Increased pulse wave velocity is not associated with elevated augmentation index in patients with diabetes

Objective Increased arterial stiffness is a risk factor for cardiovascular disease and is a feature associated with diabetes. Pulse wave velocity (PWV) is an accepted index of arterial stiffness and augmentation index (Al) derived from radial applanation tonometry has been advocated as a measurement of arterial stiffness. This study compares the relationship between PWV and Al in people with and without diabetes. Design and methods A total of 66 people with diabetes and 66 age-matched non-diabetic controls were studied. Central aortic pressure waves were generated using applanation tonometry over the radial artery and used to calculate Al. Carotid-femoral PWV (PWV cf ) was measured simultaneously. Results Relative to controls, diabetes was associated with increased pulse pressure (PP) and PWV cf (P<0.01). In contrast, Al did not differ between groups even after adjustment for heart rate. This observation remained consistent irrespective of diabetes type, arterial site, and the presence or absence of antihypertensive therapy. Multiple regression analysis revealed diabetes to be a significant determinant of PWV cf , but not Al. Conclusions PP and PWV cf are increased in people with diabetes, but this is not associated with increased Al. These findings conclusively demonstrate that Al is not a reliable measure of arterial stiffness in people with diabetes.

[1]  A. Dart,et al.  Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension. , 1998, Journal of the American College of Cardiology.

[2]  Sarah Parish,et al.  MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial , 2003, The Lancet.

[3]  M. Safar,et al.  Increased systolic pressure in chronic uremia. Role of arterial wave reflections. , 1992, Hypertension.

[4]  C. Hayward,et al.  Noninvasive determination of age-related changes in the human arterial pulse. , 1989, Circulation.

[5]  D. Webb,et al.  The influence of heart rate on augmentation index and central arterial pressure in humans , 2000, The Journal of physiology.

[6]  K. D. Hopkins,et al.  A Family History of NIDDM Is Associated With Decreased Aortic Distensibility in Normal Healthy Young Adult Subjects , 1996, Diabetes Care.

[7]  D. Webb,et al.  Increased augmentation index and systolic stress in type 1 diabetes mellitus. , 2000, QJM : monthly journal of the Association of Physicians.

[8]  M. Ikäheimo,et al.  Diminished arterial elasticity in diabetes: association with fluorescent advanced glycosylation end products in collagen. , 1993, Cardiovascular research.

[9]  M E Safar,et al.  Arterial Wave Reflections and Survival in End-Stage Renal Failure , 2001, Hypertension.

[10]  Nico Westerhof,et al.  Increased Central Artery Stiffness in Impaired Glucose Metabolism and Type 2 Diabetes: The Hoorn Study , 2004, Hypertension.

[11]  Simon R Redwood,et al.  Pressure Wave Reflection Assessed From the Peripheral Pulse: Is a Transfer Function Necessary? , 2003, Hypertension.

[12]  C. Elmets,et al.  Relation between complications of type I diabetes mellitus and collagen-linked fluorescence. , 1986, The New England journal of medicine.

[13]  M. Laakso,et al.  Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. , 1998, The New England journal of medicine.

[14]  J. Staessen,et al.  Clinical applications of arterial stiffness; definitions and reference values. , 2002, American journal of hypertension.

[15]  A. Dart,et al.  Non-invasive measurements of arterial structure and function: repeatability, interrelationships and trial sample size. , 1998, Clinical science.

[16]  H E HOFF,et al.  The Pulse Wave Velocity as an Early Indicator of Atherosclerosis in Diabetic Subjects , 1962, Circulation.

[17]  T. Spector,et al.  Physical activity reduces genetic susceptibility to increased central systolic pressure augmentation: a study of female twins. , 2003, Journal of the American College of Cardiology.

[18]  J. Blacher,et al.  Diabetes mellitus and renal failure: effects on large artery stiffness , 2001, Journal of Human Hypertension.

[19]  J. Blacher,et al.  Central Pulse Pressure and Mortality in End-Stage Renal Disease , 2002, Hypertension.

