Circadian blood pressure variation in patients with type 2 diabetes--relationship to macro- and microvascular subclinical organ damage

Prim Care Diabetes. 2011 Oct;5(3):167-73. doi: 10.1016/j.pcd.2011.04.001. Epub 2011 May 5.

Abstract

Aims: To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes.

Methods: Cross-sectional data from 663 patients with type 2 diabetes, aged 55-66 years, were analysed. Nurses measured office BP and ambulatory BP during 24h. Individuals with ≥ 10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries.

Results: We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p<0.001).

Conclusions: We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT01049737.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuminuria / etiology
  • Albuminuria / physiopathology
  • Aorta / physiopathology
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure*
  • Carotid Arteries / physiopathology
  • Circadian Rhythm*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Angiopathies / diagnosis
  • Diabetic Angiopathies / etiology*
  • Diabetic Angiopathies / physiopathology
  • Diabetic Nephropathies / etiology
  • Diabetic Nephropathies / physiopathology
  • Early Diagnosis
  • Echocardiography, Doppler
  • Female
  • Femoral Artery / physiopathology
  • Glomerular Filtration Rate
  • Humans
  • Hypertension / diagnosis
  • Hypertension / etiology*
  • Hypertension / physiopathology
  • Kidney / physiopathology
  • Linear Models
  • Male
  • Manometry
  • Microcirculation*
  • Middle Aged
  • Office Visits
  • Predictive Value of Tests
  • Prospective Studies
  • Pulsatile Flow
  • Risk Assessment
  • Risk Factors
  • Sweden

Associated data

  • ClinicalTrials.gov/NCT01049737