Role of Central Pressure Monitoring in Patients with Diabetes Mellitus and Elevated Blood Pressure
Central Pressure Monitoring in the Management of Patients with Diabetes Mellitus and Elevated Blood Pressure
Using Central Pressure Monitoring with Diabetes Mellitus and Elevated Blood Pressure Patients
Diabetes mellitus is a common chronic disease that affects approximately 10.5% of the population in the USA according to data from 2018 (34 million people). In 2016, a total of 7.8 million hospital discharges were reported with diabetes as any listed diagnosis among US adults aged 18 years or older, with 1.7 million documented for major cardiovascular diseases (75.3 per 1,000 adults with diabetes). According to the 2020 National Diabetes Statistics Report, 68.4% of diabetics had a systolic blood pressure of 140 mmHg or higher, or diastolic blood pressure of 90 mmHg or higher, or were on prescription medication for their high blood pressure. Diabetes with associated hypertension is responsible for continued morbidity, mortality and high socioeconomic costs despite the widespread availability and use of cuff brachial artery measurements for diagnosis and monitoring.
Central aortic systolic pressure is highly correlated to brachial systolic pressures; however, central systolic pressures cannot be reliably inferred from brachial pressures. Elevated central aortic pressure is predictive of end-organ damage (heart, brain, kidneys). Brachial and central aortic pressures provide complimentary information for risk prediction and management decisions.
Prescription of anti-hypertension medications has the potential of significant benefit but as with all medications, may be associated with adverse consequences (hypotension and drug specific adverse effects) and should always be judicious and carefully considered, particularly in patients with diabetes. Assessment of central pressures provides relevant information that informs prescription medication needs in diabetic patients.
Measurements of central arterial pressures can be incorporated into the current approaches to hypertension management as the dual arterial pressure SphygmoCor XCEL device, the only FDA cleared medical device for non-invasive central arterial pressure waveform analysis for all adults, can provide both brachial and central aortic pressures in the same clinic setting. Independent data have confirmed the reliability of non-invasively obtained central aortic pressures utilizing SphygmoCor technology in numerous patient populations including patients with diabetes.
Based on current technology, the availability of a non-invasive dual arterial pressure measurement system, the compelling clinical rationale and the extensive clinical published research, incorporation of central aortic pressure monitoring, which is complementary to continued reliance on brachial pressure monitoring should be a part of the care of all patients with diabetes and associated hypertension.