[20]  P. Tsai,et al.  Noninvasive measurements of central arterial pressure and distensibility by arterial applanation tonometry with a generalized transfer function: implications for nursing. , 2001, Heart & lung : the journal of critical care.

[21]  D. C. Knight,et al.  Effect of hormone replacement therapy on non‐invasive cardiovascular haemodynamics , 1997, Journal of hypertension.

[22]  G. Mancia,et al.  Early impairment of large artery structure and function in Type I diabetes mellitus , 1999, Diabetologia.

[23]  C. Reid,et al.  Correction of carotid augmentation index for heart rate in elderly essential hypertensives. ANBP2 Investigators. Australian Comparative Outcome Trial of Angiotensin-Converting Enzyme Inhibitor- and Diuretic-Based Treatment of Hypertension in the Elderly. , 2001, American journal of hypertension.

[24]  S. Anderson,et al.  Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance: An Integrated Index of Vascular Function? , 2002, Circulation.

[25]  L. Geddes,et al.  Studies of Pulse Wave Velocity in Potential Diabetic Subjects , 1965, Diabetes.

[26]  G. Mancia,et al.  Combined effects of hypertension and hypercholesterolemia on radial artery function. , 1997, Hypertension.

[27]  S. Laurent,et al.  Aortic Stiffness Is an Independent Predictor of Fatal Stroke in Essential Hypertension , 2003, Stroke.

[28]  A. Bertoni,et al.  Diabetes and idiopathic cardiomyopathy: a nationwide case-control study. , 2003, Diabetes care.

[29]  G. London,et al.  Influence of sex on arterial hemodynamics and blood pressure. Role of body height. , 1995, Hypertension.

[30]  A. Simon,et al.  Comparative effects of diabetes mellitus and hypertension on physical properties of human large arteries. , 1992, Journal of the American College of Cardiology.

[31]  J. Ward,et al.  Ultrasound measurements of pulse-wave velocity in the peripheral arteries of diabetic subjects. , 1980, Clinical science.

[32]  C. Hayward,et al.  Gender-related differences in the central arterial pressure waveform. , 1997, Journal of the American College of Cardiology.

[33]  D. Bell.  Heart Failure: A Serious and Common Comorbidity of Diabetes , 2004 .

[34]  J. Cockcroft,et al.  Assessment of arterial stiffness in clinical practice. , 2002, QJM : monthly journal of the Association of Physicians.

[35]  P. Chowienczyk,et al.  Vasoactive Drugs Influence Aortic Augmentation Index Independently of Pulse-Wave Velocity in Healthy Men , 2001, Hypertension.

[36]  J. Blacher,et al.  Aortic pulse wave velocity index and mortality in end-stage renal disease. , 2003, Kidney international.

[37]  P. Ducimetiere,et al.  Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients , 2001, Hypertension.

[38]  G. Panzram.  Mortality and survival in Type 2 (non-insulin-dependent) diabetes mellitus , 1987, Diabetologia.

[39]  J. Neaton,et al.  Diabetes, Other Risk Factors, and 12-Yr Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial , 1993, Diabetes Care.

[40]  D. Yue,et al.  Augmentation of central arterial pressure in type 1 diabetes. , 1999, Diabetes care.

[41]  Yasmin,et al.  Similarities and differences between augmentation index and pulse wave velocity in the assessment of arterial stiffness. , 1999, QJM : monthly journal of the Association of Physicians.

[42]  C. Ferro,et al.  Central aortic pressure augmentation in stable renal transplant recipients. , 2002, Kidney international.

[43]  H. Oxlund,et al.  Increased aortic stiffness in patients with Type 1 (insulin-dependent) diabetes mellitus , 1989, Diabetologia.

[44]  I. Young,et al.  Ascorbic Acid Reduces Blood Pressure and Arterial Stiffness in Type 2 Diabetes , 2002, Hypertension.

