الفهرس 
Introduction
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Hypertension and type 2 diabetes are common comorbidities in which composite cardiovascular diseases (CVD) are considered to be a leading cause of morbidity and mortality. Central blood pressure is the pressure that the target organs are exposed to and there is a strong rationale to believe that cardiovascular events may ultimately be more closely related to it rather than brachial pressure. Our study was a cross-sectional observational study, which was performed in Internal medicine outpatient clinics, Assuit University Hospitals during the period from January 2018 to January 2020. It was conducted on 150 subjects; subdivided into; 50 patients known to be diabetic and hyepertensive, 50 patients known to be diabetic and normotensive and 50 patients not known to be diabetic or hypertensive aiming at evaluation of association between central and peripheral BP in diabetic patients with or without hypertension versus control, evaluation of the effects of antihypertensive medications on central BP, and detection of the relation between central blood pressure and diabetic composite cardiovascular complications that included coronary heart diseases and ischemic stroke. Demographic data were collected using structured questionnaire, peripheral BP was measured based on the JNC7 guideline recommendation, central BP and augmentation index adjusted for 75 beats per minute of heart rate (AIx@75) were measured using Mobil-o-graph device, fasting venous blood was drawn for lipid profiles, fasting plasma glucose, glycated haemoglobin, and serum creatinine level, and urine analysis was done to detect albuminurea. This study found that although there was no significant difference between central DBP and peripheral DBP in all studied cases, peripheral SBP was very significantly higher than central SBP (p-values < 0.001) in all studied groups and in each group separately even the control group. Our study revealed an overlap of central SBP values between peripheral SBP groups as 66.7% of normal peripheral SBP patients had central SBP within the range of patients with optimal peripheral SBP, 56.4% of high normal peripheral SBP patients had central SBP within the range of patients with normal peripheral SBP, 89.7% of stage 1 peripheral SBP patients had central SBP within the range of patients with high normal peripheral SBP, and 33.3% of stage 2 peripheral SBP patients had central SBP within the range of patients with stage 1 peripheral SBP. Comparing the effects of antihypertensive drugs used on the central and peripheral blood pressure, it was found that although the differences between B-blocker group and ACEI group in peripheral BP and central BP were not significant (P-values > 0.05 for all), it was noted that patients using ACEI had lower values for peripheral systolic and diastolic blood pressure, mean peripheral pressure and central systolic and diastolic blood pressure compared with those using B- blocker. In the present study; comparing between patients with composite CVD and those without composite CVD; there was statistically significant difference between both groups as regards peripheral SBP, mean peripheral BP, and central SBP (p-value < 0.001) (higher in those with composite CVD group), and there were high significant differences between the two groups in peripheral DBP, central DBP, and Aix 75 (p-value < 0.01) (higher in those with composite CVD group). Also, there was statistically significant difference between patients with CVD and those without CVD as regards FBS, HbA1c, LDL, HDL, TG, cholesterol and microalbuminuria with P value <.05. Logistic regression analysis to detect the independent predictors of the occurrence of composite CVD in diabetic patients showed that increased BMI, central SBP and Aix 75 were significantly associated with composite CVD (p-values < 0.05). So, this work revealed that central BP indices were better than brachial BP in terms of composite CVD’s risk prediction.