Masayoshi Ohnishi

Home blood pressure variability on one occasion is a novel factor associated with arterial stiffness in patients with type 2 diabetes

Recent studies have suggested that not only mean blood pressure but also variability in blood pressure might be related to cardiovascular disease. The aim of this study was to investigate the association between home blood pressure variability on one occasion and markers of arterial stiffness in patients with type 2 diabetes. We investigated the relationship between the s.d. of clinic- or home-measured systolic blood pressure on one occasion and pulse wave velocity (PWV) in 332 patients with type 2 diabetes, and we evaluated whether the SD of clinic- or home-measured systolic blood pressure on one occasion was an independent determinant of PWV by multivariate linear regression analysis, after adjustment for known risk factors for arterial stiffness, including sex, age, duration of diabetes, body mass index, hemoglobin A1c, serum total cholesterol, triglycerides, smoking status, drinking alcohol, presence of antihypertensive medication, average systolic blood pressure and heart rate. Age, average morning home-measured systolic blood pressure, heart rate and PWV (r=0.259, P<0.0001) were positively correlated with the s.d. of morning home blood pressure on one occasion. Multiple regression analysis demonstrated that age, average morning home-measured systolic blood pressure (P=0.0019), heart rate and the s.d. of morning home-measured systolic blood pressure on one occasion (P=0.0159) were independently associated with PWV. In conclusion, home blood pressure variability on one occasion was correlated with PWV, independent of other known risk factors, in Japanese patients with type 2 diabetes.

Augmentation of central arterial pressure as a marker of atherosclerosis in patients with type 2 diabetes.

Macrovascular disease is the most common cause of morbidity and mortality in diabetic patients. With the increasing numbers of patients with type 2 diabetes, a simple, noninvasive method is needed to detect atherosclerosis. Augmentation represents the difference between the second and first peaks of the central arterial pressure waveform in systole and is a measure of systemic arterial stiffness, which causes the pressure wave to rebound. We investigated whether augmentation could serve as a marker of atherosclerosis in patients with type 2 diabetes. Central arterial pressure and degree of its augmentation by pulse wave rebound were measured sphygmographically in 208 consecutive patients with type 2 diabetes and 117 healthy control subjects. The relationship between augmentation and carotid atherosclerosis detected by carotid ultrasonography was investigated in a subgroup of 81 diabetic patients. Augmentation was greater in diabetic patients than control subjects (13.2+/-6.9 vs. 9.4+/-5.7 mm Hg, P<0.0001). The positive correlation between augmentation and intima-media thickness (r=0.309, P=0.0051) and between augmentation and plaque score (r=0.304, P=0.0059) were found in patients with type 2 diabetes. Augmentation was greater in diabetic patients with cardiovascular disease (n=47) than without (n=161; 15.1+/-8.4 vs. 12.6+/-6.3 mm Hg, P=0.031). Augmentation of central arterial pressure is a reliable marker for atherosclerosis in patients with type 2 diabetes. This simple, noninvasive determination would permit large-scale, early screening for atherosclerosis in patients with type 2 diabetes, who are at increased risk for cardiovascular disease.

Uncontrolled home blood pressure in the morning is associated with nephropathy in Japanese type 2 diabetes

The purposes of this study were to investigate the state of blood pressure control level and to investigate the relationship between blood pressure control level and nephropathy in Japanese type 2 diabetes. We measured clinic and home blood pressure in 923 type 2 diabetic patients. According to the criteria for hypertension in the Japanese Society of Hypertension Guidelines 2009, patients were classified into four groups by clinic systolic blood pressure (130 mmHg) and morning systolic blood pressure (125 mmHg), as follows: controlled hypertension (CH), white-coat hypertension (WCH), masked hypertension (MH), and sustained hypertension (SH). Of all patients, 13.9, 12.6, 13.3, and 60.2% were identified as having CH, WCH, MH, and SH, respectively. The average number of drugs prescribed was 1.8. We assessed the association between blood pressure control level and nephropathy in diabetic patients. The degree of urinary albumin excretion and the prevalence of nephropathy in diabetic patients were higher in MH and SH groups than those in the CH group. The majority of patients had poor blood pressure control, regardless of ongoing conventional antihypertensive therapy, and diabetic patients with MH and SH were associated with nephropathy. It is suggested that more aggressive antihypertensive treatment is recommended to prevent nephropathy in diabetic patients.

