Ambulatory Blood Pressure Level Rather than Dipper/Nondipper Status Predicts Vascular Events in Type 2 Diabetic Subjects

Nakano, Shigeru; Ito, Tomohiko; Furuya, Keisuke; Tsuda, Shinichi; Konishi, Kazunori; Nishizawa, Makoto; Nakagawa, Atsushi; Kigoshi, Toshikazu; Uchida, Keiji

doi:10.1291/hypres.27.647

Cited by 60 publications

(54 citation statements)

References 31 publications

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“…Therefore, this is the first study to show a significant relationship between high nocturnal BP and incident stroke. Nocturnal high BP (or nondipping) is a well-known predictor of cardiovascular events in hypertensive patients (21)(22)(23)(24)(25)(26)(27). Our study expands the previous findings of nocturnal BP in hypertensive patients to risk stratification for CHF patients.…”

Section: Nocturnal Bp and Strokesupporting

confidence: 75%

Factors Associated with Incident Ischemic Stroke in Hospitalized Heart Failure Patients: A Pilot Study

et al. 2008

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Stroke is sometimes seen in patients with congestive heart failure (CHF). The factors that best predict incident stroke in hospitalized CHF patients are not well known. We performed this pilot study to explore the clinical markers of incident stroke in CHF patients. We studied 111 hospitalized patients with CHF (mean age, 67 ± 11 years). Ambulatory blood pressure (BP) monitoring, blood tests, and echocardiography were performed in these patients just before they left the hospital, and all cardiovascular events during the study period were followed for an average of 18 ± 9 months. Cox regression analysis was performed to explore the predictors of incident stroke using age, sex, body mass index (BMI), casual and ambulatory systolic BP (SBP), and brain-type natriuretic peptide (BNP). There were 10 stroke events (9%) during the follow-up period. The stroke group had higher nocturnal SBP and plasma BNP levels than the non-stroke group. With Cox regression analysis, both nocturnal SBP and BNP were significant predictors of incident stroke independent of other covariates. When nocturnal BP of 120 mmHg and BNP of 600 pg/mL (75th percentile) were used as cutoffs, nocturnal SBP ≥ 120 mmHg was associated with a 7-fold increase in the risk of incident stroke, while BNP ≥ 600 pg/mL was associated with a 46.6-fold increase. However, abnormal circadian BP patterns were not associated with incident stroke. In this pilot study, elevated nocturnal BP and high plasma BNP just before patients left the hospital were significant predictors of stroke events in CHF patients. Further study is needed to confirm this hypothesis. (Hypertens Res 2008; 31: 289-294)

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Section: Nocturnal Bp and Strokesupporting

confidence: 75%

Factors Associated with Incident Ischemic Stroke in Hospitalized Heart Failure Patients: A Pilot Study

et al. 2008

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“…Absolute BP levels, particularly at night, probably have a higher predictive value for vascular damage than the BP dipper/nondipper status. [26][27][28] Nevertheless, a recent article has reported that type 2 diabetics with a riser profile of BP showed 88% mortality during a follow-up of 9 years meanwhile mortality in the non-risers was 45%. 7 This study has some limitations that deserve discussion.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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on behalf of the Spanish Society of Hypertension ABPM Registry investigators 9Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68 045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of 41200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12 600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, Po0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, Po0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, Po0.001).Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, Po0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered. Hypertension Research (2011) 34, 1185-1189; doi:10.1038/hr.2011.100; published online 11 August 2011Keywords: ambulatory blood pressure monitoring; circadian profile; diabetes; hypertension control INTRODUCTION Hypertension affects the majority of patients with diabetes and constitutes a major risk factor for vascular complications. 1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.

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“…47 Finally, a longitudinal study of 392 subjects with type II diabetes mellitus demonstrated that the mean nighttime systolic BP predicted nonfatal vascular events more strongly than nocturnal fall in systolic BP. 48 …”

Section: Diabeticsmentioning

confidence: 99%

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

et al. 2010

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At present, clinic blood pressure (BP) evaluation is being increasingly complemented by ambulatory BP measurements for the evaluation of haemodynamic patterns during daily activities and sleep. Nondipping pattern, a measure of decreased attenuation of nighttime over daytime BP, has been correlated with enhanced target organ damage and adverse cardiovascular (CV) outcomes in different clinical settings beyond pure hypertensive cohorts. As the nondipping pattern is a derivative extract of both daytime and nighttime BP, it is yet questionable whether the crude estimate of nocturnal BP is superior to daytime BP and nondipping pattern in the prediction of subclinical damage and CV events. In this review, we aimed at comparing the CV predictive value of the nondipping pattern with that of nocturnal BP using cross-sectional and longitudinal data obtained from different cohort studies within the past 10 years. Our findings suggest that nocturnal BP including the phenotype of isolated nocturnal hypertension is better associated with CV target organ damage and 'hard end points' as compared with the nondipping pattern.

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Ambulatory Blood Pressure Level Rather than Dipper/Nondipper Status Predicts Vascular Events in Type 2 Diabetic Subjects

Cited by 60 publications

References 31 publications

Factors Associated with Incident Ischemic Stroke in Hospitalized Heart Failure Patients: A Pilot Study

Factors Associated with Incident Ischemic Stroke in Hospitalized Heart Failure Patients: A Pilot Study

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

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