Pulse pressure is independently associated with sensorimotor peripheral neuropathy in patients with type-2 Diabetes

Background:The mechanisms responsible for the onset and progression of sensorimotor peripheral neuropathy (SMPN )in type-2 diabetes remain largely unknown.Although a link between hypertension and SMPN has been observed, it is not clear which blood pressure component ( i.e. systolic,SBP;diastolic,DBP;or pulse pressure,PP )is primarily involved. Aim:To determine the relationship between different blood pressure components and parameters of nerve function in type 2 diabetes. Methods: In 55 consecutive ambulatory patients with stable type 2 diabetes ( age 62.6+-8.0 years, mean+-SD) we measured clinic blood pressure and 10 neurophysiologic parameters: motor nerves conduction velocity ( median,ulnar,posterior tibial and peroneal nerve ),sensory amplitude, and latency ( median,ulnar and sural nerve ). Results:Univariate analysis showed that age,diabetes duration, SBP and PP were negatively correlated with nerve function.Regression analysis showed that, after correcting for age, duration of diabetes, glycated haemoglobin, body mass index, microalbuminuria, and SBP, PP was independently and negatively associated with nerve conduction velocity ( median, P= 0.011; ulnar, P= 0.001; peroneal, P= 0.006; and posterior tibial , P= 0.005 and signal amplitude ( ulnar, P =0.027; sural, P =0.055 ) and positively associated with signal latency ( median,P =0.083; sural, P=0.021 ). SBP was negatively associated with signal amplitude ( median, P= 0.012 ) and positively associated with latency ( ulnar, P= 0.018 ). By contrast, DBP failed to show any significant correlation with nerve function. Conclusion: PP is strongly associated with neurophysiologic parameters of nerve function in patients with type 2 diabetes. This relationship is independent of traditional risk factors and other BP components.