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Elevated Brain Natriuretic Peptide and High Brachial Pulse Pressure in Patients With Diabetes
Jean-Guillaume Dillinger1,2, Charlotte Patin1, Philippe Bonnin2
1Université de Paris, AP-HP, Hôpital Lariboisière, Département de Cardiologie, Paris, France.
Insights
In diabetic patients, elevated brachial pulse pressure, an easily measured blood pressure parameter, independently predicts a higher risk of developing heart failure. This finding aids in early detection and risk stratification for cardiovascular events.
Area of Science:
- Cardiology
- Endocrinology
- Hypertension Research
Background:
- Heart failure (HF) is a common complication in patients with diabetes mellitus (DM).
- Early detection of HF risk in diabetic patients is crucial for improving prognosis.
Purpose of the Study:
- To investigate if brachial blood pressure (BP) analysis in daily practice can identify diabetic patients at high risk for subsequent HF.
- To assess the association between BP parameters and HF risk, defined by brain natriuretic peptide (BNP) levels.
Main Methods:
- A prospective study of 3,367 outpatients with DM and no prior cardiovascular disease.
- Analysis of brachial blood pressure parameters, including pulse pressure (PP), and their association with HF risk markers (BNP).
- Multivariate analysis and central aortic BP assessment in a subset of patients.
Main Results:
- Brachial pulse pressure (PP) was the strongest predictor of high HF risk compared to other BP measures.
- Elevated PP (≥65 mm Hg) was independently associated with a 2.1-fold increased risk of incident HF.
- High HF risk was linked to increased arterial stiffness and subendocardial ischemia.
- Elevated PP was also associated with increased all-cause mortality during follow-up.
Conclusions:
- Brachial pulse pressure is a powerful, independent, and easily recorded parameter for identifying diabetic patients at high risk of heart failure.
- This finding supports the use of brachial PP for early HF risk stratification in diabetic populations.
Background:
Heart failure (HF) is frequent in patients with diabetes mellitus (DM), and early detection improves prognosis. We investigated whether analysis of brachial blood pressure (BP) in daily practice can identify patients with DM and high risk for subsequent HF, as defined by brain natriuretic peptide (BNP) >50 pg/ml.
Methods:
3,367 outpatients with DM without a history of cardiovascular disease were enrolled in a prospective study.
Results:
Age (mean ± SD) was 56 ± 14 years, 57% were male, 78% had type 2 DM, and HbA1C was 7.4 ± 1.4%. A history of hypertension was recorded in 43% of patients and uncontrolled BP was observed in 13%. BNP concentration (mean ± SD) was 21 ± 21 ng/l and 9% of patients had high risk of incident HF. Brachial pulse pressure (PP) was the best BP parameter associated with high risk of incident HF compared with diastolic, systolic, or mean BP (area under the receiver operating characteristic curve: 0.70, 0.65, 0.57, and 0.57, respectively). A multivariate analysis demonstrated that elevated PP was independently associated with high risk of incident HF (odds ratio [95% confidence interval, CI]: 2.1 [1.5-2.8] for PP ≥65 mm Hg). Study of central aortic BP and pulse wave velocity on 117 patients demonstrated that high risk of incident HF was associated with increased arterial stiffness and subendocardial ischemia. After a mean follow-up of 811 days, elevated PP was associated with increased all-cause mortality (hazard ratio [95% CI]: 1.7 [1.1-2.8]).
Conclusions:
Brachial PP is powerful and independent "easy to record" BP parameter associated with high risk of incident HF in diabetic patients.
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