardiovascular disease (CVD). Acute physical activity (PA) improves vascular function; however, its relationship with arterial health across varying habitual PA levels remains understudied.
METHODS
We analyzed Framingham Heart Study (FHS) data (Generation 2: Exam 8, 2005-2008, n = 2999 and Generation 3: Exam 1, 2002-2005, n = 4064). Habitual PA was assessed using a standardized questionnaire. Carotid-femoral pulse wave velocity (niCFPWV, inverse-transformed CFPWV), central pulse pressure (CPP), and forward wave pressure (FWP) were measured using applanation tonometry. We examined associations between PA scores (as quintiles) and arterial health using linear regression and effect modification by age and sex, as well as mediation by arterial health measures on heart failure, CVD mortality, and all-cause mortality.
RESULTS
In 6451 FHS participants (mean age 50 ± 15 years, 55% women), the highest quintile of PA was associated with lower aortic stiffness (niCFPWV, β = -0.06 ± 0.02, p = 0.01). Continuous PA was associated with higher CPP (std β = 0.02 ± 0.01, p = 0.03) but not FWP. We observed an age-interaction: PA was associated with lower niCFPWV in individuals ⩾ 48 years (std β = -0.21 ± 0.07, p = 0.005) and higher CPP in those < 48 years (std β = 0.01 ± 0.004, p = 0.01). No significant effect modification by sex was noted. In stratified analyses, PA was associated with higher CPP among individuals without hypertension (β = 0.02 ± 0.01, p = 0.02), but not among those with hypertension. In mediation analyses, vascular measures did not contribute significantly to cardiovascular outcomes.
CONCLUSION
Higher PA score was associated with lower arterial stiffness, particularly in older adults, and with higher pressure pulsatility in younger adults.
Mawra Jha, Zhi-Yong Dong, Sean P. Meagher et al.· Vascular Medicine· 0 citations
Objective To identify hemodynamic phenotypes based on arterial stiffness index (ASI) and pulse pressure (PP) and examine their associations with incident diabetic microvascular complications (DMC) in individuals with type 2 diabetes (T2D). Methods A total of 9,163 participants with T2D free of DMC at baseline were included from the UK Biobank. K-means clustering based on ASI and PP was used to identify hemodynamic phenotypes. Associations with incident DMC were evaluated using cause-specific Cox and Fine–Gray models. Restricted cubic spline analyses assessed nonlinear associations. Secondary analyses examined diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic neuropathy (DN). Results During a median follow-up of 12.9 years, 2,349 participants developed DMC. Three phenotypes were identified. Compared with the low ASI–low PP phenotype, the high PP phenotype was associated with a higher risk of DMC in both cause-specific Cox models (hazard ratio [HR] 1.16, 95% CI 1.05–1.28) and Fine–Gray models (subdistribution hazard ratio [SHR] 1.16, 95% CI 1.05–1.29), whereas no significant association was observed for the high ASI phenotype. ASI and PP showed L-shaped and J-shaped associations with DMC, respectively. ASI was primarily associated with DKD, whereas PP was associated with both DKD and DR. Conclusions Hemodynamic phenotypes defined by ASI and PP were associated with differential risks of DMC in T2D. Elevated PP, rather than elevated ASI, was consistently associated with increased microvascular risk. Distinct associations of ASI and PP suggest heterogeneous hemodynamic pathways underlying DMC.
Aochuan Sun, Hao Liu, Xusheng Yang et al.· Frontiers in Endocrinology· 0 citations
BACKGROUND AND OBJECTIVES
Blood pressure variability (BPV) has been recognized as a cardiovascular risk factor beyond mean blood pressure, but its role in ischemic stroke among patients receiving hemodialysis remains incompletely defined, particularly across stroke subtypes. We evaluated the association between visit-to-visit BPV and incident ischemic stroke in a multicenter hemodialysis cohort.
DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS
In this prospective cohort study, 1,136 patients undergoing maintenance hemodialysis were enrolled from 12 centers. Pre-dialysis blood pressure measurements were collected over a standardized 12-week baseline period (approximately 36 readings per patient). BPV was quantified using the coefficient of variation (CV) and analyzed per 10% greater CV and by tertiles. The primary outcome was incident ischemic stroke, including large artery atherosclerosis (LAA) and small vessel occlusion (SVO). Fine-Gray competing risk models were used to estimate subdistribution hazard ratios (sHRs), adjusting for demographics, blood pressure, comorbidities, medication, and dialysis-related factors.
