Prognostic impact of clinic and ambulatory blood pressure components in high-risk type 2 diabetic patients

Salles, Gil F.; Leite, Nathalie C.; Pereira, Basílio de Bragança; Nascimento, Emília Matos do; Cardoso, Claudia R.L.

doi:10.1097/hjh.0b013e328364103f

Cited by 39 publications

(60 citation statements)

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“…The characteristics of this cohort, the baseline procedures and the diagnostic definitions have been detailed elsewhere [15,[18][19][20]. In brief, the inclusion criteria were all adults with type 2 diabetes who were aged up to 80 years and had either any microvascular (retinopathy, nephropathy or neuropathy) or macrovascular (coronary, cerebrovascular or peripheral artery disease) complication, or at least two other modifiable cardiovascular risk factors.…”

Section: Methodsmentioning

confidence: 99%

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Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

et al. 2015

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Aims/hypothesis Diabetic peripheral neuropathy (DPN) is a chronic microvascular complication that is strongly associated with poor glycaemic control and also with a worse prognosis. We aimed to evaluate the predictors of the development and progression of DPN in a cohort of high-risk patients with type 2 diabetes. Methods In a prospective study, 477 patients with type 2 diabetes were clinically assessed for the presence of DPN at baseline and after a median follow-up of 6.2 years (range 2-10 years). Clinical laboratory data were obtained at study entry and throughout the follow-up. Aortic stiffness was assessed by the carotid-femoral pulse wave velocity (cf-PWV) at baseline. Multivariate Poisson regression analysis was used to examine independent predictors of the development/progression of DPN. Results At baseline, 135 patients (28%) had DPN, and during follow-up 97 patients (20%) had either a new development or a worsening of DPN. Patients who showed a development or progression of DPN were taller and had a longer duration of diabetes, a greater prevalence of other microvascular complications and hypertension, greater aortic stiffness and poorer glycaemic control than patients who did not have new or progressive neuropathy. After adjustments for the baseline prevalence of DPN, the patient's age and sex, and the time interval between DPN assessments; an increased aortic stiffness (cf-PWV >10 m/s) were predictive of new/progressive DPN (incidence rate ratio 2.04, 95% CI 1.28, 3.23; p=0.002).Other independent predictors were the mean first-year HbA 1c level ( p=0.05), nephropathy ( p=0.006), arterial hypertension ( p=0.06) and height ( p=0.03). Conclusions/interpretation Increased aortic stiffness at baseline predicts the future development or progression of peripheral neuropathy, independent of diabetic metabolic control, suggesting a physiopathological link between macrovascular and microvascular abnormalities in type 2 diabetes.

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Section: Methodsmentioning

confidence: 99%

“…The diagnostic criteria for chronic complications of diabetes have previously been detailed [15,[18][19][20]. Briefly, CHD was diagnosed by clinical electrocardiographic criteria or by positive ischaemic stress tests.…”

Section: Methodsmentioning

confidence: 99%

Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

et al. 2015

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“…All were submitted to a standard baseline protocol that included a complete clinical examination, laboratory evaluation, and cf-PWV measurement. Diagnostic criteria for chronic diabetes complications have previously been described (9,(24)(25)(26). Specifically for this analysis, patients with aorto-iliac occlusive disease were excluded because of its effect on pulse wave velocity measurement (26).…”

Section: Patients and Baseline Proceduresmentioning

confidence: 99%

“…All participants gave written informed consent, and the local ethics committee had previously approved the study protocol. The characteristics of this cohort, the baseline procedures, and the diagnostic definitions have previously been described (9,(24)(25)(26). In brief, subjects included were all adults with type 2 diabetes up to 80 years old either with any microvascular (retinopathy, nephropathy, or neuropathy) or macrovascular (coronary, cerebrovascular, or peripheral artery disease) complication or with at least two other modifiable cardiovascular risk factors.…”

Section: Patients and Baseline Proceduresmentioning

confidence: 99%

Correlates of Aortic Stiffness Progression in Patients With Type 2 Diabetes: Importance of Glycemic Control

