Key result
A non-dipping night blood pressure pattern was not associated with increased left ventricular mass index (59 vs 63 g/m2) or glomerular filtration rate (148 vs 134 ml/min) compared to dippers.
Why the study?
Does a non-dipping blood pressure pattern associate with increased renal or cardiac lesions in microalbuminuric Type 1 diabetic patients without hypertension?
Cross-Sectional (n=23)
Does a non-dipping blood pressure pattern associate with increased renal or cardiac lesions in microalbuminuric Type 1 diabetic patients without hypertension?
Impaired reduction of night blood pressure (non-dipping) does not appear to be associated with more signs of renal or cardiac lesions in normotensive microalbuminuric Type 1 diabetic patients.
Answers are grounded in this paper and cite their sources.
Non-dipping may not mark higher cardiac or renal risk in normotensive microalbuminuric T1D; leaves open the value of nocturnal BP monitoring.
Ambulatory blood pressure was measured in 23 microalbuminuric Type 1 diabetic patients without hypertension. Nine patients had a reduction in mean arterial blood (MAP) pressure at night < 10% of their day-time value (non-dippers). The following parameters were measured: glomerular filtration rate (GFR), overnight urinary excretion of albumin (UAE), sodium and potassium, left ventricular dimensions, extracellular volume (ECV), plasma aldosterone, and arginine vasopressin (AVP). Night-time MAP was 11 mmHg lower in patients designated as dippers than in non-dippers. Day-time MAP was similar in dippers (98 +/- 5 mmHg) and non-dippers (99 +/- 8 mmHg, NS). No statistical significant difference was found for UAE in dippers (geometric mean, x/- tolerance factor, microgram min-1) (72 x/- 2.1) vs non-dippers (63 x/- 2.1), for left ventricular mass index (63 +/- 12 vs 59 +/- 10 g m-2), or for GFR (134 +/- 19 vs 148 +/- 22 ml min-1). Aldosterone and AVP were lower in non-dippers (p < 0.05) and a negative correlation in all patients was noticed between ECV and aldosterone (rho = -0.50, p < 0.05). Sodium and potassium excretion and ECV were indistinguishable between the groups. We conclude (1) that impaired reduction of night blood pressure does not seem to be associated with more signs of renal or cardiac lesions and (2) that the lower aldosterone and AVP in non-dippers may counteract volume expansion.
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Hansen et al. (1995) conducted a cross-sectional in Type 1 diabetes with microalbuminuria (n=23). Non-dipping night blood pressure pattern vs. Dipping night blood pressure pattern was evaluated on Renal or cardiac lesions (urinary albumin excretion, left ventricular mass index, and glomerular filtration rate) (p=NS). A non-dipping night blood pressure pattern was not associated with increased left ventricular mass index (59 vs 63 g/m2) or glomerular filtration rate (148 vs 134 ml/min) compared to dippers.
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