Pulse pressure and chronic kidney disease in patients with type 2 diabetes.

To determine the association between both age and degree of albuminuria and pulse pressure in patients with type 2 diabetes, we conducted this study consisting of two cross-sectional observations. A total of 833 ambulatory and 107 hospitalized type 2 diabetic patients with serum creatinine <2.00 mg/dl were studied. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were compared among ambulatory patients stratified according to the degree of albuminuria, as well as according to age at 10-year intervals. In the hospitalized patients, 24-h blood pressure was monitored, and 24-h SBP, DBP, and PP were correlated with aortic pulse wave velocity (PWV) and mean intima-media thickness (IMT) of the carotid arteries. In the ambulatory patients, SBP and PP were greater in patients with microalbuminuria and clinical albuminuria, as well as in the older groups, whereas DBP tended to be lower in the older age groups. Multiple regression analysis adjusted for covariates including age indicated that increased albuminuria was independently associated with greater PP (p < 0.001). In the hospitalized patients, stepwise increases were observed in SBP and PP (daytime, nighttime and overall 24-h), but not in DBP, in microalbuminuric and albuminuric patients. SBP and PP were positively and DBP was negatively associated with aortic PWV; however, no association was found with IMT. In conclusion, PP is closely associated with higher age, degree of albuminuria, and large artery stiffness in patients with type 2 diabetes.