et al. 2015

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OBJECTIVEThe correlates of serial changes in aortic stiffness in patients with diabetes have never been investigated. We aimed to examine the importance of glycemic control on progression/regression of carotid-femoral pulse wave velocity (cf-PWV) in type 2 diabetes. RESEARCH DESIGN AND METHODSIn a prospective study, two cf-PWV measurements were performed with the Complior equipment in 417 patients with type 2 diabetes over a mean followup of 4.2 years. Clinical laboratory data were obtained at baseline and throughout follow-up. Multivariable linear/logistic regressions assessed the independent correlates of changes in cf-PWV. RESULTSMedian cf-PWV increase was 0.11 m/s per year (1.1% per year). Overall, 212 patients (51%) increased/persisted with high cf-PWV, while 205 (49%) reduced/persisted with low cf-PWV. Multivariate linear regression demonstrated direct associations between cf-PWV changes and mean HbA 1c during follow-up (partial correlation 0.14, P = 0.005). On logistic regression, a mean HbA 1c ‡7.5% (58 mmol/mol) was associated with twofold higher odds of having increased/persistently high cf-PWV during follow-up. Furthermore, the rate of HbA 1c reduction relative to baseline levels was inversely associated with cf-PWV changes (partial correlation 20.11, P = 0.011) and associated with reduced risk of having increased/persistently high aortic stiffness (odds ratio 0.82 [95% CI 0.69-0.96]; P = 0.017). Other independent correlates of progression in aortic stiffness were increases in systolic blood pressure and heart rate between the two cf-PWV measurements, older age, female sex, and presence of dyslipidemia and retinopathy. CONCLUSIONSBetter glycemic control, together with reductions in blood pressure and heart rate, was the most important correlate to attenuate/prevent progression of aortic stiffness in patients with type 2 diabetes.

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“…36 Moreover, a recent study in high-risk patients with type 2 diabetes mellitus reported significantly more CV events for an achieved nighttime SBP ≥120 mm Hg compared with nighttime SBP <110 mm Hg. 37 Interestingly, from the data of the MAPEC study, 8 lower CV risk was found with the progressive reduction in achieved asleep SBP, irrespective of administration time of antihypertensive drugs. 38 Thus, for both dosing regimens CV risk was lowest in patients with achieved asleep SBP <103 mm Hg and significantly higher when >115 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Targeting Nocturnal Hypertension in Type 2 Diabetes Mellitus

et al. 2014

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During the past decades, several studies in different populations have suggested that nighttime blood pressure (BP) is a stronger predictor of cardiovascular (CV) events than daytime BP. [1][2][3][4][5] Indeed, a recent meta-analysis concluded that nighttime BP is superior to daytime BP in predicting CV events and total mortality in both patients and general populations. 6 Consequently, treatment strategies to target nighttime BP have come into focus.Bedtime administration (BA) of different classes of antihypertensive drugs has been shown to reduce nighttime BP, although results are not unequivocal. 7 Moreover, a recent prospective study concluded that BA of ≥1 antihypertensive drugs resulted in a significantly lower relative risk of total events and major CV events.8 Consequently, the American Diabetes Association now recommends administering ≥1 antihypertensive drugs at bedtime. 9Diabetes mellitus is a condition in which CV risk is markedly increased. 10 The predictive role of nighttime BP has also been established in patients with diabetes mellitus.3 Nocturnal hypertension is more frequent in diabetic compared with that in nondiabetic patients, in part, because of autonomic dysfunction. Only a few studies have investigated the effect of BA of antihypertensive drugs in diabetes mellitus, 11,12 and these studies applied BA irrespective of the level of nighttime BP.Hence, it was our aim to conduct a randomized crossover study on the effect of change of administration time of oncedaily antihypertensive drugs in a population of patients with type 2 diabetes mellitus and nocturnal hypertension, defined as nighttime systolic BP (SBP) ≥120 mm Hg. Our primary end point was changes in ambulatory BP parameters, with specific focus on nighttime BP. MethodsThe study was approved by the Central Denmark Region Committees on Health Research Ethics and the Danish Data Protection Agency. All patients provided informed consent. The study was registered at ClinicalTrials.gov with ID NCT01158625. Study PopulationInclusion criteria included (1) type 2 diabetes mellitus, (2) antihypertensive treatment including ≥1 once-daily renin-angiotensin system Abstract-Several studies in different populations have suggested that nighttime blood pressure (BP) is a stronger predictor of cardiovascular events than daytime BP. Consequently, treatment strategies to target nighttime BP have come into focus. The aim of the present study was to investigate the effect of change of administration time of antihypertensive drugs. We included 41 patients with type 2 diabetes mellitus and nocturnal hypertension (nighttime systolic BP >120 mm Hg) in an open-label, crossover study. Patients were randomized to 8 weeks of either morning or bedtime administration of all of the individual's once-daily antihypertensive drugs, followed by 8 weeks of switched dosing regimen. Bedtime administration of antihypertensive drugs resulted in a significant reduction in nighttime (7.5 mm Hg; P<0.001) and 24-hour (3.1 mm Hg; P=0.014) systolic BP, with a nonsignificant reduct...

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Prognostic impact of clinic and ambulatory blood pressure components in high-risk type 2 diabetic patients

Cited by 39 publications

References 40 publications

Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

Correlates of Aortic Stiffness Progression in Patients With Type 2 Diabetes: Importance of Glycemic Control

Targeting Nocturnal Hypertension in Type 2 Diabetes Mellitus

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