Hoge polsdruk voorspelt CV events, mortaliteit en ESRD in DM type 1

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High pulse pressure predicts CV events, mortality and ESRD in Type 1 diabetes

30 September 2010
European Association for the Study of Diabetes 46th Annual Meeting; Stockholm, Sweden: 20–24 September 2010.

High pulse pressure predicts cardiovascular (CV) events, mortality, and end stage renal disease (ESRD) in patients with Type 1 diabetes, report researchers.

Previous results have shown that patients with Type 1 and 2 diabetes have increased all-cause and CV disease (CVD) mortality compared with individuals without diabetes, and CVD events are the most common cause of death among diabetic patients.

High pulse pressure (PP) is a marker of arterial stiffness and has been shown to be a causal factor for CVD morbidity and mortality in different populations, including those with Type 2 diabetes.

To assess whether this also occurs in patients with Type 1 diabetes, Simone Theilade (Steno Diabetes Center, Gentofte, Denmark) conducted a prospective, observational follow-up study of 898 individuals, aged a mean of 42.1 years, with the condition. Of these, 456 had overt diabetic nephropathy (mean glomerular filtration rate (GFR), 76 ml/min/1.73 m2) and 442 had normoalbuminuria. The participants had a long duration of diabetes, at 28.1 years on average.

The patients were followed up for a median period of 8 years from baseline (1993-2001) until study completion (2006). During this time, 178 patients died - 109 from CVD causes. In addition, 99 participants developed ESRD and 134 had non-fatal CVD events.

For every 10 mmHg increase in PP in the overall group, the relative risk for all-cause death, CVD death, nonfatal CVD events and progression to ESRD increased by a significant 20%, 30%, 10%, and 30%, respectively. These associations remained valid after adjustment for factors such as gender, age, diabetes duration, nephropathy status, and smoking status.

Of note, the team did not adjust for systolic blood pressure (SBP). "The reason for not adjusting for SBP is the close association between pulse pressure (PP) and SBP, which means that if we did adjust for SBP we would to some extent adjust for PP itself," said Theilade.

She added that adjustment for diastolic blood pressure did not significantly affect the results.

On further analysis, the team found that patients with low SBP and PP (below median for SBP and PP) had a 2.9-fold lower risk for all-cause death and a 3.7-fold lower risk for CVD death over the follow-up period than did patients with low SBP and high PP. These associations became non-significant after adjusting for CV risk factors, however.

"We feel we have reached a final conclusion that PP is a surrogate for arterial stiffness," said Theilade, who presented the study findings at the European Association for the Study of Diabetes 46th annual meeting in Stockholm, Sweden.

"In patients with Type 1 diabetes, PP predicts all-cause mortality, CV mortality, nonfatal CV events and progression to ESRD."

She added: "We also feel that PP may add to the predictive value of SBP."

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