Research Article Volume 5 Issue 2
Medicine Department, Lagos State University Teaching Hospital, Nigeria
Correspondence: Adegbenga B Ademolu, Medicine Department, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, Tel +2348033575940
Received: February 01, 2018  Published: March 5, 2018
Citation: Adegbenga AB. Mean arterial pressure, pulse pressure in diabetic and non diabetic male African population: a comparative study. J Diabetes Metab Disord Control. 2018;5(2):3136. DOI: 10.15406/jdmdc.2018.05.00135
Objective: Mean arterial pressure (MAP) and pulse pressure (PP) are important parameters that predict cardiovascular risk both in diabetics and non diabetic population in both genders. Data on this subject area in Nigeria, Africa and worldwide are few. The aim of this paper is to examine the pattern of MAP and PP in a diabetic male population compared to a general population of males in Africans. Is the pattern of MAP and PP the same in both diabetic and non diabetic? Does any significant disparity exist?
Methods: This is a preliminary prospective study. Randomly, the blood pressure of 20 men from the general Lagos population was taken at heart level using a mercurial sphygmomanometer during a free medical screening exercise in surlier. Similarly, the blood pressure of 20 consecutive known diabetic men was taken at heart level using a mercurial sphygmomanometer. The diabetic patients were recruited from the endocrinology clinic of the Lagos State University Teaching Hospital, Ikeja, and Lagos, Nigeria. Individual consent was obtained from both groups of participants. The PP of each individual was computed by subtracting the diastolic blood pressure from the systolic blood pressure. The MAP of each individual was computed by adding one third of the PP to the diastolic blood pressure. The limitation of this study includes the very small size of the study population and Africans are not well represented in the sample size.
Results or case presentation: The age range of the non diabetic was 31 to 70years while the age range of the diabetics was 31 to 82years.The mean(average) pulse pressure among the non diabetic was 46.5mmHg while the average pulse pressure among the diabetics was 67.7mmHg. Among the non diabetic the mean of the MAP was 103.20mmHg while among the diabetics it was 96.97mmHg.The highest MAP among the diabetic group was 133.33mmHg while the highest among the non diabetic was 150mmHg.
Discussion: This paper shows that the average MAP is higher in the general African male population than among diabetic male Africans. This supports autopsy finding in literature that hemorrhagic cerebra vascular accident occurs slightly more commonly in non diabetic compared to diabetics while cerebral infarction occurs more in diabetic subjects compared to non diabetics. Similarly it was noticed in the study that African male diabetics tend to have higher pulse pressure than the general African population.
Conclusion: MAP is lower in male African diabetics compared to the general African male population. Conversely, PP is higher among male African diabetics compared to the general African male population.
Keyword: Mean Arterial Pressure, Pulse Pressure, Diabetics, Non Diabetics
Mean arterial pressure and pulse pressure are important parameters that predicts cardiovascular risk both in diabetics and non diabetic population in both gender. Data on this subject area in Nigeria, Africa and worldwide are few. It was estimated that in the United States 30% of inpatient cost (around 22,254 million US dollars) was due to cardiovascular vascular disease (CVD) hospitalization among people with type 2 diabetes in 2012.^{1,2} An even greater diabetesattributable hospitalization cost of 46.5% was found in a major hospital in Cambridge shire, England.^{3} A paradoxical finding is that the wellknown relationship between CVD and systolic blood pressure in the general population was insignificant in a metaanalysis using data from people with diabetes.^{4} Greater use of antihypertensive medicine and a higher prevalence of heart failure than people without diabetes have been proposed as possible reasons for this paradox.^{5,6} Mean arterial pressure (MAP) reflects both peripheral resistance and cardiac output. Recently, in the ADVANCE study,^{7} a trial among type 2 diabetes patients, MAP correlated with major CVD events: with a 13% increase in risk per 13 mmHg increase in MAP. If MAP is a marker for CVD risk among type 2 diabetes patients, it should be associated with greater CVD hospitalization. However, the association between MAP and hospitalization in type 2 diabetes has not been investigated, and a doseresponse relationship between CVD hospitalization and MAP may exist. Moreover, blood pressure and CVD are influenced by long term glycemic control,^{812} usually assessed using HbA1c, which also has an association with hospitalization risk.^{13}
