Why the radial augmentation index is low in patients with diabetes: The J-HOP study

Background: Radial augmentation index (rAI), a marker of aortic wave reflection, is usually lower in patients with diabetes (DM) than in non-DM subjects, even though atherosclerotic change is advanced in DM. Objective: We sought to explore why rAI in DM is lower than in non-DM. Methods: We performed radial applanation tonometry in 1787 subjects who had at least one cardiovascular risk factor. The rAI was defined as [late systolic shoulder pressure amplitude (PP2)]/[radial pulse pressure (rPP)]. The late systolic shoulder blood pressure (SBP2) and PP2 of a radial pressure wave were used as estimates of the central SBP and PP (cPP), respectively. Results: The age (65.8 +/- 9.8 vs. 65.8 +/- 12.1 yrs) and mean brachial SBP (141 +/- 16 vs. 141 +/- 17 mmHg) were similar between the DM and non-DM groups. The rAI was significantly lower in the DM group (83.3 +/- 14.1 vs. 87.3 +/- 15.7%, p < 0.001), but clinic PP (62 +/- 14 vs. 59 +/- 14 mmHg, p < 0.001) and cPP (51 +/- 15 vs. 49 +/- 15 mmHg, p = 0.019) were significantly greater in the DM group than in the non-DM group. In multivariable analyses adjusting for covariates, the significant determinants of rAI were the estimated glomerular filtration rate (eGFR) (beta = 0.17, p < 0.001) in the DM group, and the log-transformed homeostatic model assessment of insulin resistance (HOMA-IR) (beta = -0.15, p < 0.001) in the non-DM group. The same trends were also seen for central SBP and cPP. Conclusions: The lower rAI in DM associated with higher cPP compared to non-DM suggests proximal conduit-predominant arterial stiffening causing reduced reflection coefficients at systemic reflection sites. As renal function decreases, a cPP increase may overcome the increase of augmentation pressure in the DM group. (C) 2016 Elsevier Ireland Ltd. All rights reserved.