[45]  G. Gennser,et al.  Increased stiffness of the aorta in children and adolescents with insulin-dependent diabetes mellitus. , 1996, Ultrasound in medicine & biology.

[46]  G. Mancia,et al.  Progression of large artery structural and functional alterations in Type I diabetes , 2001, Diabetologia.

[47]  Thomas Weber,et al.  Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease , 2004, Circulation.

[48]  J. Degaute,et al.  Validity of pulse pressure and augmentation index as surrogate measures of arterial stiffness during beta-adrenergic stimulation , 2004, Journal of hypertension.

[49]  J. Westerbacka,et al.  Resistance to acute insulin induced decreases in large artery stiffness accompanies the insulin resistance syndrome. , 2001, The Journal of clinical endocrinology and metabolism.

[50]  P. McNamara,et al.  Morbidity and Mortality in Diabetics In the Framingham Population: Sixteen Year Follow-up Study , 1974, Diabetes.

[51]  L. Poston,et al.  British Hypertension Society guidelines for hypertension management 1999: summary , 1999, BMJ.

[52]  C. Hayward,et al.  Effect of combination hormone replacement therapy on ambulatory blood pressure and arterial stiffness in diabetic postmenopausal women. , 2001, American journal of hypertension.

[53]  D K Yue,et al.  Augmentation of central arterial pressure in Type 2 diabetes , 2001, Diabetic medicine : a journal of the British Diabetic Association.

[54]  J. Blacher,et al.  Impact of aortic stiffness on survival in end-stage renal disease. , 1999, Circulation.

[55]  L. Bortel,et al.  Vessel Wall Properties of Large Arteries in Uncomplicated IDDM , 1995, Diabetes Care.

[56]  A. Siebenhofer,et al.  The reproducibility of central aortic blood pressure measurements in healthy subjects using applanation tonometry and sphygmocardiography , 1999, Journal of Human Hypertension.

[57]  M. E. Safar,et al.  Aortic Pulse Wave Velocity Predicts Cardiovascular Mortality in Subjects >70 Years of Age , 2001, Arteriosclerosis, thrombosis, and vascular biology.

[58]  P Hjemdahl,et al.  Biochemical assessment of sympathetic activity and prejunctional modulation of noradrenaline release in humans. , 1996, Journal of hypertension.

[59]  J. Nürnberger,et al.  Augmentation index is associated with cardiovascular risk , 2002, Journal of hypertension.

[60]  Bryan Williams,et al.  Pulse wave analysis and hypertension: evangelism versus scepticism. , 2004, Journal of hypertension.

[61]  S. Laurent,et al.  Aortic Stiffness Is an Independent Predictor of Primary Coronary Events in Hypertensive Patients: A Longitudinal Study , 2002, Hypertension.

[62]  J. Cockcroft,et al.  Diminished wave reflection in the aorta. A novel physiological action of insulin on large blood vessels. , 1999, Hypertension.

[63]  T. Shoji,et al.  Correlation between the intima-media thickness of the carotid artery and aortic pulse-wave velocity in patients with type 2 diabetes. Vessel wall properties in type 2 diabetes. , 1999, Diabetes care.

[64]  J. Westerbacka,et al.  Insulin-induced decrease in large artery stiffness is impaired in uncomplicated type 1 diabetes mellitus. , 2000, Hypertension.

[65]  M. O'Rourke,et al.  Pulse wave analysis. , 1996, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[66]  J. Cockcroft,et al.  Pressure Amplification Explains Why Pulse Pressure Is Unrelated to Risk in Young Subjects , 2001, Hypertension.

[67]  N. Westerhof,et al.  Determinants of brachial artery mean 24 h pulse pressure in individuals with Type II diabetes mellitus and untreated mild hypertension. , 2002, Clinical science.

[68]  Veikko Salomaa,et al.  Non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC Study. Atherosclerosis Risk in Communities Study. , 1995, Circulation.

[69]  M. C. Kyle,et al.  Arterial pulse waves and velocity and systolic time intervals in diabetic children. , 1974, American heart journal.