Andropausal symptoms in men with Type 2 diabetes.

Diabet. Med. 29, 1036–1042 (2012)

Beneficial effect of calcium channel blockers on home blood pressure variability in the morning in patients with type 2 diabetes

Recent studies have shown the association between blood pressure variability and cardiovascular events. The present study was designed to investigate the relationship between antihypertensive drug class and home blood pressure variability in patients with type 2 diabetes.

Optimal home SBP targets for preventing the progression of diabetic nephropathy in patients with type 2 diabetes mellitus.

Objectives: Home blood pressure control can reduce the risk of increased urinary albumin excretion in patients with diabetes mellitus. However, the optimal home blood pressure targets to prevent the onset or progression of diabetic nephropathy are not well defined. Methods: We performed a retrospective cohort study of 851 patients with type 2 diabetes mellitus. Logistic regression models were used to evaluate the correlations of home SBP levels with progression of diabetic nephropathy. Results: During the follow-up of 2 years, 86 patients had progression of diabetic nephropathy. Adjusted odds ratios (95% confidence interval) for progression of diabetic nephropathy in patients with morning SBP of 120–129 mmHg [2.725 (1.074–6.917), P = 0.035], 130–139 mmHg [3.703 (1.519–9.031), P = 0.004] and in those with morning SBP equal or more than 140 mmHg [2.994 (1.182–7.581), P = 0.021] were significantly higher than that in those with morning SBP less than 120 mmHg in multiple logistic analyses. Conclusion: The preferable morning SBP targets might be less than 120 mmHg for preventing the onset or progression of diabetic nephropathy in patients with type 2 diabetes mellitus.

Home-measured heart rate is associated with albuminuria in patients with type 2 diabetes mellitus: a post-hoc analysis of a cross-sectional multicenter study

Epidemiological studies have shown that elevated heart rate (HR) is associated with an increased risk of diabetic nephropathy, as well as cardiovascular events and mortality, in patients with type 2 diabetes mellitus. Recently, the advantages of the self-measurement of blood pressure (BP) at home have been recognized. The aim of this study was to investigate the relationship between home-measured HR and albuminuria in patients with type 2 diabetes mellitus. We designed a cross-sectional multicenter analysis of 1245 patients with type 2 diabetes mellitus. We investigated the relationship between the logarithm of urinary albumin excretion (log UAE) and home-measured HR or other factors that may be related to nephropathy using univariate and multivariate analyses. Multivariate linear regression analysis indicated that age, duration of diabetes mellitus, morning HR (β=0.131, P<0.001), morning systolic BP (β=0.311, P<0.001), hemoglobin A1C, triglycerides, daily consumption of alcohol, use of angiotensin II receptor blockers and use of beta-blockers were independently associated with the log UAE. Multivariate logistic regression analysis indicated that the odds ratio (95% confidence interval) associated with 1 beat per min and 1 mm Hg increases in the morning HR and morning systolic BP for albuminuria were 1.024 ((1.008–1.040), P=0.004) and 1.039 ((1.029–1.048), P<0.001), respectively. In conclusion, home-measured HR was significantly associated with albuminuria independent of the known risk factors for nephropathy, including home-measured systolic BP, in patients with type 2 diabetes mellitus.

