Augmentation of central arterial pressure in Type 2 diabetes

Aims Aortic systolic blood pressure has been shown to be augmented in Type 1 diabetes, indicative of more rapid pulse wave reflection due to increased arterial stiffness. This abnormality is more pronounced in diabetic males. The aim of this study was to examine the effects of diabetes on augmentati on of aortic systolic pressure in subjects with Type 2 diabetes. Methods Radial artery pressure waveforms were obtained non-invasively by ap planation tonometry. A central aortic waveform can be derived using a trans fer function obtained from previous studies during cardiac catheterization. A total of 88 subjects with Type 2 diabetes (51 men and 37 women, aged 55. 8 years (interquartile range (IR) 49.7-64.1), duration of diabetes 7.5 year s (IR 2.4-12.4), HbA(1c) 7.6% (IR 6.6-8.7)) and 85 controls subjects (40 me n and 45 women, aged 55.3 years (IR 44.2-66.4)) were studied. The central a ortic waveform allowed determination of the: (i) aortic augmentation index and (ii) subendocardial viability ratio. Results Similar to Type 1 diabetic subjects, patients with Type 2 diabetes had a significantly higher aortic augmentation index (136.1 +/- 18.0% vs. 1 28.3 +/- 19.2%, t = 2.8, P = 0.006) and lower subendocardial viability rati o (137.4 +/- 25.0% vs. 155.1 +/- 25.9%; t = 4.6, P = 0.0001) compared with controls. Multivariate analysis identified diabetes as an important determi nant of aortic augmentation index (t = 4.0, P = 0.0001). The higher aortic augmentation index was due mainly to the male cohort (t = 2.6; P = 0.01) an d was not apparent for females with diabetes (P = 0.2). Conclusions Type 2 diabetes is characterized by higher augmentation of aort ic systolic pressure and unfavourable ratio of myocardial perfusion to card iac workload. These results are consistent with increased arterial stiffnes s. The age-related progression of arterial stiffness is similar in Type 1 a nd Type 2 diabetes. Anti-hypertensive agents that reduce wave reflection an d augmentation may help to prevent systolic hypertension and cardiac hypert rophy in diabetes.