Reverse dipping in patients with diabetes was associated with a twofold increased risk of all-cause mortality compared with dippers over a 21-year follow-up (HR 2.2; 95% CI 1.3-3.8).
Cohort (n=349)
Do abnormal circadian blood pressure patterns (nondipping and reverse-dipping) increase the risk of long-term mortality in patients with diabetes?
In patients with diabetes, a reverse-dipping blood pressure pattern on 24-hour ambulatory monitoring is associated with a doubled risk of all-cause mortality over a 21-year follow-up.
Estimación del efecto: HR 2.2 (95% CI 1.3-3.8)
Abstract Aims To establish the long‐term prognostic value of abnormal circadian blood pressure (BP) patterns in diabetes. Materials and Methods We retrospectively examined a cohort of 349 outpatients with diabetes who were screened for microvascular complications and followed up for 21 years. Dipping, nondipping and reverse‐dipping status were defined based on 24‐hour ambulatory BP monitoring (ABPM) as ≥10% reduction, <10% reduction, and any increase in average nighttime versus daytime systolic BP (SBP), respectively. Results After 6251 person‐years of follow‐up (median range follow‐up 21.0 1.1‐22.0 years, 52% women, age 57.1 ± 11.9 years, 81.4% type 2 diabetes and 18.6% type 1 diabetes), a total of 136 deaths (39%) occurred. Compared with dippers, the nondippers and reverse dippers showed progressively higher prevalence of chronic kidney disease (CKD), cardiac autonomic neuropathy (CAN) and postural hypotension. Reverse dippers showed a 13.4% (2.5‐year) reduction in mean overall survival and a twofold increased risk of all‐cause mortality after adjustment for traditional risk factors (hazard ratio 2.2 95% confidence interval 1.3‐3.8). Each 1% decrease in nighttime versus daytime SBP ratio was independently associated with a 4% reduction in 20‐year mortality risk. Conclusions In patients with diabetes, reverse dipping is associated with a higher prevalence of CKD and CAN and more than doubled the adjusted risk of all‐cause mortality over a 21‐year observation.
Chiriacò et al. (Thu,) conducted a cohort in diabetes (n=349). Reverse-dipping blood pressure pattern vs. Dipping blood pressure pattern was evaluated on all-cause mortality (HR 2.2, 95% CI 1.3-3.8). Reverse dipping in patients with diabetes was associated with a twofold increased risk of all-cause mortality compared with dippers over a 21-year follow-up (HR 2.2; 95% CI 1.3-3.8).
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