Association between Changes in the Systolic Blood Pressure from Evening to the Next Morning and Night Glucose Variability in Heart Disease Patients

Abstract

Aims To assess the impact of glycemic variability on blood pressure in hospitalized patients with cardiac disease. Methods In 40 patients with cardiovascular disease, the glucose levels were monitored by flash continuous glucose monitoring (FGM; Free-Style Libre™ or Free-Style Libre Pro; Abbott, Witney, Oxfordshire, UK) and self-monitoring blood glucose (SMBG) for 14 days. Blood pressure measurements were performed twice daily (morning and evening) at the same time as the glucose level measurement using SMBG. Results The detection rate of hypoglycemia using the FGM method was significantly higher than that with the 5-point SMBG method (77.5% vs. 5.0%, P<0.001). Changes in the systolic blood pressure from evening to the next morning (morning -evening [ME] difference) were significantly correlated with night glucose variability (r=0.63, P<0.001). A multiple regression analysis showed that night glucose variability using FGM was more closely correlated with the ME difference (r=0.62 [95% confidence interval, 0.019-0.051]; P< 0.001) than with the age, body mass index, or smoking history. Night glucose variability was also more closely associated with the ME difference in patients with unstable angina pectoris (UAP) than in those with acute myocardial infarction (AMI) or heart failure (HF) (r=0.83, P=0.058). Conclusion Night glucose variability is associated with the ME blood pressure difference, and FGM is more accurate than the 5-point SMBG approach for detecting such variability.

Relationship between Short- and Mid-Term Glucose Variability and Blood Pressure Profile Parameters: A Scoping Review

“…One study used the DexCom G4 Platinum technology [ 28 ] whereas seven studies used Medtronic glucose sensors [ 21 , 23 , 25 , 27 , 29 , 31 , 32 ]. One study used an intermittently scanned CGM device (using flash technology—FGM) for 14 days [ 30 ]. Regarding the BP assessment methodology, seven studies used ambulatory BP monitoring (ABPM) for the assessment of the participants’ BP profiles [ 20 , 24 , 25 , 27 , 28 , 31 , 32 ].…”

“…Regarding the BP assessment methodology, seven studies used ambulatory BP monitoring (ABPM) for the assessment of the participants’ BP profiles [ 20 , 24 , 25 , 27 , 28 , 31 , 32 ]. Five studies used office BP measurements [ 21 , 22 , 26 , 29 , 30 ], most of them with a significant lack of details, and a single study reported the use of self-measurements [ 23 ].…”

“…There was also a high degree of heterogeneity regarding the indices reported ( Figure 1 ) and the type of associations between the GV and BP parameters examined ( Table 3 ). The most commonly studied index of GV was MAGE [ 20 , 21 , 22 , 23 , 25 , 27 , 32 ], as well as the SD of glucose [ 23 , 30 , 31 , 32 ], while for BP parameters, average levels [ 20 , 22 , 23 , 24 , 26 , 28 ], SD [ 32 ], and dipping status were studied [ 27 ]. A few studies reported positive associations between GV indices and average BP levels [ 22 , 24 , 26 ].…”

“…Moreover, the second study could suggest that pathological conditions, such as diabetes and hypertension, are accompanied by similar patterns of disruptions in these regulatory mechanisms, as reflected in the positive association between GV and BPV. The other studies included several populations, mainly with type 1 or 2 diabetes, and reported either significant associations between BP indices—mainly average BP levels—and GV [ 20 , 21 , 22 , 24 , 25 , 26 , 30 , 31 ] or a lack of such associations [ 23 , 27 ]. Another important limitation of the included studies was the variation in the monitoring period for assessing GV, which ranged from a few hours to several days.…”

Nocturnal hypoxia and the difference in morning and evening blood pressure measured at home

“…The group with an MEdif of ≥20 mm Hg had higher stroke incidence and CVD events compared to the group with an MEdif <20 mm Hg [4,11]. Similar to nocturnal hypoxia, MEdif was also significantly associated with markers of subclinical CVD and cardiac damage parameters such as total cholesterol levels [12], night glucose variability [13], left ventricular hypertrophy, relative wall thickness and left ventricular diastolic dysfunction [14,15] among hypertensive patients. Available evidence has shown that the cutoff value of 20 mm Hg is a potential threshold for clinical MEdif.…”