Repeatability and reproducibility of pulse wave velocity in relation to hemodynamics and sodium excretion in stable patients with hypertension.

OBJECTIVE: Pulse wave velocity (PWV) is a useful marker for determining subclinical vascular damage and patient risk stratification. Repeatability and reproducibility of PWV in relation to influencing factors have not yet been determined. This study examined the repeatability and reproducibility of PWV, and whether hemodynamics and sodium excretion impact on PWV in hypertensive patients remaining on stable medication. METHODS: Office blood pressure (BP), heart rate (HR), carotid--femoral PWV and central BP (SphygmoCor device), impedance cardiography (HOTMAN device) and 24-h urinary sodium excretion (UNa) were measured at baseline and after 4 weeks in 74 hypertensive patients (age 56.8 ±â€Š11.5 years, mean ±â€ŠSD). Two PWV measurements were performed at each visit. RESULTS: Intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) between the two PWV measurements were 0.981 (0.970--0.988) at baseline, 0.975 (0.960--0.984) after 4 weeks and 0.851 (0.773--0.903) between both visits. There were no significant changes in BP, HR, thoracic fluid content, stroke volume and UNa between visits. Despite excellent ICC, reproducibility of PWV was related to BP (P < 0.001) and HR (P = 0.07) changes between visits. Nineteen out of 74 patients had a difference in PWV greater than ±1 m/s between both visits. CONCLUSION: In the medium-term observation, changes in BP and HR seem to affect PWV values. Our findings suggest that the assessment of PWV should be performed under stabilized BP and HR values, particularly in patients with newly diagnosed hypertension and/or low--moderate cardiovascular risk in whom the detection of asymptomatic hypertension-mediated organ damage impact on patient risk stratification.

Comparison of pioglitazone and gliclazide in sustaining glycemic control over 2 years in patients with type 2 diabetes.

OBJECTIVE: The hypothesis that pioglitazone treatment is superior to gliclazide treatment in sustaining glycemic control for up to 2 years in patients with type 2 diabetes was tested. RESEARCH DESIGN AND METHODS: This was a randomized, multicenter, double-blind, double-dummy, parallel-group, 2-year study. Approximately 600 patients from 98 centers participated. Eligible patients had completed a previous 12-month study and consented to continue treatment for a further year. To avoid selection bias, all patients from all centers were included in the primary analysis (a comparison of the time-to-failure distributions of the two groups by using a log-rank test) regardless of whether they continued treatment for a 2nd year. By using repeated-measures ANOVA, time course of least square means of HbA(1c) and homeostasis model of assessment (HOMA) indexes (HOMA-%S and HOMA-%B) were analyzed. RESULTS: A greater proportion of patients treated with pioglitazone maintained HbA(1c) <8% over the 2-year period than those treated with gliclazide. A difference between the Kaplan-Meier curves was apparent as early as week 32 and widened at each time point thereafter, becoming statistically significant from week 52 onward. At week 104, 129 (47.8%) of 270 pioglitazone-treated patients and 110 (37.0%) of 297 gliclazide-treated patients maintained HbA(1c) <8%. Compared with gliclazide treatment, pioglitazone treatment produced a larger decrease in HbA(1c), a larger increase in HOMA-%S, and a smaller increase in HOMA-%B during the 2nd year of treatment. CONCLUSIONS: Pioglitazone is superior to gliclazide in sustaining glycemic control in patients with type 2 diabetes during the 2nd year of treatment.