Prognostic significance of reverse dipping status on lower limb event in type 2 diabetic patients without peripheral arterial disease

Prognostic value of 24‐hour ambulatory blood pressure patterns in diabetes: A 21‐year longitudinal study

“…This novel information provides new insight into the importance of reverse dipping as an independent prognostic factor for all-cause mortality in diabetes, which was previously supported by a limited number of studies with follow-up periods shorter than 10 years. 19,[21][22][23] The increased mortality risk related to reverse dipping does not seem specific to diabetes, given that a similar increase in the risk for cardiovascular events 39 and all-cause mortality 40 has been previously reported in the general population. However, the impact of reverse dipping may be greater in patients with diabetes, for its prevalence in this group has been reported to be three to five times greater compared with the general population, 39,40 underscoring the particular need for diabetic patients to be screened for dipping abnormalities.…”

“…According to our data, in fact, the negative effects of reverse dipping are only marginally relevant during the first 5 years of observation (or for even longer without accounting for traditional risk factors), becoming increasingly evident afterwards (Figure 2). This novel information provides new insight into the importance of reverse dipping as an independent prognostic factor for all‐cause mortality in diabetes, which was previously supported by a limited number of studies with follow‐up periods shorter than 10 years 19,21‐23 …”

“…Although the associations of abnormal BP dipping with diabetes complications and CVD have been extensively explored in cross‐sectional studies, longitudinal studies are scarce and have short follow‐up periods (no longer than 10 years) 16,19‐22 . Moreover, “reverse dippers” (also called “risers” or “inverted dippers”), who have a mean nocturnal BP higher than diurnal BP (nighttime/daytime SBP ratio >1), have been assessed separately from nondippers in only a few studies 19,21‐23 . This is of particular interest since recent evidence has shown that reverse dippers are characterized by more severe hypertension‐mediated organ damage and increased risk of CVD and Alzheimer's disease in the general population and of lower limb events in patients with type 2 diabetes 23‐26 …”

“…16,[19][20][21][22] Moreover, "reverse dippers" (also called "risers" or "inverted dippers"), who have a mean nocturnal BP higher than diurnal BP (nighttime/daytime SBP ratio >1), have been assessed separately from nondippers in only a few studies. 19,[21][22][23] This is of particular interest since recent evidence has shown that reverse dippers are characterized by more severe hypertension-mediated organ damage and increased risk of CVD and Alzheimer's disease in the general population and of lower limb events in patients with type 2 diabetes. [23][24][25][26] The aim of the present study was to define the clinical features and long-term prognostic value for all-cause mortality of the different BP patterns, as measured through 24-hour ambulatory BP monitoring (ABPM), in patients with diabetes.…”

“…19,[21][22][23] This is of particular interest since recent evidence has shown that reverse dippers are characterized by more severe hypertension-mediated organ damage and increased risk of CVD and Alzheimer's disease in the general population and of lower limb events in patients with type 2 diabetes. [23][24][25][26] The aim of the present study was to define the clinical features and long-term prognostic value for all-cause mortality of the different BP patterns, as measured through 24-hour ambulatory BP monitoring (ABPM), in patients with diabetes. To this end, we retrospectively analysed cross-sectional and 21-year longitudinal data from the "CHronic diabetes complications and All-cause Mortality in PIsa from 1999…”