RESULTS
During a median follow-up of 54 months, 144 patients developed ischemic stroke. Higher systolic BPV was independently associated with greater stroke risk (sHR per 10% greater CV, 1.74; 95% confidence interval [CI], 1.10-2.76, P=0.02) in the clinically adjusted model, with consistent findings in extended analyses. In subtype-specific analyses, systolic BPV was significantly associated with LAA and showed a directionally consistent but attenuated association with SVO after extended adjustment. In contrast, diastolic BPV showed weaker associations that were not statistically significant after multivariable adjustment.
CONCLUSIONS
Higher systolic BPV was independently associated with ischemic stroke in patients receiving hemodialysis, with the most consistent subtype-specific association observed for large artery atherosclerosis. These findings suggest that systolic BPV may serve as a clinically accessible marker of cerebrovascular risk beyond mean blood pressure in this high-risk population.
Mu-Yang Hsieh, Li-Kai Tsai, Ru-Yin Hsu et al.· American Society of Nephrolo...· 0 citations
BACKGROUND
The aim of this study was to characterize hypertension-associated cardiac damage in the blood pressure (BP) phenotypes sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT) and sustained hypertension (SHT).
METHODS
In a population-based study, 4115 individuals were examined with office and home BP measurement, computed tomography, coronary computed tomography angiography and echocardiography. The odds ratios of hypertension-associated cardiac damage in the BP phenotypes were analysed with SNT and SHT as references, respectively, for coronary artery calcium score (CACS) at least 100 and at least 300, Segment Involvement Score (SIS) at least 4, any significant (>50%) coronary stenosis, left ventricular ejection fraction (LVEF) less than 50%, E/e΄ ratio (E/e΄) at least 14, and global longitudinal strain (GLS) greater than -17 (men) or greater than -18 (women).
RESULTS
The odds of having hypertension-associated cardiac damage were significantly higher for WCHT than for SNT [LVEF < 50%: OR 1.83 (1.17-2.86), CACS ≥ 100: OR 1.58 (1.19-2.11)], and for SHT than for SNT [LVEF < 50%: OR 2.34 (1.53-3.57), CACS ≥ 100: OR 1.52 (1.14-2.02)]. The odds of having hypertension-associated cardiac damage were also significantly higher for MHT than for SNT (LVEF < 50%: OR 2.68 (1.41-5.10), CACS ≥ 100: OR 2.15 (1.37-3.38) and CACS ≥ 300: OR 2.34 (2.21-4.52)].
CONCLUSION
The prevalence of hypertension-associated cardiac damage was higher in WCHT and in MHT compared to SNT. WCHT and MHT should therefore be considered when assessing cardiovascular risk, and BP should be measured both in the office and at home when diagnosing and monitoring hypertension.
M. Randjelovic, M. Wijkman, Karin Festin et al.· Journal of Hypertension· 0 citations
BACKGROUND
In clinical practice, blood pressure (BP) is typically assessed using brachial measurements, whereas finger plethysmography is widely used in vascular physiology research. However, agreement between BP levels at the finger and more proximal sites is not straightforward because of interindividual differences in BP gradients along the arterial tree.
METHODS
We investigated factors associated with the mean arterial pressure (MAP) difference between non-invasive radial artery and finger measurements in 574 normotensive and hypertensive individuals without cardiovascular disease, diabetes, or antihypertensive medication. Recordings included pulse wave analysis from radial BP, plethysmographic finger BP, and whole-body impedance cardiography. Radial BP signals were calibrated using oscillometric contralateral brachial artery measurements.
RESULTS
Simultaneous mean radial and finger BP (systolic/diastolic) were 131/75 and 122/69 mmHg, respectively (p < 0.001). When examined in quartiles of the radial-finger BP gradient, the average MAP difference was -7, 4, 10, and 20 mmHg, respectively. In linear regression analysis (enter method), a greater MAP difference was significantly associated with higher radial MAP (p < 0.001), age (p = 0.001), and stroke index (p = 0.015); and with lower pulse wave velocity (p < 0.001), pulse pressure amplification (p = 0.002), and insulin sensitivity check index (p = 0.022).
CONCLUSIONS
High mean arterial pressure is a major factor contributing to greater blood pressure difference between the radial and finger sites. However, the difference is also more pronounced in the presence of lower large artery stiffness, lower pulse pressure amplification, and higher stroke index, older age, and greater insulin resistance.
M. Choudhary, Tuomas P. Saarinen, Matti Oivo et al.· Blood Pressure· 0 citations
