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ß-blocker Treatment is Associated with High Augmentation Index and with High Aortic, but not Brachial, Pulse Pressure in Type 2 Diabetes
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.ORCID iD: 0000-0002-9095-403X
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Endocrinology and Gastroenterology UHL.
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2010 (English)In: The journal of clinical metabolism and diabetes, Vol. 1, no 1, 55-62 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To explore the associations between ß-blocker treatment and clinic, ambulatory, and central pulse pressure (PP) and central augmentation index (AIx), and left ventricular mass index (LVMI), respectively, in patients with type 2 diabetes.Methods: In 124 middle-aged patients with type 2 diabetes who were treated in primary care and used at least one antihypertensive drug, we measured clinic PP (mean value of three nurse-recorded measurements in the sitting position) and ambulatory PP (24-hour ambulatory measurements with the Spacelab 90217 measurement device). Central PP was measured non-invasively, using applanation tonometry (SphygmoCor), which also yielded values of AIx. LVMI was determined echocardiographically in all patients.Results: Patients whose antihypertensive drug regimen included a ß-blocker (n=67) had significantly higher central PP compared with patients whose antihypertensive drug regimen did not include a ß-blocker (ß-blocker: 49.6±12.2 mmHg, no ß-blocker: 45.1±10.2 mmHg; p=0.03) despite having similar clinic PP (ß-blocker: 60.4±16.3 mmHg, no ß-blocker: 58.9±13.1 mmHg; p=0.59) and similar ambulatory PP (ß-blocker: 55.2±9.1 mmHg, no ß-blocker: 54.8±10.6 mmHg; p=0.40). Patients treated with ß-blockers also had significantly higher AIx (ß-blocker: 30.7±8.4%, no ß-blocker: 25.8±8.8%; p<0.01) and higher LVMI (ß-blocker: 129.5±29.7 g/m2, no ß-blocker: 117.4±27.4 g/m2; p=0.02) compared with patients who were not treated with ß-blockers.Conclusions: In our cohort, ß-blocker use was associated with high central but not brachial PP and with high central AIx and high LVMI. Non-invasive measurement of central hemodynamic parameters may improve the evaluation of antihypertensive treatment efficacy in patients with type 2 diabetes.

Place, publisher, year, edition, pages
2010. Vol. 1, no 1, 55-62 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-66160OAI: oai:DiVA.org:liu-66160DiVA: diva2:401980
Available from: 2011-03-04 Created: 2011-03-04 Last updated: 2017-03-27Bibliographically approved
In thesis
1. Acute, ambulatory and central blood pressure measurements in diabetes
Open this publication in new window or tab >>Acute, ambulatory and central blood pressure measurements in diabetes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In patients with diabetes, high blood pressure is an established risk factor for cardiovascular disease. The aim of this thesis was to explore the associations between blood pressure levels measured with different techniques and during different circumstances, and the degree of cardiovascular organ damage and subsequent prognosis in patients with diabetes.

Methods: We analysed baseline data from patients with type 2 diabetes who participated in the observational cohort study CARDIPP (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care), and longitudinal data from patients registered in the Swedish national quality registry RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive care Admissions). Patients in CARDIPP underwent nurse-recorded, 24-hour ambulatory and non-invasive central blood pressure measurements. Patients in RIKS-HIA had their systolic blood pressure measured upon hospitalisation for acute chest pain.

Results: In CARDIPP, nearly one in three patients with office normotension (<130/80 mmHg) were hypertensive during the night (≥120/70 mmHg). This phenomenon, masked nocturnal hypertension, was significantly associated with increased arterial stiffness and increased central blood pressure. Furthermore, nearly one in five CARDIPP patients with office normotension had high central pulse pressure (≥50 mmHg), and there was a significant association between high central pulse pressure and increased carotid intima-media thickness and increased arterial stiffness. Among CARDIPP patients who used at least one antihypertensive drug, those who used beta blockers had significantly higher central pulse pressure than those who used other antihypertensive drugs, but there were no significant between-group differences concerning office or ambulatory pulse pressures. In CARDIPP patients with or without antihypertensive treatment, ambulatory systolic blood pressure levels were significantly associated with left ventricular mass, independently of central systolic blood pressure levels. When RIKS-HIA patients, admitted to hospital for chest pain, were stratified in quartiles according to admission systolic blood pressure levels, the risk for all-cause one-year mortality was significantly lower in patients with admission systolic blood pressure in the highest quartile (≥163 mmHg) than in patients with admission systolic blood pressure in the reference quartile (128-144 mmHg). This finding remained unaltered when the analysis was restricted to include only patients with previously known diabetes.

Conclusions: In patients with type 2 diabetes, ambulatory or central blood pressure measurements identified patients with residual risk factors despite excellent office blood pressure control or despite ongoing antihypertensive treatment. Ambulatory systolic blood pressure predicted left ventricular mass independently of central systolic blood pressure. In patients with previously known diabetes who were hospitalised for acute chest pain, there was an inverse relationship between systolic blood pressure measured at admission and the risk for one-year all-cause mortality.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1292
Keyword
Ambulatory blood pressure, Arterial stiffness, Central blood pressure, Diabetes, Hypertension.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75352 (URN)978-91-7519-966-5 (ISBN)
Public defence
2012-04-20, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
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Supervisors
Available from: 2012-02-27 Created: 2012-02-27 Last updated: 2017-03-27Bibliographically approved

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Wijkman, MagnusLänne, TosteEngvall, JanLindström, TorbjörnÖstgren, Carl JohanNyström, Fredrik

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Wijkman, MagnusLänne, TosteEngvall, JanLindström, TorbjörnÖstgren, Carl JohanNyström, Fredrik
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Internal MedicineFaculty of Health SciencesPhysiologyDepartment of Thoracic and Vascular Surgery in ÖstergötlandClinical PhysiologyDepartment of Clinical Physiology UHLDepartment of Endocrinology and Gastroenterology UHLGeneral PracticePrimary Health Care Centres
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