Key result
In diabetic patients during the pre-heart failure phase, non-dipper and riser nocturnal blood pressure patterns significantly increased the risk of developing left ventricular diastolic dysfunction compared to the dipper pattern (HR 3.00 and 3.58, respectively).
Why the study?
The integrated importance of diabetes and altered nocturnal blood pressure variation as predictors of left ventricular diastolic dysfunction was unknown in the pre-heart failure period.
Do non-dipper and riser nocturnal hypertension patterns predict the progression of left ventricular diastolic dysfunction in diabetic patients without heart disease?
Cohort (n=422)
Do non-dipper and riser nocturnal hypertension patterns predict the progression of left ventricular diastolic dysfunction in diabetic patients without heart disease?
Altered nocturnal blood pressure variations (non-dipper and riser patterns) are significant predictors for the progression of left ventricular diastolic dysfunction in diabetic patients during the pre-heart failure period.
Answers are grounded in this paper and cite their sources.
Nocturnal BP profiles may predict diastolic dysfunction progression in diabetic pre-HF; leaves open need for prospective trials.
Background Diabetes is an important risk factor of heart failure (HF) and is associated with left ventricular (LV) diastolic dysfunction. However, integrated importance of diabetes and its comorbid conditions, such as altered nocturnal blood pressure (BP) variation, as predictors of diastolic dysfunction is not known in pre-HF period. The present study was conducted as longitudinal examination of the predictive value of nocturnal hypertension profiles on progression of LV diastolic dysfunction in diabetic and non-diabetic patients without heart diseases. Methods Pre-heart failure 422 subjects (154 diabetes, 268 non-diabetes) were followed for 36.8 ± 18.2 months. The relationships among the patterns of nocturnal hypertension and the outcome of LV diastolic dysfunction, defined as increase in E/e’ >14, were investigated in the patients with and without diabetes. Results The interaction effect of the diabetes status and the patterns of nocturnal hypertension on the hazard rate of the occurrence of E/e’>14 was statistically significant (p=0.017). Kaplan-Meier analysis results revealed that diabetic patients with non-dipper (p=0.016 vs. dipper) and riser (p=0.007 vs. dipper) had a significantly greater risk for a diastolic dysfunction event. Furthermore, multivariable Cox proportional hazards analysis revealed that non-dipper (HR: 3.00; 95% CI: 1.11–8.06, p = 0.029) and riser (HR: 3.58; 95% CI:1.24–10.35, p = 0.018) patterns were significantly associated with elevated risk of the outcome of LV diastolic dysfunction. In contrast, no similar significant associations were found in non-diabetic patients. Conclusions During pre-HF periods, nocturnal hypertension is an important predictor for progression of LV diastolic dysfunction in diabetic patients.
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Kidawara et al. (2023) conducted a cohort in Pre-heart failure with cardiovascular risk factors (n=422). Nocturnal hypertension (non-dipper pattern) vs. Dipper pattern was evaluated on Development of left ventricular diastolic dysfunction (E/e' >14) (HR 3.00, 95% CI 1.11-8.06, p=0.029). In diabetic patients during the pre-heart failure phase, non-dipper and riser nocturnal blood pressure patterns significantly increased the risk of developing left ventricular diastolic dysfunction compared to the dipper pattern (HR 3.00 and 3.58, respectively).
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