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Akintunde AA, Olamoyegun MA, Akinlade MO, Yusuf OA, Salawu A. Abnormal blood pressure dipping pattern: frequency, determinants, and correlates in Diabetes Mellitus patients in the Cardiovascular Health Risk Assessment in Diabetes Mellitus (CHiD) study. J Diabetes Metab Disord 2024; 23:689-697. [PMID: 38932843 PMCID: PMC11196480 DOI: 10.1007/s40200-023-01337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/24/2023] [Indexed: 06/28/2024]
Abstract
Purpose Non-dipping status is associated with increased total and cardiovascular mortality in many disease conditions including diabetes mellitus. The pattern and its implications are not well described among Africans. This study was done to describe the frequency of abnormal blood pressure (BP) dipping among T2DM subjects, its determinants and correlates in Ogbomoso, Nigeria. Methods This was a cross-sectional study done at the LAUTECH Teaching Hospital, Ogbomoso. One hundred individuals diagnosed with T2DM were recruited and they had 24-hour ambulatory BP monitoring, echocardiography, ECG, and carotid Doppler among other evaluations. Statistical analysis was done using SPSS 27.0 (Chicago Ill, USA). Results The mean age of the participants was 59.3 ± 10.8 years, mean body mass index 27.7 ± 5.9 kg/m2 with a mean duration of diabetes of 7.52 ± 5.54 years. Abnormal BP dipping was present in 89% (consisting of 41% or reverse dippers and 48% non-dippers). T2DM subjects with abnormal dipping pattern were more likely to be females, had higher glycated haemoglobin, lower fractional shortening, higher left atrial volume and left ventricular mass index, and a higher DM duration than those with normal BP dipping status. The major determinants of abnormal dipping pattern were the duration of diabetes and low HDL-C concentration. Conclusion Abnormal BP dipping pattern is highly prevalent in T2DM subjects, especially among females. Abnormal BP dipping was also associated with markers of increased cardiovascular risk such as impaired kidney function, left ventricular hypertrophy, postural hypotension, history of intermittent claudication, and presence of plaques on carotid Doppler studies. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01337-8.
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Affiliation(s)
- Adeseye A. Akintunde
- Cardiology Unit, Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
- Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Michael A. Olamoyegun
- Endocrinology Unit, Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
- Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Mathias O. Akinlade
- Cardiology Unit, Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
- Cardiology Department, Royal Infirmary of Edinburgh, 51 Little France, Edinburgh, EH16 4SA Scotland
| | | | - Afolabi Salawu
- Department of Chemical Pathology, Faculty of Basic Clinical Sciences, Ladoke Akintola University of Technology, Prof. Adeseye A. Akintunde, P.O. Box 3238, Osogbo, Nigeria
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Mishra A, Alam F, Mateen S, Jabeen F, Anjum M, Mamrawala N. Fragmented Ventricular Complexes and Blood Pressure Variability Assessed by Ambulatory Blood Pressure Monitoring in Patients With Metabolic Syndrome. Cureus 2024; 16:e59950. [PMID: 38854183 PMCID: PMC11161866 DOI: 10.7759/cureus.59950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Hypertension is a leading risk factor for the development of cardiovascular and metabolic derangements. In patients with metabolic syndrome (MetS), hypertension is one of the cornerstones showing high variability which is detected in ambulatory blood pressure monitoring. Fragmented ventricular complexes on ECG are seen as hypertensives and are a viable and easy measure of myocardial fibrosis even in the absence of obvious hypertrophy. Aim The present study was undertaken to study the blood pressure variability in patients of MetS with fragmented QRS (fQRS) versus normal ventricular complexes (QRS). Results Out of 100 patients, 22 (22%) had fQRS complexes. Hypertension and diabetes were the most prevalent associated in both groups but a difference was seen with coronary artery disease, which was significantly associated in the fQRS group (8.97% vs 95.45%, p<0.001) as compared to the non-fQRS group. Significant differences were observed in waist circumference (p=0.019), triglyceride (p=0.006) and left ventricular ejection fraction (p<0.001) between the two groups. There was a marked difference (p<0.05) between heart rate variability during day and night time between normal and fQRS sub-groups, being higher in the latter. A similar pattern of change was observed for systolic and diastolic blood pressures and associated dipping. Conclusion Significant differences exist between heart rate and blood pressure changes in patients with fQRS of MetS, thus making fQRS a potent indicator of cardiovascular status.