The pulse pressure is the difference between the systolic and diastolic blood pressure. It is influenced by the stroke volume and vascular resistance. As people age the walls of their arteries become stiffer. This increases the pulse pressure. A high pulse pressure may be associated with reduced coronary perfusion. It may therefore be a predictor of future cardiovascular events, but this has not been confirmed by metaanalysis.^{14} Classically, a wide (high) pulse pressure is a sign of aortic valve regurgitation and a narrow (low) pulse pressure is a sign of aortic stenosis. In the absence of valvular disease, a high pulse pressure may be a sign of stiffness in the arterial walls, and is a risk factor for coronary artery disease and myocardial infarction. The aim of this paper is to examine the pattern of mean arterial pressure and pulse pressure in a diabetic male population compared to a general population of males in Africans. Is the pattern of mean arterial pressure, pulse pressure the same in both diabetic and non diabetic? Does any significant disparity exist?
This is a preliminary comparative prospective study that looks into the mean arterial pressure and pulse pressure of a diabetic and non diabetic male population in Africa. Randomly, the blood pressure of 20 men from the general Lagos population were taken at heart level using mercurial sphygmomanometer during a free medical screening exercise in surlier Lagos. Similarly, the blood pressure of 20 consecutive known diabetic men was taken at heart level using a mercurial sphygmomanometer. The diabetic patients were recruited from the endocrinology clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Individual consent was obtained from both groups of participants. The pulse pressure of each individual was computed by subtracting the diastolic blood pressure from the systolic blood pressure. The mean arterial pressure of each individual was computed by adding one third of the pulse pressure to the diastolic blood pressure. The limitation of this study includes the very small size of the study population and Africans are not well represented in the sample size. The study was analysed using SPSS version 17.0 version.
By using descriptive statistics among the nondiabetics male Africans, the mean of the ages was 49.8 years with standard error of the mean of 3.02,the median was 52.5 years with mode of 31 years. The standard deviation was 13.5 with 0.143 Skewness, the least age was 31 and the highest was 70.The range of Mean Arterial Pressure was 110mmHg, the lowest value was 73.33 while the highest was 183.33, the mean was 104.64 while the standard error of the mean was 5.6, the median was 96.67, the distribution was bimodal with values of 93.3mmHg and 96.67mmHg. The standard deviation was 25.29 with a variance of 640.08; the Skewness was 1.81 with standard error of skewness of 0.512 (Table 1). The pulse pressure range was 100mmHg, the least value was 30mmHg while the maximum was 130mmHg.the mean was 50.70mmHg while the standard error of the mean was 5.13, the standard deviation was 22.94 while the variance was 526.53.The Skewness was 2.50 with standard error of Skewness of 0.512. By using Pearson correlation (Table 2), age correlated fairly well with pulse pressure with a value of 0.408 and pvalue of 0.075 compared to mean arterial pressure where the correlation was 0.294 with a pvalue of 0.209.Similarly,pulse pressure in these nondiabetics correlated significantly well with mean arterial pressure with a value of 0.876 with pvalue of 0.0001. By using descriptive statistics among the diabetic Africans (Table 3), the mean of the ages was 67.4 years with a standard error of the mean of 2.61, and the median was 69.5 years with a mode of 65 years. The standard deviation was 11.69 with Skewness of 1.863,the least age was 31years and the highest was 82.The range of the mean arterial pressure was 60mmHg,the lowest value was 73.33mmHg while the highest was 133.33,the mean was 96.96 mmHg while the standard error of the mean was 4.06,the median was 95mmHg,the distribution of mean arterial pressure was bimodal with values of 80mmHg and 96.67mmHg,the standard deviation was 18.17 with a variance of 330.26, the Skewness was 0.67 with standard error of Skewness of 0.512.


