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Ambulatory Systolic Blood Pressure and Carotid Atherosclerosis in Type 2 Diabetes: A Critical Role of Glycemic

Hui Liu1, Qidong Zheng2, Hengjing Wu1

  • 1Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China.

Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy
|April 20, 2026
PubMed

Insights

In poorly controlled type 2 diabetes, elevated systolic blood pressure (SBP) measured by ambulatory blood pressure monitoring (ABPM) is linked to carotid plaques. This highlights the importance of combined ABPM and HbA1c assessment for early vascular risk detection.

Area of Science:

  • Cardiology
  • Endocrinology
  • Vascular Medicine

Background:

  • Ambulatory blood pressure monitoring (ABPM) is crucial for cardiovascular risk assessment in diabetes.
  • The association between ABPM and early atherosclerosis, specifically carotid plaques, remains unclear in diabetic patients.

Purpose of the Study:

  • To investigate the relationship between ABPM parameters and the presence of carotid plaques in individuals with type 2 diabetes.
  • To stratify these associations based on glycated hemoglobin (HbA1c) levels.

Main Methods:

  • A cross-sectional observational study analyzed 498 patients with type 2 diabetes using 24-hour ABPM and carotid ultrasound.
  • Patients were stratified by HbA1c levels (<5.7%, 5.7-6.4%, >6.4%).
  • Logistic regression, adjusted for confounders, assessed associations between ABPM and carotid plaques.

Main Results:

  • Carotid plaque prevalence was 46.6% in the study population.
  • Elevated systolic blood pressure (SBP) by ABPM was significantly associated with carotid plaques only in patients with HbA1c ≥6.4%.
  • Specific associations included 24-hour SBP ≥130 mmHg (OR=2.14), awake SBP ≥135 mmHg (OR=1.87), and asleep SBP ≥120 mmHg (OR=1.78). No significant associations were found for diastolic BP or in lower HbA1c groups.

Conclusions:

  • In type 2 diabetes with poor glycemic control (HbA1c ≥6.4%), elevated SBP measured via ABPM is an independent predictor of carotid plaques.
  • Combined assessment of ABPM and HbA1c levels can aid in detecting early vascular risk.
Abstract

Keywords:
HbA1cambulatory blood pressurecarotid plaquediabetes mellitussystolic blood pressure

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