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Affiliation(s)
- Ajay Mishra
- Internal Medicine, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Fakhare Alam
- Internal Medicine, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | - Saboor Mateen
- Internal Medicine, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Firdaus Jabeen
- Internal Medicine, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Mehvish Anjum
- Internal Medicine, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Neel Mamrawala
- Internal Medicine, Era's Lucknow Medical College and Hospital, Lucknow, IND
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Feitosa ADDM, Barroso WKS, Mion Junior D, Nobre F, Mota-Gomes MA, Jardim PCBV, Amodeo C, Oliveira AC, Alessi A, Sousa ALL, Brandão AA, Pio-Abreu A, Sposito AC, Pierin AMG, Paiva AMGD, Spinelli ACDS, Machado CA, Poli-de-Figueiredo CE, Rodrigues CIS, Forjaz CLDM, Sampaio DPS, Barbosa ECD, Freitas EVD, Cestario EDES, Muxfeldt ES, Lima Júnior E, Campana EMG, Feitosa FGAM, Consolim-Colombo FM, Almeida FAD, Silva GVD, Moreno Júnior H, Finimundi HC, Guimarães ICB, Gemelli JR, Barreto-Filho JAS, Vilela-Martin JF, Ribeiro JM, Yugar-Toledo JC, Magalhães LBNC, Drager LF, Bortolotto LA, Alves MADM, Malachias MVB, Neves MFT, Santos MC, Dinamarco N, Moreira Filho O, Passarelli Júnior O, Vitorino PVDO, Miranda RD, Bezerra R, Pedrosa RP, Paula RBD, Okawa RTP, Póvoa RMDS, Fuchs SC, Lima SGD, Inuzuka S, Ferreira-Filho SR, Fillho SHDP, Jardim TDSV, Guimarães Neto VDS, Koch VHK, Gusmão WDP, Oigman W, Nadruz Junior W. Brazilian Guidelines for In-office and Out-of-office Blood Pressure Measurement - 2023. Arq Bras Cardiol 2024; 121:e20240113. [PMID: 38695411 DOI: 10.36660/abc.20240113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024] Open
Affiliation(s)
- Audes Diogenes de Magalhães Feitosa
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Instituto de Assistência, Pesquisa e Ensino em Saúde (IAPES), Recife, PE - Brasil
| | | | - Decio Mion Junior
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Nobre
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Marco Antonio Mota-Gomes
- Centro Universitário CESMAC, Maceió, AL - Brasil
- Hospital do Coração de Alagoas, Maceió, AL - Brasil
- Centro de Pesquisas Clínicas Dr. Marco Mota, Maceió, AL - Brasil
| | | | - Celso Amodeo
- Hcor, Associação Beneficente Síria, São Paulo, SP - Brasil
| | | | | | - Ana Luiza Lima Sousa
- Faculdade de Enfermagem da Universidade Federal de Goiás (UFG), Goiânia, GO - Brasil
| | | | - Andrea Pio-Abreu
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo - Brasil
| | | | | | | | | | | | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde,Sorocaba, SP - Brasil
| | | | | | | | | | | | - Elizabeth Silaid Muxfeldt
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho - Programa de Hipertensão Arterial Resistente (ProHArt), Rio de Janeiro, RJ - Brasil
- Instituto de Educação Médica (IDOMED) - Universidade Estácio de Sá, Rio de Janeiro, RJ - Brasil
| | | | | | - Fabiana Gomes Aragão Magalhães Feitosa
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE - Brasil
| | | | - Fernando Antônio de Almeida
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde,Sorocaba, SP - Brasil
| | - Giovanio Vieira da Silva
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Marcio Ribeiro
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | | | - Luciano F Drager
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | - Marcus Vinícius Bolívar Malachias
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Fundação Educacional Lucas Machado (FELUMA), Belo Horizonte, MG - Brasil
| | | | - Mayara Cedrim Santos
- Universidade Federal de Pernambuco (UFPE), Recife, PE - Brasil
- Instituto de Assistência, Pesquisa e Ensino em Saúde (IAPES), Recife, PE - Brasil
| | - Nelson Dinamarco
- Colegiado de Medicina - Universidade Estadual de Santa Cruz (UESC), Ilhéus, BA - Brasil
| | | | | | | | | | - Rodrigo Bezerra
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE - Brasil
- Laboratório de Imunopatologia Keizo Asami da Universidade Federal de Pernambuco, Recife, PE - Brasil
| | | | | | | | | | - Sandra C Fuchs
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Sayuri Inuzuka