Age 
Systolic 
Diastolic 
PP 
MAP 
N 
Valid 
20 
20 
20 
20 
20 
Missing 
0 
0 
0 
0 
0 

Mean 
49.8 
138.45 
87.75 
50.7 
104.649 

Std. Error of Mean 
3.02411 
8.80983 
4.24008 
5.13097 
5.65721 

Median 
52.5 
130 
80 
41 
96.67 

Mode 
31 
130 
80 
40 
93.33a 

Std. Deviation 
13.52425 
39.39874 
18.96222 
22.94639 
25.29982 

Variance 
182.905 
1552.261 
359.566 
526.537 
640.081 

Skewness 
0.143 
2.232 
1.372 
2.506 
1.814 

Std. Error of Skewness 
0.512 
0.512 
0.512 
0.512 
0.512 

Range 
39 
170 
80 
100 
110 

Minimum 
31 
100 
60 
30 
73.33 

Maximum 

70 
270 
140 
130 
183.33 
Table 1 Statistical analysis of mean arterial pressure (map), pulse pressure (pp) in non diabetics male Africans
^{a}Multiple modes exist. The smallest value is shown


Age 
Systolic 
Diastolic 
PP 
MAP 
AGE 
Pearson Correlation 
1 
0.347 
0.227 
0.408 
0.294 
Sig. (2tailed) 
0.134 
0.335 
0.075 
0.209 

Sum of Squares and Crossproducts 
3475.2 
3510.8 
1108 
2402.8 
1908.816 

Covariance 
182.905 
184.779 
58.316 
126.463 
100.464 

N 
20 
20 
20 
20 
20 

SYSTOLIC 
Pearson Correlation 
0.347 
1 
.927** 
.951** 
.982** 
Sig. (2tailed) 
0.134 
0 
0 
0 

Sum of Squares and Crossproducts 
3510.8 
29492.95 
13160.25 
16332.7 
18603.89 

Covariance 
184.779 
1552.261 
692.645 
859.616 
979.152 

N 
20 
20 
20 
20 
20 

DIASTOLIC 
Pearson Correlation 
0.227 
.927** 
1 
.765** 
.981** 
Sig. (2tailed) 
0.335 
0 
0 
0 

Sum of Squares and Crossproducts 
1108 
13160.25 
6831.75 
6328.5 
8940.955 

Covariance 
58.316 
692.645 
359.566 
333.079 
470.577 

N 
20 
20 
20 
20 
20 

PP 
Pearson Correlation 
0.408 
.951** 
.765** 
1 
.876** 
Sig. (2tailed) 
0.075 
0 
0 
0 

Sum of Squares and Crossproducts 
2402.8 
16332.7 
6328.5 
10004.2 
9662.934 

Covariance 
126.463 
859.616 
333.079 
526.537 
508.575 

N 
20 
20 
20 
20 
20 

MAP 
Pearson Correlation 
0.294 
.982** 
.981** 
.876** 
1 
Sig. (2tailed) 
0.209 
0 
0 
0 

Sum of Squares and Crossproducts 
1908.816 
18603.89 
8940.955 
9662.934 
12161.54 

Covariance 
100.464 
979.152 
470.577 
508.575 
640.081 


N 
20 
20 
20 
20 
20 
Table 2 Pearson correlation of mean arterial pressure (map) and pulse pressure (pp) in non diabetic male Africans
**Correlation is significant at the 0.01 level (2tailed).


Age 
Systolic 
Diastolic 
PP 
MAP 
FBS 
N 
Valid 
20 
20 
20 
20 
20 
20 
Missing 
0 
0 
0 
0 
0 
0 

