Key result
Higher baseline nocturnal systolic blood pressure (138 vs 129 mmHg) and reduced nocturnal blood pressure fall preceded the development of diabetic nephropathy and cardiovascular events in hypertensive patients with type 2 diabetes.
Why the study?
Does reduced nocturnal blood pressure fall predict the development of diabetic nephropathy and cardiovascular events in hypertensive patients with type 2 diabetes?
Cohort (n=70)
No
Does reduced nocturnal blood pressure fall predict the development of diabetic nephropathy and cardiovascular events in hypertensive patients with type 2 diabetes?
Absolute Event Rate: 138% vs 129%
p-value: p=<0.05
Elevations in nocturnal blood pressure and reduced nocturnal blood pressure fall precede the development of diabetic nephropathy and increase cardiovascular risk in hypertensive patients with type 2 diabetes.
May support nocturnal BP monitoring in T2D hypertension; leaves open whether targeting it reduces nephropathy or events.
BACKGROUND: Hypertensive patients with reduced blood pressure fall (BPF) at night are at higher risk of cardiovascular events (CVE). METHODS: We evaluated in hypertensive diabetic patients, if a reduced nocturnal BPF can precedes the development of diabetic nephropathy (DN). We followed 70 patients with normal urinary albumin excretion (UAE) for two years. We performed 24-hours ambulatory BP monitoring in baseline and at the end of the study. RESULTS: Fourteen (20%) patients (GI) developed DN (N = 11) and/or CVE (n = 4). Compared to the remaining 56 patients (GII) in baseline, GI had similar diurnal systolic (SBP) and diastolic BP (DBP), but higher nocturnal SBP (138 +/- 15 vs 129 +/- 16 mmHg; p < 0.05) and DBP (83 +/- 12 vs 75 +/- 11 mmHg; p < 0,05). Basal nocturnal SBP correlated with occurrence of DN and CVE (R = 0.26; P < 0.05) and with UAE at the end of the study (r = 0.3; p < 0.05). Basal BPF (%) correlated with final UAE (r = -0.31; p < 0.05). In patients who developed DN, reductions occurred in nocturnal systolic BPF (12 +/- 5 vs 3 +/- 6%, p < 0,01) and diastolic BPF (15 +/- 8 vs 4 +/- 10%, p < 0,01) while no changes were observed in diurnal SBP (153 +/- 17 vs 156 +/- 16 mmHg, NS) and DBP (91 +/- 9 vs 90 +/- 7 mmHg, NS). Patients with final UAE < 20 microg/min, had no changes in nocturnal and diurnal BP. CONCLUSIONS: Our results suggests that elevations in nocturnal BP precedes DN and increases the risk to develop CVE in hypertensive patients with T2DM.
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Felício et al. (2010) conducted a cohort in Hypertension and Type 2 Diabetes Mellitus (n=70). Elevated nocturnal blood pressure and reduced nocturnal blood pressure fall vs. Normal nocturnal blood pressure fall (dippers) was evaluated on Development of diabetic nephropathy and/or cardiovascular events (p=<0.05). Higher baseline nocturnal systolic blood pressure (138 vs 129 mmHg) and reduced nocturnal blood pressure fall preceded the development of diabetic nephropathy and cardiovascular events in hypertensive patients with type 2 diabetes.
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