Kidney Week

Abstract: TH-PO692

Impact of Pulse Pressure and Mean Arterial Pressure on All-Cause and Cardiovascular Mortality in Subjects with Diabetes in a Nationwide Cohort from a General Japanese Population

Session Information

• Hypertension and CVD: Epidemiology, Risk Factors
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

• Toida, Tatsunori, University of Miyazaki, Miyazaki, MIyazaki, Japan

Tatsunori Toida,

• Sato, Yuji, University of Miyazaki Hospital, Miyazaki, Japan

Yuji Sato,

• Fujimoto, Shouichi, University of Miyazaki, Miyazaki, Japan

Shouichi Fujimoto,

• Konta, Tsuneo, Yamagata University Graduate School of Medical Science, Yamagata, Japan

Tsuneo Konta,

• Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan

Kazuhiko Tsuruya,

• Shibagaki, Yugo, St Marianna University Hospital, Kawasaki, Japan

Yugo Shibagaki,

• Iseki, Kunitoshi, Nakamura Clinic, Urasoe, Japan

Kunitoshi Iseki,

• Narita, Ichiei, Niigata University, Niigata, Japan

Ichiei Narita,

• Kasahara, Masato, Institute for Clinical and Translational Science Nara Medical University Hospital, Kashihara, Japan

Masato Kasahara,

• Moriyama, Toshiki, Osaka University Health Care Center, Toyonaka, Japan

Toshiki Moriyama,

• Kondo, Masahide, University of Tsukuba, Tsukuba, Japan

Masahide Kondo,

• Yamagata, Kunihiro, University of Tsukuba, Tsukuba, Japan

Kunihiro Yamagata,

• Asahi, Koichi, Iwate Medical University, Morioka, Japan

Koichi Asahi,

• Watanabe, Tsuyoshi, Fukushima Medical University School of Medicine, Fukushima City, Japan

Tsuyoshi Watanabe,

Background

In the general population, blood pressure (BP) and physiological factors that influence arterial stiffness, such as pulse pressure (PP, difference between systolic BP [SBP] and diastolic BP [DBP]) and mean arterial pressure (MAP, 2/3 DBP + 1/3 SBP), are associated with mortality and cardiovascular (CV) outcomes; however, the impact of these markers in diabetic patients remains unclear.

Methods

Study design: Cohort study.
Setting, Participants: Data from a nationwide database from the annual “Specific Health Check and Guidance in Japan”, including 20,748 people with diabetes, eGFR≥30, aged 40 to 75 years, and 42.4% female.
Predictor: SBP, DBP, PP, and MAP at baseline
Outcomes: All-cause and CV mortality during a median follow-up of 5.3 years.
Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between predictors and outcomes, and adjusted for potential confounders.

Results

During the follow-up, the incidence of death was 448 (4.1 per 1000 person-years), including 101 CV deaths (0.9 per 1000 person-years). HRs for all-cause mortality for each 1-SD elevation in SBP, DBP, PP, and MAP did not significantly increase. On the other hand, HRs for the CV mortality of MAP significantly increased, whereas those of other BP parameters did not, as shown in Table 1. Furthermore, when patients were divided into two groups based on the presence and absence of proteinuria, HRs for CV mortality for each 1-SD elevation in PP and MAP significantly increased in subjects without proteinuria. However, no parameters correlated with cardiovascular mortality in subjects with proteinuria.

Conclusion

In diabetes patients without proteinuria, markers of arterial stiffness, such as PP and MAP, may be suitable for predicting CV outcomes.

Multivariate analysis of blood pressure parameters and cardiovascular death.

* Diabetes mellitus patients whose eGFR was more than 30 ml/min/1.73m2.