Could home arterial stiffness index be a novel marker for arterial stiffness in patients with type 2 diabetes

Recent studies suggested that home arterial stiffness index (HASI) may be a new measure of arterial stiffness. The aim of this study was to investigate whether HASI is more strongly associated with arterial stiffness than is pulse pressure (PP) and thus a more suitable tool than PP for evaluating arterial stiffness in patients with type 2 diabetes. We evaluated the relationship of HASI or PP with pulse wave velocity (PWV) as well as with major cardiovascular risk factors in 332 patients with type 2 diabetes. Furthermore, we compared the area under the receiver-operator characteristic curve (AUC) of HASI or PP for PWV. Morning PP was positively associated with PWV (r=0.303, P<0.0001), while morning HASI was not (r=−0.006, P=0.9063). Multiple regression analysis demonstrated that morning PP (β=0.179, P=0.0210), but not morning HASI (β=−0.040, P=0.5036), was independently associated with PWV. The AUCs (95% confidence interval (CI)) of morning HASI and morning PP for arterial stiffness were 0.510 (0.448–0.573) (P=0.745) and 0.638 (0.578–0.698) (P<0.0001), respectively. The AUC (95% CI) of morning HASI for arterial stiffness was significantly less than that of morning PP (P=0.0005). In conclusion, morning HASI is less correlated with PWV than is morning PP in patients with type 2 diabetes.

Maximum home blood pressure is a useful indicator of diabetic nephropathy in patients with type 2 diabetes mellitus: KAMOGAWA-HBP study:

Objective: Maximum home systolic blood pressure has been shown to predict target organ damage. We aimed to clarify the association between maximum home systolic blood pressure and urine albumin to creatinine ratio, an indicator of early-phase diabetic nephropathy in patients with type 2 diabetes. Methods: In 1040 patients, we assessed the relationship of mean or maximum home systolic blood pressure and urine albumin to creatinine ratio, and compared the area under the receiver operating characteristic curve of mean or maximum home systolic blood pressure for diabetic nephropathy (urine albumin to creatinine ratio ⩾30 mg/g Cr). Results: Multivariate linear regression analyses indicated that mean morning systolic blood pressure (β = 0.010, p < 0.001) and maximum morning systolic blood pressure (β = 0.008, p < 0.001) were significantly associated with urine albumin to creatinine ratio. Area under the receiver operating characteristic curve (95% confidence interval) for diabetic nephropathy in mean and maximum morning systolic blood pressure was 0.667 (0.634–0.700; p < 0.001) and 0.671 (0.638–0.703; p < 0.001), respectively. Conclusion: Maximum home systolic blood pressure, as well as mean home systolic blood pressure, was significantly associated with diabetic nephropathy in patients with type 2 diabetes.

938 BENEFICIAL EFFECT OF CALCIUM CHANNEL BLOCKERS ON HOME BLOOD PRESSURE VARIABILITY IN THE MORNING IN PATIENTS WITH TYPE 2 DIABETES

Background: Recent studies have revealed the association between blood pressure variability and cardiovascular events. Furthermore, recent several meta-analyses of randomized controlled trials of antihypertensive drugs have shown that there are drug-class differences on blood pressure variability. This study was designed to investigate the relationship between antihypertensive-drug class and home blood pressure variability in patients with type 2 diabetes. Methods: We compared home blood pressure variability among patients treated with calcium channel blockers (n=44), with angiotensin II receptor blockers and/or angiotensin-converting enzyme inhibitors (n=159), and with calcium channel blockers combined with angiotensin II receptor blockers and/or angiotensin-converting enzyme inhibitors (n=183). Next, we analyzed the effect of calcium channel blockers on home blood pressure variability in the morning using multiple linear regression analysis. Results: Coefficient variation of morning systolic blood pressure in patients treated with calcium channel blockers was significantly lower than that in patients treated with angiotensin II receptor blockers and/or angiotensin-converting enzyme inhibitors (P = 0.036). Multivariate linear regression analyses indicated that treatment with calcium channel blockers was significantly correlated with coefficient variation of morning systolic blood pressure after adjusting for other potential co-factors (&bgr; = -0.264, P = 0.001). Conclusions: This study implies a possibility for validity on selecting calcium channel blockers in hypertensive patients with type 2 diabetes to reduce home blood pressure variability.