Mean 
67.4 
142.1 
74.4 
67.7 
96.9665 
143.1 

Std. Error of Mean 
2.61514 
5.23445 
4.28117 
4.66628 
4.06366 
13.54095 

Median 
69.5 
145 
70 
64 
95 
126.5 

Mode 
65.00a 
120 
70 
60 
80.00a 
111 

Std. Deviation 
11.69525 
23.40917 
19.14598 
20.86826 
18.17325 
60.55698 

Variance 
136.779 
547.989 
366.568 
435.484 
330.267 
3667.147 

Skewness 
1.863 
0.11 
0.493 
0.383 
0.674 
1.203 

Std. Error of Skewness 
0.512 
0.512 
0.512 
0.512 
0.512 
0.512 

Range 
51 
80 
70 
80 
60 
200 

Minimum 
31 
100 
40 
30 
73.33 
73 

Maximum 
82 
180 
110 
110 
133.33 
273 
Table 3 Statistical analysis of mean arterial pressure (map) and pulse pressure (pp) in diabetic male Africans
^{a}Multiple modes exist. The smallest value is shown
The pulse pressure range was 80mmHg, the least was 30mmHg and the highest was 110mmHg, the mean was 67.7 mmHg, with a standard error of the mean of 4.6, the median was 64mmHg, the mode was 60mmHg, the standard deviation was 20.86 while the variance was 435.48.The Skewness was 0.383 with standards error of Skewness of 0.512. The fasting blood sugar range was 200mg/dl, the least was 73mg/dl and the highest was 273mg/dl, the mean was 143.1mg/dl with a standard error of the mean of 13.54, the median was 126.5mg/dl, the mode was 111mg/dl, the standard deviation was 60.55 while the variance was 3667.1.The Skewness was 1.203 with standard error of Skewness of 0.512. By using the person correlate among these diabetic Africans (Table 4), age was inversely correlated to mean arterial pressure with value of 0.082 with pvalue 0.730, it correlated poorly with pulse pressure with values of 0.237 and pvalue o.314,age correlation value to fasting blood sugar was not significant with a value of 0.056 and a pvalue of 0.815.In diabetics Africans, no significant correlation between pulse pressure with mean arterial pressure and fasting blood sugar with values of 0.048,pvalue 0.841 and 0.025,pvalue 0.918.Similarly,Mean arterial pressure has no significant correlation with fasting blood sugar with values of 0.045,pvalue 0.850.


Age 
Systolic 
Diastolic 
PP 
MAP 
FBS 


Age 
Pearson Correlation 
1 
0.077 
0.164 
0.237 
0.082 
0.056 


Sig. (2tailed) 
0.747 
0.489 
0.314 
0.73 
0.815 


Sum of Squares and Crossproducts 
2598.8 
401.2 
699.2 
1100.4 
332.392 
751.2 


Covariance 
136.779 
21.116 
36.8 
57.916 
17.494 
39.537 


N 
20 
20 
20 
20 
20 
20 


Systolic 
Pearson Correlation 
0.077 
1 
.534* 
.631** 
.805** 
0.05 


Sig. (2tailed) 
0.747 
0.015 
0.003 
0 
0.835 


Sum of Squares and Crossproducts 
401.2 
10411.8 
4551.2 
5860.6 
6504.747 
1341.8 


Covariance 
21.116 
547.989 
239.537 
308.453 
342.355 
70.621 


N 
20 
20 
20 
20 
20 
20 


Diastolic 
Pearson Correlation 
0.164 
.534* 
1 
0.318 
.932** 
0.034 


Sig. (2tailed) 
0.489 
0.015 
0.172 
0 
0.887 


Sum of Squares and Crossproducts 
699.2 
4551.2 
6964.8 
2413.6 
6160.248 
749.2 


Covariance 
36.8 
239.537 
366.568 
127.032 
324.224 
39.432 


N 
20 
20 
20 
20 
20 
20 


PP 
Pearson Correlation 
0.237 
.631** 
0.318 
1 
0.048 
0.025 


Sig. (2tailed) 
0.314 
0.003 
0.172 
0.841 
0.918 


Sum of Squares and Crossproducts 
1100.4 
5860.6 
2413.6 
8274.2 
344.499 
592.6 


Covariance 
57.916 
308.453 
127.032 
435.484 
18.132 
31.189 


N 
20 
20 
20 
20 
20 
20 


MAP 
Pearson Correlation 
0.082 
.805** 
.932** 
0.048 
1 
0.045 


Sig. (2tailed) 
0.73 
0 
0 
0.841 
0.85 


Sum of Squares and Crossproducts 
332.392 
6504.747 
6160.248 
344.499 
6275.073 
946.107 


