414 American Journal of Hypertension 35(5) May 2022 ORIGINAL ARTICLE 1 Université de Paris, AP-HP, Hôpital Lariboisière, Département de Cardiologie, Paris, France; 2 Université de Paris, AP-HP, Hôpital Lariboisière, Physiologie Clinique—Explorations Fonctionnelles, Paris, France; 3 Université de Paris, AP-HP, Hôpital Lariboisière, Centre Universitaire du Diabète et de ses Complications, Paris, France. © The Author(s) 2021. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Correspondence: Jean-Guillaume Dillinger ( jean-guillaume.dillinger@ aphp.fr). Initially submitted June 23, 2021; date of frst revision October 14, 2021; accepted for publication December 30, 2021; online publication December 30, 2021. Te incidence of heart failure (HF) is high among patients with diabetes (DM), and HF is a major contributor to car- diovascular (CV) morbidity and mortality in patients with DM. Tere are many reasons: hypertension is very common, arterial stifness is usual in diabetic patients, diabetic cardi- omyopathy has been described, coronary artery disease is common, autonomic neuropathy could play a role as fuid overload. Te prevalence of DM in patients with HF ranges from approximately 25% to 40%, depending on the population studied. 1 Te prognosis of patients with HF is worse in those with DM compared with those without DM. 1,2 Impaired lef ventricular (LV) systolic function with or without coronary artery disease and diastolic dysfunction related to LV hyper- trophy and remodeling can contribute to HF in patients with DM. 3 Early identifcation of HF is mandatory in patients with DM to improve prognosis and adapt therapeutics, 4 for example introducing sodium–glucose cotransporter 2 inhibitors. Diagnosis of HF is difcult in daily practice because HF Elevated Brain Natriuretic Peptide and High Brachial Pulse Pressure in Patients With Diabetes Jean-Guillaume Dillinger, 1,2 Charlotte Patin, 1 Philippe Bonnin, 2 Tiphaine Vidal-Trecan, 3 Elise Paven, 1 Jean-François Gautier, 3 Jean-Pierre Riveline, 3 Guy Amah, 2 and Patrick Henry 1 BACKGROUND Heart failure (HF) is frequent in patients with diabetes mellitus (DM), and early detection improves prognosis. We investigated whether analysis of brachial blood pressure (BP) in daily practice can identify patients with DM and high risk for subsequent HF, as defned by brain natriuretic peptide (BNP) >50 pg/ml. METHODS 3,367 outpatients with DM without a history of cardiovascular disease were enrolled in a prospective study. RESULTS Age (mean ± SD) was 56 ± 14 years, 57% were male, 78% had type 2 DM, and HbA1C was 7.4 ± 1.4%. A history of hypertension was re- corded in 43% of patients and uncontrolled BP was observed in 13%. BNP concentration (mean ± SD) was 21 ± 21 ng/l and 9% of patients had high risk of incident HF. Brachial pulse pressure (PP) was the best BP parameter associated with high risk of incident HF compared with diastolic, systolic, or mean BP (area under the receiver operating char- acteristic curve: 0.70, 0.65, 0.57, and 0.57, respectively). A multivariate analysis demonstrated that elevated PP was independently associated with high risk of incident HF (odds ratio [95% confdence interval, CI]: 2.1 [1.5–2.8] for PP ≥65 mm Hg). Study of central aortic BP and pulse wave velocity on 117 patients demonstrated that high risk of incident HF was associated with increased arterial stifness and subendocardial ischemia. After a mean follow-up of 811 days, elevated PP was asso- ciated with increased all-cause mortality (hazard ratio [95% CI]: 1.7 [1.1–2.8]). CONCLUSIONS Brachial PP is powerful and independent “easy to record” BP param- eter associated with high risk of incident HF in diabetic patients. GRAPHICAL ABSTRACT Keywords: blood pressure; brain natriuretic peptide; diabetes mellitus; heart failure; hypertension; mean blood pressure; pulse pressure. https://doi.org/10.1093/ajh/hpab179 Downloaded from https://academic.oup.com/ajh/article/35/5/414/6490212 by guest on 02 April 2023