Nocturnal hypertension and left ventricular diastolic dysfunction in diabetic patients with pre-heart failure phase: Prospective cohort HSCAA study

Abstract

Background: Diabetes is an important risk factor of heart failure (HF) and is associated with left ventricular (LV) diastolic dysfunction. However, integrated importance of diabetes and its comorbid conditions, such as altered nocturnal blood pressure (BP) variation, as predictors of diastolic dysfunction is not known in pre-HF period. The present study was conducted as longitudinal examination of the predictive value of nocturnal hypertension profiles on progression of LV diastolic dysfunction in diabetic and non-diabetic patients without heart diseases. Methods: Pre-heart failure 422 subjects (154 diabetes, 268 non-diabetes) were followed for 36.8 ± 18.2 months. The relationships among the patterns of nocturnal hypertension and the outcome of LV diastolic dysfunction, defined as increase in E/e' >14, were investigated in the patients with and without diabetes. Results: The interaction effect of the diabetes status and the patterns of nocturnal hypertension on the hazard rate of the occurrence of E/e'>14 was statistically significant (p=0.017). Kaplan-Meier analysis results revealed that diabetic patients with non-dipper (p=0.016 vs. dipper) and riser (p=0.007 vs. dipper) had a significantly greater risk for a diastolic dysfunction event. Furthermore, multivariable Cox proportional hazards analysis revealed that non-dipper (HR: 3.00; 95% CI: 1.11–8.06, p = 0.029) and riser (HR: 3.58; 95% CI: 1.24–10.35, p = 0.018) patterns were significantly associated with elevated risk of the outcome of LV diastolic dysfunction. In contrast, no similar significant associations were found in non-diabetic patients. Conclusions: During pre-HF periods, nocturnal hypertension is an important predictor for progression of LV diastolic dysfunction in diabetic patients.