Ambulatory Blood Pressure Monitoring in Normotensive and Hypertensive Type 2 Diabetics Prevalence of Impaired Diurnal Blood Pressure Patterns

Abstract

To assess the prevalence of an impaired diurnal blood pressure (BP) pattern in a population of both normotensive and hypertensive diabetics, noninvasive ambulatory BP monitoring (SpaceLabs 5200, Redmond, WA) was performed in 96 outpatients with type 2 diabetes (47 normotensives and 48 hypertensives) and in 103 control subjects without diabetes (50 normotensives and 53 hypertensives). Mean 24 h and daytime (06:00 to 22:00) BP and heart rate (HR) were not statistically different in diabetic patients compared to nondiabetic ones. Nighttime (22:00 to 06:00) BP and HR tended to be higher in both normotensive and hypertensive diabetics, although not significantly. Heart rate, diastolic BP (DBP), and especially the nocturnal systolic BP (SBP) decrease, were less marked in both normotensive and hypertensive diabetics, with a consequent increase in rate-pressure. A significant correlation was found between the percent decrease in nighttime SBP and the decrease in orthostatic SBP in casual BP measurements. The analysis of individual recordings allowed us to detect an impaired circadian pattern (the disappearance of the nocturnal BP decrease or a paradoxical BP increase) in 30% of the normotensive and 31% of the hypertensive diabetics (v 6% of the normotensive and 6.4% of the hypertensive nondiabetic subjects). As the absence of a nocturnal BP fall has been associated with the increased prevalence of left ventricular hypertrophy and atherosclerotic cardiovascular disease, its detection by ambulatory monitoring might be of prognostic and therapeutic importance.

Ambulatory monitoring of blood pressure (AMBP) in patients with primary hyperparathyroidism

“…In particular, Verdecchia et al 23,24,38 showed an increase of the cardiovascular events in 'non-dipper' patients, and Shimada et al 39 found higher incidence of cerebrovascular injury, as documented by magnetic resonance (MRI), and finally Palatini et al 40 detected a higher incidence of left ventricular hypertrophy in non-dipper hypertensive subjects. In particular, in patients with diabetes and patients with chronic renal failure, 41 in whom a more important global cardiovascular risk for all daytime BP level is well known, a lack or a reduction in nocturnal pressure fall was observed.…”

Blood pressure control in subjects with type 2 diabetes

“…16,18 Our results suggest that white coat hypertension may represent the first stage in the development of hypertension. Two participants died during the follow-up, and no conclusion can be drawn from the mortality.…”

“…Of the hypertensive type 2 diabetic subjects, 8-23% have white coat hypertension 16 and 30-31% show the non-dipper phenomenon. 18 The 24-h ABPM could be useful in the treatment of hypertension of subjects with type 2 diabetes to detect the ones with white coat hypertension (lowrisk) and the non-dipper phenomenon (high-risk).…”

Relationship between homocysteine and non-dipper pattern in patients with type 2 diabetes mellitus

“…Fogari and cols. compared 47 normotensive and 48 hypertensive diabetic patients with 103 healthy individuals and were unable to detect a decrease in NBP in 30% of the normotensive diabetics and in 31% of hypertensive patients (18). Bauduceau and cols.…”