Predictors of mortality in patients with type 2 diabetes with or without diabetic nephropathy: a follow-up study

Astrup, Anne Sofie; Nielsen, F. S.; Rossing, Peter; Ali, Samir Ben; Kastrup, Jens; Smidt, Ulla M; Parving, Hans‐Henrik

doi:10.1097/hjh.0b013e3282f06428

Cited by 96 publications

(84 citation statements)

References 41 publications

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“…[26][27][28] Nevertheless, a recent article has reported that type 2 diabetics with a riser profile of BP showed 88% mortality during a follow-up of 9 years meanwhile mortality in the non-risers was 45%. 7 This study has some limitations that deserve discussion. First, the cross-sectional design precludes conclusions about prognosis but the large number of patients included makes our data valuable in estimating prevalences of abnormalities in ambulatory BP in hypertensive patients with diabetes.…”

Section: Discussionmentioning

confidence: 90%

“…4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.…”

Section: Introductionmentioning

confidence: 99%

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Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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on behalf of the Spanish Society of Hypertension ABPM Registry investigators 9Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68 045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of 41200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12 600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, Po0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, Po0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, Po0.001).Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, Po0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered. Hypertension Research (2011) 34, 1185-1189; doi:10.1038/hr.2011.100; published online 11 August 2011Keywords: ambulatory blood pressure monitoring; circadian profile; diabetes; hypertension control INTRODUCTION Hypertension affects the majority of patients with diabetes and constitutes a major risk factor for vascular complications. 1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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“…12 The association between diurnal ABPM parameters, mortality and CV events in patients with type 2 diabetes has also been evaluated in previous studies. In a 9.2 year follow-up study, Astrup et al 10 found that non-dipping independently predicted total mortality in 104 normo-and microalbuminuric type 2 diabetic patients. The association with CV events was not reported, and PP was not calculated.…”

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%

“…Moreover, some studies report the association with total mortality, not with CV mortality. 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.…”

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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Subcutaneous adipose tissue transplantation in diet-induced obese mice attenuates metabolic dysregulation while removal exacerbates it

et al. 2013

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Adipose tissue distribution is an important determinant of obesity-related comorbidities. It is well established that central obesity (visceral adipose tissue accumulation) is a risk factor for many adverse health consequences such as dyslipidemia, insulin resistance and type-2-diabetes. We hypothesize that the metabolic dysregulation that occurs following high fat diet-induced increases in adiposity are due to alterations in visceral adipose tissue function which influence lipid flux to the liver via the portal vein. This metabolic pathology is not exclusively due to increases in visceral adipose tissue mass but also driven by intrinsic characteristics of this particular depot. In Experiment 1, high fat diet (HFD)-induced obese control (abdominal incision, but no fat manipulation) or autologous (excision and subsequent relocation of adipose tissue) subcutaneous tissue transplantation to the visceral cavity. In Experiment 2 mice received control surgery, subcutaneous fat removal or hetero-transplantation (tissue from obese donor) to the visceral cavity. Body composition analysis and glucose tolerance tests were performed 4 weeks post-surgery. Adipose mass and portal adipokines, cytokines, lipids and insulin were measured from samples collected at 5 weeks post-surgery. Auto- and hetero- transplantation in obese mice improved glucose tolerance, decreased systemic insulin concentration and reduced portal lipids and hepatic triglycerides compared with HFD controls. Hetero-transplantation of subcutaneous adipose tissue to the visceral cavity in obese mice restored hepatic insulin sensitivity and reduced insulin and leptin concentrations to chow control levels. Fat removal, however, as an independent procedure exacerbated obesity-induced increases in leptin and insulin concentrations. Overall subcutaneous adipose tissue protects against aspects of metabolic dysregulation in obese mice. Transplantation-induced improvements do not occur via enhanced storage of lipid in adipose tissue, however altered hepatic lipid regulation may play a contributory role.

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Predictors of mortality in patients with type 2 diabetes with or without diabetic nephropathy: a follow-up study

Cited by 96 publications

References 41 publications

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

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

Subcutaneous adipose tissue transplantation in diet-induced obese mice attenuates metabolic dysregulation while removal exacerbates it

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