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Brachial-to-radial systolic blood pressure amplification in patients with type 2 diabetes mellitus

journal contribution
posted on 2023-05-18, 14:49 authored by Rachel ClimieRachel Climie, Dean PiconeDean Picone, Michelle Keske, James SharmanJames Sharman
Brachial-to-radial-systolic blood pressure amplification (Bra-Rad-SBPAmp) can affect central SBP estimated by radial tonometry. Patients with type 2 diabetes mellitus (T2DM) have vascular irregularities that may alter Bra-Rad-SBPAmp. By comparing T2DM with non-diabetic controls, we aimed to determine the (1) magnitude of Bra-Rad-SBPAmp; (2) haemodynamic factors related to Bra-Rad-SBPAmp; and (3) effect of Bra-Rad-SBPAmp on estimated central SBP. Twenty T2DM (64 ± 8 years) and 20 non-diabetic controls (60 ± 8 years; 50% male both) underwent simultaneous cuff deflation and two-dimensional ultrasound imaging of the brachial and radial arteries. The first Korotkoff sound (denoting SBP) was identified from the first inflection point of Doppler flow during cuff deflation. Bra-Rad-SBPAmp was calculated by radial minus brachial SBP. Upper limb and systemic haemodynamics were recorded by tonometry and ultrasound. Radial SBP was higher than brachial SBP for T2DM (136 ± 19 vs 127 ± 17 mm Hg; P < 0.001) and non-diabetic controls (135 ± 12 vs 121 ± 11 mm Hg; P < 0.001), but Bra-Rad-SBPAmp was significantly lower in T2DM (9 ± 8 vs 14 ± 7 mm Hg; P = 0.042). The product of brachial mean flow velocity × brachial diameter was inversely and independently correlated with Bra-Rad-SBPAmp in T2DM (β = −0.033 95% confidence interval −0.063 to −0.004, P = 0.030). When radial waveforms were calibrated using radial, compared with brachial SBP, central SBP was significantly higher in both groups (T2DM, 116 ± 13 vs 125 ± 15 mm Hg; and controls, 112 ± 10 vs 124 ± 11 mm Hg; P < 0.001 both) and there was a significant increase in the number of participants classified with ‘central hypertension’ (SBP ≫ 130 mm Hg; P = 0.004). Compared with non-diabetic controls, Bra-Rad-SBPAmp is significantly lower in T2DM. Regardless of disease status, radial SBP is higher than brachial SBP and this results in underestimation of central SBP using brachial-BP-calibrated radial tonometry.


Publication title

Journal of Human Hypertension








Menzies Institute for Medical Research


Nature Publishing Group

Place of publication

United Kingdom

Rights statement

Copyright 2015 Macmillan Publishers Limited

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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