Patients with Type 2 diabetes mellitus have an exaggerated brachial and central blood pressure response to exercise: relation to left ventricular hypertrophy

Due to differences in pressure amplification, central BP can differ greatly between individuals with similar brachial BP. Recent large trials have highlighted an independent role of central BP for predicting CV events. However, measuring central BP requires extra effort and dedicated equipment. This study sought to identify individuals most likely to clinically benefit from assessment of central BP. Supine brachial BP was recorded by sphygmomanometry and central BP by validated radial tonometry in a heterogeneous population of 765 people (214 healthy, 207 with known or suspected CAD, 219 with type 2 diabetes, 125 at increased risk of CVD). Normal central SBP was defined as 115 mmHg (men) or 109 mmHg (women) based on Framingham data. Amplification of SBP (SBPamp) was the difference between brachial and central SBP. Across all levels of brachial BP, there was wide variation in SBPamp (2 – 33 mmHg, mean SD, 12 5 mmHg). Normal or high-normal brachial SBP was evident in 68% (n 521) of the population. However, 47% (n 246) of these 521 people had above normal central SBP. There was no additional value (in terms of categorizing individuals as having “normal” or “high” BP) in assessing central BP in people with brachial SBP 160 mmHg because central SBP was high (139 mmHg) in all. The table shows individuals grouped according to brachial SBP and the impact of central SBP measurement on BP categorization in. In terms of further assessing whether patients have, or do not have, elevated SBP, people with normal to mild hypertension (160 mmHg) are those most likely to benefit from central BP monitoring. This does not exclude central BP monitoring as being useful in selected individuals from these or other groups