4.5 A SYSTEMATIC REVIEW AND META-ANALYSIS OF CENTRAL TO BRACHIAL BLOOD PRESSURE AMPLIFICATION IN PATIENTS TYPE 2 DIABETES MELLITUS

• Main Authors: Rachel Climie*, Petr Otahal, Martin Schultz, James Fell, Velandai Srikanth, James Sharman
• Format: Article
• Language: English
• Published: Atlantis Press 2015-11-01
• Series: Artery Research
• Online Access: https://www.atlantis-press.com/article/125930700/view

Background: Brachial blood pressure (BP) may not reflect central BP due to systolic BP (SBP) amplification. Patients with type 2 diabetes mellitus (T2DM) elicit vascular irregularities that may affect SBP amplification or other central BP indices (including pulse pressure [PP], augmentation pressure [AP] and augmentation index [AIx]). By systematic review and meta-analysis, this study aimed to determine the magnitude and variation of central-to-brachial SBP and PP amplification, AIx and AP in T2DM compared to non-diabetic controls. Methods: Online databases were searched for published studies reporting invasive or non-invasive central and brachial SBP in T2DM and non-diabetic controls. Random effects meta-analyses and meta-regression were used to analyse the studies. Results: We identified 17 studies with a total of 2,711 T2DM and 10,460 non-diabetic controls. There was no significant difference in SBP amplification between groups (T2DM = 10.8, non-diabetic = 10.2 mmHg; pooled estimate = 0.6 mmHg, 95%CI −0.3, 1.5, p = 0.21), but large variation in both (T2DM range = 2.0–16.6 mmHg, non-diabetic range = 1.0–16.1 mmHg). In the meta-regression, duration of T2DM explained 16.3% of the variance in the pooled data (p = 0.15); the difference in amplification between groups increasing by 0.3 mmHg per year of T2DM. PP amplification was not significantly different between groups (p = 0.16). AP, AIx and AIx corrected for heart rate were significantly higher in T2DM (p < 0.05 all). Conclusions: Patients with T2DM have increased AP and AIx, but no difference in SBP (or PP) amplification compared to non-diabetic individuals. However, SBP amplification is highly variable and increases with duration of T2DM; altogether confirming that central systolic loading cannot be reliably estimated from brachial BP in T2DM.