Covariance 
17.494 
342.355 
324.224 
18.132 
330.267 
49.795 


N 
20 
20 
20 
20 
20 
20 


FBS 
Pearson Correlation 
0.056 
0.05 
0.034 
0.025 
0.045 
1 


Sig. (2tailed) 
0.815 
0.835 
0.887 
0.918 
0.85 


Sum of Squares and Crossproducts 
751.2 
1341.8 
749.2 
592.6 
946.107 
69675.8 


Covariance 
39.537 
70.621 
39.432 
31.189 
49.795 
3667.147 



N 
20 
20 
20 
20 
20 
20 



*Correlation is significant at the 0.05 level (2tailed). 


**Correlation is significant at the 0.01 level (2tailed). 
Table 4 Pearson correlation of mean arterial pressure (map) and pulse pressure (pp) in diabetic male Africans
The cohorts studied consist of 20 male non diabetic Africans and 20 known diabetic males in Nigeria Africa. The age range of the non diabetic is 31 to 70years with a mean age of 49.8years while the age range of the diabetics was 31 to 82 years with mean age of 67.4 years. The mean pulse pressure among the non diabetic was 46.5mmHg while the mean pulse pressure among the diabetics was 67.7mmHg.Among the non diabetic the mean of the mean arterial pressure was 103.20mmHg while among the diabetics it was 96.97mmHg. In both diabetic and non diabetic group, 20% of participants (4 in each group) had mean arterial pressure above 110mmHg.The highest mean arterial pressure among the diabetic group was 133.33mmHg while the highest among the non diabetic was 150mmHg.The lowest mean arterial pressure in the diabetic group was 73.33mmHg.The lowest mean arterial pressure in the non diabetic group was the same figure.
This paper shows that mean arterial pressure is higher in the general African male population than among diabetic male Africans, this is probably because other risk factors for higher mean arterial pressure are in the general population. Also this paper suggest that diabetes mellitus is not the worst cause of high mean arterial pressure as the highest mean arterial pressure of 150mmHg was in the general male population studied compared to the highest of 133.33 among the diabetic group. This supports autopsy finding in literature that hemorrhagic cerebrovascular accident occurs slightly more commonly in non diabetic compared to diabetics while cerebral infarction occurs more in diabetic subjects compared to non diabetics since hemorrhagic cerebrovascular accident tend to occur at higher mean arterial pressure (like 150mmHg) while ischemic cerebrovascular accident occurs at lower mean arterial pressure.^{15} It was observed that the absolute value of each of the mean, the median and the mode were higher in nondiabetics compared to diabetics. One salient point noted in this study is that while pulse pressure correlated significantly with mean arterial pressure in nondiabetics with value of 0.876 pvalue 0.0001, there was a noticeable insignificant correlation between pulse pressure and mean arterial pressure in diabetics with value 0.048, pvalue 0.841.The effects of chronic hyperglycaemia on the caliber of vessels overtime in diabetics will probably explain this. Similarly in nondiabetics, pulse pressure correlated significantly with systolic and diastolic blood pressure with values 0.951, pvalue 0.0001 and 0.785, pvalue 0.0001 whereas pulse pressure correlated significantly only with systolic blood pressure in diabetics with values 0.631, pvalue0.003 while it was inversely correlated to diastolic pressure with values 0.318, pvalue 0.172. Similarly it was noticed in the study that African diabetic male tend to have higher pulse pressure than the general African non diabetic male population as the absolute value of each of the mean, the median and the mode were higher in the male African diabetics.
Mean arterial pressure is lower in male African diabetics compared to the general African male population. Conversely, pulse pressure is higher among male African diabetics compared to the general African male population. One salient point noted in this study is that while pulse pressure correlated significantly with mean arterial pressure in nondiabetics with value of 0.876 pvalue 0.0001, there was a noticeable insignificant correlation between pulse pressure and mean arterial pressure in diabetics.
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