Non-dipping in diabetic patients: insights from the siesta

Perk, Gila; Mekler, Judith; Ishay, D B; Bursztyn, Michael

doi:10.1038/sj.jhh.1001412

Cited by 25 publications

(16 citation statements)

References 29 publications

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“…It has been shown previously that the diurnal-nocturnal differences in blood pressure are smaller among T2DM patients than in controls. 18,19 A reduction in the actions of insulin may be one of the important physiological defects underlying the abnormal circadian rhythm of blood pressure in patients with T2DM and other related diseases. 20 Non-dipper hypertensive patients have been shown to be more insulin resistant and glucose intolerant than dipper hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Non-dipping pattern in ambulatory blood pressure monitoring is associated with metabolic abnormalities in a random sample of middle-aged subjects

2009

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A reduction in the blood pressure decline at night (o10% from daytime systolic blood pressure (SBP)) during 24-h ambulatory blood pressure monitoring (ABPM) ('non-dipping pattern') is associated with cardiovascular morbidity. Our aim was to evaluate whether ABPM characteristics are associated with metabolic abnormalities in subjects without known hypertension or type 2 diabetes mellitus (T2DM). This is a cross-sectional population-based study on middle-aged subjects (n¼462). Two distinct definitions of metabolic syndrome (MetS) were used: National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) and International Diabetes Federation (IDF) criteria. Results suggested that subjects characterized by non-dipping in 24 h ABPM were more obese (P¼0.014). After adjustment for body mass index, age and sex, non-dippers had higher verylow-density lipoprotein (VLDL)-cholesterol (P¼0.003), total (P¼0.029)-and VLDL-triglycerides (P¼0.026) and oral glucose tolerance test 2 h blood glucose (P¼0.027) compared with dippers. Non-dipping status was more common among subjects with MetS (Pp0.01), impaired glucose tolerance (IGT) (Po0.05) and in those with the combination of IGT-T2DM (Pp0.01) than among those without these abnormalities. ABPM non-dipping status was an independent predictor of IGT in multivariate models (Po0.05). With respect to MetS components, high triglycerides (Pp0.005) and low high density lipoprotein-cholesterol (Po0.05) were associated with a non-dipping pattern. The percentage decline in blood pressure from day to night decreased with the number of metabolic abnormalities (P¼0.012). In conclusion, ABPM non-dipping status is an independent predictor of glucose intolerance. It is also associated with several other metabolic abnormalities. Whether non-dipping pattern is causally related to these metabolic aberrations remains to be explored in a future prospective follow-up of this cohort.

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Section: Discussionmentioning

confidence: 99%

Non-dipping pattern in ambulatory blood pressure monitoring is associated with metabolic abnormalities in a random sample of middle-aged subjects

2009

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“…Among subjects reporting having taken an uninterrupted afternoon siesta, diabetics displayed a similar naptime BP decline to their night-time BP decline, which was blunted as compared to the non-diabetic controls. 75 Several small studies have shown that insulin resistance in non-diabetic hypertensive subjects is also associated with a reduced nocturnal fall in BP. [76][77][78] Mancia et al, however, did not find an increase in non-dipping pattern in patients with the metabolic syndrome, although less than one-third of these individuals had impaired glucose intolerance.…”

Section: Clinical Conditionsmentioning

confidence: 99%

Can nocturnal hypertension predict cardiovascular risk?

Friedman

Logan²

2009

IBPC

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Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.

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“…Despite the high frequency of non-dipping pattern in diabetes mellitus (DM) (Perk et al 2002) and its close relationship with IR (Della Mea et al 2005), the association of non-dipping pattern with MS surprisingly failed to be proven (Cuspidi et al 2004c). This might be due to the inadequacy of the diagnostic method of MS to reflect the excess risk contributed to this syndrome.…”

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confidence: 99%

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

Tartan

Uyarel

Kaşıkçıoğlu

et al. 2006

Tohoku J. Exp. Med.

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Metabolic syndrome (MS) and nondipping hypertension both increase cardiovascular mortality. Although both clinical modalities share common pathophysiologic factors in their etiologies, previous studies did not find any association between them. We aimed to investigate the association between MS and non-dipping blood pressure by comparing different definitions of MS. One hundred-thirty-two consecutive patients (58 men) who underwent 24-hour ambulatory blood pressure monitoring were analyzed. MS was evaluated according to the currently used Adult Treatment Panel (ATP) III definition criteria, named MS-ATP III. In order to reveal the weights of risk contributing to MS, a new diagnostic scoring method (MS-Score) was used in comparison with MS-ATP III. Nocturnal non-dipping refers to a reduction in average systolic and/or diastolic blood pressure at night ( 10%) compared with daytime average values. Non-dipping pattern was found in 61.4% of patients. The frequency of MS according to MS-Score, but not MS ATP III, was significantly higher in patients with nondipping pattern than those without it ( p = 0.009). Although more prominent in the nighttime, MS-Score showed positive correlation with all systolic blood pressure results (r = 0.27, p = 0.002). Adjusted for baseline characteristics, high ( 27.5) MS-Score remained as an independent predictor of non-dipping pattern (OR 2.64, p = 0.038). Finally, high MS-Score, but not MS-ATP III, is a predictor of non-dipping pattern. Nighttime systolic blood pressure is higher in patients with high MS-Score. Therefore, patients with high MS-Score may be more prone to cardiovascular events than those with low MSScore.circadian blood pressure variation; hypertension; metabolic syndrome score; metabolic syndrome adult treatment panel III; non-dipping pattern

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Non-dipping in diabetic patients: insights from the siesta

Cited by 25 publications

References 29 publications

Non-dipping pattern in ambulatory blood pressure monitoring is associated with metabolic abnormalities in a random sample of middle-aged subjects

Non-dipping pattern in ambulatory blood pressure monitoring is associated with metabolic abnormalities in a random sample of middle-aged subjects

Can nocturnal hypertension predict cardiovascular risk?

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

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