Reversed circadian blood pressure rhythm is associated with occurrences of both fatal and nonfatal vascular events in NIDDM subjects.

Nakano, Shigeru; Fukuda, Morikuni; Hotta, Fumitake; Ito, Tomohiko; Ishii, Tomohiro; Kitazawa, Mitsutaka; Nishizawa, Makoto; Kigoshi, Toshikazu; Uchida, Keiji

doi:10.2337/diabetes.47.9.1501

Cited by 180 publications

(110 citation statements)

References 13 publications

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“…At present, no studies on the long-term predictive value of ambulatory PP for nephropathy progression in patients with type 2 diabetes have been published. Impaired nocturnal BP decline ('non-dipping') is another BP abnormality that has been associated with micro- [1,[10][11][12][13][14][15][16][17] and macrovascular [1,18] complications in type 1 and type 2 diabetic patients. In a recently published 3 year follow-up study in elderly patients with type 2 diabetes [19], patients with a reversed diurnal BP rhythm (nocturnal BP 'risers') had an increased risk of nephropathy progression compared with those who had a normal reduction in BP during the night ('dippers').…”

Section: Introductionmentioning

confidence: 99%

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

et al. 2009

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Aims/hypothesis We followed type 2 diabetic patients over a long period to evaluate the predictive value of ambulatory pulse pressure (PP) and decreased nocturnal BP reduction (non-dipping) for nephropathy progression. Methods Type 2 diabetic patients (n=112) were followed for an average of 9.5 (range 0.5-14.5) years. At baseline, all patients underwent 24 h ambulatory BP measurement. Urinary albumin excretion rate was evaluated by three urinary albumin:creatinine ratio measurements at baseline and follow-up. Results At baseline, patients who subsequently progressed to a more advanced nephropathy stage (n=35) had reduced diastolic night/day BP variation and higher 24 h systolic BP and PP values; they also had more advanced nephropathy and were more likely to smoke than those with no progression of nephropathy (n=77). In a Cox regression analysis, independent predictors of nephropathy progression were 24 h PP (p<0.01), diastolic night:day BP ratio (p=0.02) and smoking (p=0.02). The adjusted hazards ratio (95% CI) for each mmHg increment in 24 h PP was 1.04 (1.01-1.07), whereas the adjusted hazards ratio (95% CI) for each 1% increase in diastolic night:day BP ratio was 1.06 (1.01-1.11). Only one of 33 patients (3.0%) with both a diastolic night:day BP ratio and a 24 h PP below the median progressed, whereas 17 of 32 patients (53.1%) with both a diastolic night:day BP ratio and a 24 h PP equal to or above the median progressed to a more advanced nephropathy stage (p<0.001). Conclusions/interpretation Ambulatory PP, impaired nocturnal BP decline and smoking are strong, independent predictors of nephropathy progression in type 2 diabetic patients.

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Section: Introductionmentioning

confidence: 99%

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

et al. 2009

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“…Even in diabetes, we have shown that ambulatory BP levels more accurately predict future cardiovascular events. 5 An abnormal dipping pattern has been established as a risk factor, 6 and white-coat hypertension and masked hypertension have been shown to be moderate risk factors. 7,8 We showed that BP variability during sleep was a risk factor for cardiovascular disease even after adjusting for BP levels in patients with diabetes.…”

mentioning

confidence: 99%

“…12 At present, it has been proven that the riser pattern is extremely harmful. 6 If this pattern is combined with a sleep disturbance such as short duration of sleep or disordered breathing during sleep, it could have a synergistic impact on the incidence of cardiovascular disease. 13 Chronological therapy in diabetes is also important in patients with diabetes.…”

mentioning

confidence: 99%

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

Eguchi

2011

Hypertens Res

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H ypertension is one of the most important determinants of micro-and macrovascular complications in patients with diabetes. Recent guidelines on treating hypertension in diabetes patients, based on clinical evidence of protection against target organ damage, especially as demonstrated by renal outcomes, recommended that office blood pressure (BP) be lowered to 130/ 80 mmHg in these patients. 1 However, very few studies have consistently achieved BP levels as low as 130/80 mmHg in diabetic patients.A landmark report related to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study showed that targeting a systolic BP of o120 mm Hg, as compared with o140 mm Hg, did not reduce the rate of a composite outcome of fatal and non-fatal major cardiovascular events in type 2 diabetics with at high risk for cardiovascular events. 2 As a secondary outcome, intensive BP lowering was effective in reducing total stroke (P¼0.01) and non-fatal stroke events (P¼0.03). 2 Although many observational studies support the 'the lower, the better' theory, it has not been clearly shown that the aggressive lowering of BP is indeed beneficial in the management of hypertension. The ACCORD study was a randomized control study that examined cardiovascular disease as an outcome. The extent of BP lowering in diabetes should be individualized by cardiovascular complications, microvascular complications and the severity of diabetes and hypertension. In the ACCORD subjects, 34% had experienced previous cardiovascular events, and 87% were on antihypertensive medications. The mean baseline BP was as low as 139/76 mmHg in all patients. It is not surprising that no benefit of a further reduction of BP was seen when targeting a systolic BP of o120 mm Hg. In the early stage of diabetes, aggressive control of risk factors could be effective for reducing cardiovascular outcomes. 3,4 In clinical practice, physicians occasionally hesitate to add antihypertensive medications to achieve clinic BP of 130/80 mmHg. The target BP level in patients with diabetes remains to be established. In terms of individualized BP control, ambulatory BP monitoring (ABPM) is the most useful tool for accurately evaluating BP level and variability.For the assessment and management of BP, ABPM is better than clinic BP. 5 ABPM can more reliably and easily assess actual BP levels than clinic BP and is helpful for predicting cardiovascular events, target organ damage and antihypertensive effects. Even in diabetes, we have shown that ambulatory BP levels more accurately predict future cardiovascular events. 5 An abnormal dipping pattern has been established as a risk factor, 6 and white-coat hypertension and masked hypertension have been shown to be moderate risk factors. 7,8 We showed that BP variability during sleep was a risk factor for cardiovascular disease even after adjusting for BP levels in patients with diabetes. 9 Unless ABPM is performed, it is difficult to assess these measures and to perform detailed assessments, especially of nighttime BP. In the meantime, ...

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“…The loss of nocturnal BP dipping has been considered to be a risk factor for the progression of nephropathy and of prognostic value with respect to target organ damage and cardiovascular morbidity. [1][2][3] Ambulatory BP monitoring allows the acquisition of valuable information not only about the average BP over 24 h (the 24-h BP) but also about the variations in the BP values during the course of the day. Using information from ambulatory BP monitoring, previous studies have found that BP variability is a complex phenomenon that involves both short-and long-lasting changes.…”

Section: T He Accumulated Results Of Clinical Trialsmentioning

confidence: 99%

Questionable link between normo- to microalbuminuria and home-measured blood pressure variability in hypertension

Tamura

Shibuya²,

Takeshita

et al. 2012

Hypertens Res

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Reversed circadian blood pressure rhythm is associated with occurrences of both fatal and nonfatal vascular events in NIDDM subjects.

Cited by 180 publications

References 13 publications

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

Questionable link between normo- to microalbuminuria and home-measured blood pressure variability in hypertension

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