What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=531). Intervention: Reverse-dipper blood pressure pattern vs. Dipper blood pressure pattern. Primary outcome: Prevalence of type 2 diabetes (OR 2.067, 95% CI 1.103-3.876, p=0.024).

April 25, 2016Open Access

Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients

LSLu SunGuangdong Academy of Medical Sciences BYBin YanFirst Affiliated Hospital of Xi'an Jiaotong University YGYa GaoJinzhong University

Key Result

A reverse-dipper blood pressure pattern was independently associated with a significantly higher odds of type 2 diabetes compared to a normal dipper pattern in hypertensive patients (OR 2.067).

Study Design

Type

Cross-Sectional (n=531)

Multicenter

Structured PICO

Is a reverse-dipper blood pressure pattern associated with type 2 diabetes in hypertensive patients?

Population

531 Chinese adults aged 18 to 90 years with untreated hypertension who underwent 24-hour ambulatory blood pressure monitoring to assess the association between circadian blood pressure patterns and type 2 diabetes.

Exposure

Reverse-dipper pattern of blood pressure (evaluated with ambulatory blood pressure monitoring)

Comparator

Dipper pattern and nondipper pattern of blood pressure

Outcome

Prevalence/diagnosis of type 2 diabetes

A reverse-dipper blood pressure pattern on ambulatory monitoring is independently associated with a higher prevalence of type 2 diabetes in hypertensive patients.

Main Result

Odds Ratio: 2.067 (95% CI 1.103–3.876)

Absolute Event Rate: 32.3% vs 21.4%

p-value: p=0.024

Limitations

Retrospective cross-sectional design limits the ability to establish causality.
Incomplete HbA1c data required reliance on fasting glucose for diabetes diagnosis.
Study was conducted in a single center in a Chinese population, limiting generalizability to other ethnic groups.
A single 24-hour ABPM recording may not capture day-to-day blood pressure variations.

Abstract

Recent studies suggested that nocturnal variations of blood pressure (BP) were closely related to type 2 diabetes. However, little information has been revealed about the relationship between reverse-dipper pattern of BP and type 2 diabetes. In this cross-sectional study, BP variations of 531 hypertensive patients were evaluated with ambulatory BP monitoring (ABPM). Diagnosis of diabetes in Chinese adults was made according to diabetes diagnostic criteria of 2015. Multivariate logistic regression was used to examine the relationships between type 2 diabetes and ABPM results. In the study, patients with reverse-dipper pattern (32.3%) had the highest prevalence of type 2 diabetes compared with dippers (21.4%) and nondippers (23.3%). After multivariate logistic regression, reverse-dipper BP pattern (OR 2.067, P = 0.024) and nondipper BP pattern (OR 1.637, P = 0.039) were found to be correlated with type 2 diabetes compared with dipper pattern. The results of our study also suggested that type 2 diabetes might contribute to the reverse-dipper pattern of BP (OR 1.691, P = 0.023). In addition, fasting glucose was negatively correlated with the decline rate of nocturnal SBP (r = -0.095, P = 0.029). Reverse-dipper pattern of BP in ABPM may be independently associated with type 2 diabetes in patients with hypertension.

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