Non‐dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus

Sturrock, Nigel; George, Emad; Pound, Nicholas; Stevenson, John; Peck, G.M.; Sowter, Heidi M.

doi:10.1046/j.1464-5491.2000.00284.x

Cited by 164 publications

(117 citation statements)

References 42 publications

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“…Our results were consistent with results by the Coomer et al 8 It could be proposed that haemodialysis has less cardiovascular risk regarding BP characteristics as compared with CAPD at the first day of haemodialysis. However, the circadian BP rhythm, which is reported as another predictor of cardiac mortality, 17,18 is more deteriorated in the first day in haemodialysis patients as compared with CAPD patients.…”

Section: Discussionmentioning

confidence: 95%

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

et al. 2002

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The aim of this study was to compare the results of the 44-h ambulatory blood pressure monitoring (ABPM) data between haemodialysis (HDp) and CAPD patients and to investigate the relation of circadian rhythm in blood pressure (BP) with development of left ventricular hypertrophy. Twenty-two HDp (11 male, 11 female, mean age: 50 ± 17 years) and 24 CAPDp (11 male, 13 female, mean age: 47 ± 15 years) were included. Echocardiographic measurements and ABPM were performed in all study groups. ABPM of the first and second days were analysed separately and compared with CAPDp. Left ventricular hypertrophy was detected in 17 of the 22 HDp (77%) and 17 of the 24 CAPDp (71%). There was no significant differences between HD and CAPDp in respect to 44-h, daytime and night-time systolic and diastolic BP values. Although the course of BP in CAPDp was stable during the 44-h period, systolic and diastolic BP levels on the second day were significantly higher than those of on the first day in HDp (P Ͻ 0.001

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Section: Discussionmentioning

confidence: 95%

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

et al. 2002

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“…Sturrock et al 16 reported non-dipping to predict total mortality in diabetes patients, but the conclusions were based on a retrospective study in a mixed cohort of 75 type 1 and 2 diabetes patients with only 13 deaths, thus limiting the generalisability of the reported associations. PP was not reported.…”

Section: Effect Of Combined 10 Mmhg Increase In 24-h Pp Andmentioning

confidence: 99%

“…[10][11][12][13][14][15][16] However, only a few BP parameters were evaluated in each of these studies and the potential interaction between BP parameters were not examined. Moreover, some studies report the association with total mortality, not with CV mortality.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 In addition, the general applicability of some of the reported associations is limited owing to methodological characteristics of the individual studies, as they are either cross-sectional; 12 the study-populations consist of older patients with a long duration of diabetes; 13,14 ABPM was performed in hospitalised patients 15 or in a mixed cohort of type 1 and 2 diabetes patients. 16 Hence, despite these previous studies, several questions remain unresolved, particularly if 24-h PP, AASI and diurnal BP parameters obtained from ambulatory measurement in the early course of the disease predict future CV events above other BP parameters, after adjustment for well-established CV risk markers. Thus, the aim of the present long-term followup study was to evaluate the predictive value of ABPM-derived values of 24-h PP, AASI and systolic and diastolic night-day ratio, compared with 24-h systolic and diastolic BP, for fatal and non-fatal CVD in a well-characterized cohort of middle-aged type 2 diabetes patients with a relatively short duration of diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Pulse pressure and systolic night–day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

et al. 2011

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Patients with type 2 diabetes mellitus are at increased risk of cardiovascular disease (CVD). We examined the predictive ability of 24-hour ambulatory pulse pressure (24-h PP), ambulatory arterial stiffness index (AASI) and diurnal blood pressure (BP) parameters for fatal and non-fatal CVD in patients with type 2 diabetes mellitus. A total of 108 patients with type 2 diabetes mellitus (mean duration 6.6 years) were followed for 9.5 (0.5-14.5) years. At baseline, all patients underwent ambulatory BP monitoring. During follow-up, 45 patients had cardiovascular (CV) events (35 non-fatal and 10 fatal). In bivariate analysis, events during follow-up were predicted by 24-h PP (Po0.01), AASI, 24-h systolic BP and systolic and diastolic night-day BP ratio (Po0.05 for all). In Cox regression analysis adjusted for established risk markers, only 24-h PP and systolic night-day BP ratio predicted CV events, Po0.05 for both. A significant interaction between the two parameters was found, Po0.05; thus, the higher the systolic night-day ratio, the greater the increase in hazard ratio (HR) per mmHg increase in 24-h PP and vice versa. A combined 10 mmHg increase in 24-h PP and 10%-point increase in systolic night-day ratio from the 25th percentile increased the adjusted HR (95% confidence interval) for CV events with 1.29 (0.53; 3.12), whereas a similar increase from the 75th percentile increased the HR with 4.2 (1.54; 11,51). Our study showed that 24-h PP and systolic night-day ratio interact as predictors of CV events in type 2 diabetes patients, and should be considered in conjunction when evaluating the risk of CVD.

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“…The resultant obesity is associated with increased blood glucose, cholesterol, and triglyceride levels, as observed in obese humans with metabolic syndrome [35]. Additionally, reduced circadian BP variation is associated with increased mortality [36].…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysregulation in ob/ob mice is improved by inhibition of angiotensin-converting enzyme

et al. 2009

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The leptin deficient ob/ob mice are insulin resistant and obese. However, the control of blood pressure in this model is not well defined. The goal of this study was to evaluate the role of leptin and of the renin-angiotensin system in the cardiovascular abnormalities observed in obesity using a model lacking leptin. To this purpose, we measured blood pressure in ob/ob and control animals by radiotelemetry combined with fast Fourier transformation before and after both leptin and enalapril treatment. Autonomic function was assessed pharmacologically. Blood pressure during daytime was slightly higher in the ob/ob compared to control mice while no difference in heart rate was observed. Blood pressure response to trimetaphane and heart rate response to metoprolol were greater in ob/ob mice than in control littermates indicating an activated sympathetic nervous system. Heart rate response to atropine was attenuated. Baroreflex sensitivity and heart rate variability were blunted in ob/ob mice, while low frequency of systolic blood pressure variability was found increased. Chronic leptin replacement reduced blood pressure and reversed the impaired autonomic function observed in ob/ob mice. Inhibition of angiotensin converting enzyme by enalapril treatment had similar effects, prior to the loss of weight. These findings suggest that the renin-angiotensin system is involved in the autonomic dysfunction caused by the lack of leptin in ob/ob mice and support a role of this interplay in the pathogenesis of obesity, hypertension, and metabolic syndrome.

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Non‐dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus

Cited by 164 publications

References 42 publications

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

Pulse pressure and systolic night–day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

Autonomic dysregulation in ob/ob mice is improved by inhibition of angiotensin-converting enzyme

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