- Unidade de Hipertensão Arterial - NIPEE - LHA/UFG, Goiânia, GO - Brasil
| | | | | | | | | | - Vera Hermina Kalika Koch
- Instituto da Criança e do adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Waléria Dantas Pereira Gusmão
- Centro Universitário CESMAC, Maceió, AL - Brasil
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL - Brasil
| | - Wille Oigman
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
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Sada K, Yoshida Y, Shibuta K, Kimoto K, Miyamoto S, Ozeki Y, Okamoto M, Gotoh K, Masaki T, Yokoyama K, Kubota T, Shibata H. Associations of Diabetic Retinopathy Severity With High Ambulatory Blood Pressure and Suppressed Serum Renin Levels. J Clin Endocrinol Metab 2023; 108:e1624-e1632. [PMID: 37319371 DOI: 10.1210/clinem/dgad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
CONTEXT The relationships between serum renin levels, severity of diabetic retinopathy (DR), and 24-hour blood pressure (BP) have not been previously reported. OBJECTIVE To explore causes for DR and the relationships of 24-hour ambulatory BP, and hormone levels with the severity of DR. METHODS The diabetic patients were classified as having no DR, simple DR, or severe DR (preproliferative DR plus proliferative DR) based on funduscopic examination, and we measured 24-hour BP, serum active renin (ARC), aldosterone (SAC), adrenocorticotropic hormone, and cortisol levels in each group. RESULTS Compared to those with no DR or simple DR, patients with severe DR showed significantly higher 24-hour BPs, including daytime and nighttime systolic and diastolic BP levels, independent of diabetic duration and HbA1c levels. The variability of nighttime systolic BP was greater in patients with severe DR than in those with nonsevere DR, although nocturnal BP reduction was similar between the groups. The ambulatory BPs were significantly inversely associated with ARC. The ARC was significantly lower in severe DR patients than in those with no DR or simple DR (3.2 [1.5-13.6] vs 9.8 [4.6-18.0] pg/mL, P < .05), but there were no differences in SAC in patients taking calcium channel blockers and/or α-blockers. No associations were found between DR severity and other hormone levels. CONCLUSION Severe DR was associated with higher 24-hour BPs and suppressed ARC. These findings suggest that mineralocorticoid receptor overactivation may play a role in higher BP levels and severe DR in diabetic patients.
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Affiliation(s)
- Kentaro Sada
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Yuichi Yoshida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Kanako Shibuta
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Kenichi Kimoto
- Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Shotaro Miyamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Yoshinori Ozeki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Mitsuhiro Okamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Koro Gotoh
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Katsuhiko Yokoyama
- Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Toshiaki Kubota
- Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
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Lithovius R, Groop PH. The many faces of hypertension in individuals with type 1 diabetes. Diabetes Res Clin Pract 2023; 197:110564. [PMID: 36738830 DOI: 10.1016/j.diabres.2023.110564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Several disturbed blood pressure (BP) patterns, including disparities between office and out-of-office BP measurements (such as white-coat and masked hypertension), disturbed circadian BP variability (such as abnormal dipping patterns and nocturnal hypertension) and treatment-resistant hypertension, are common in individuals with type 1 diabetes. Consequently, office or home BP measurements alone may not reflect real BP variation and may lead to inadequate diagnosis and treatment of hypertension. The early detection of these disturbed BP patterns is especially crucial in individuals with type 1 diabetes, as these patterns may indicate future development of adverse cardiovascular and renal outcomes. In this review we will describe these disturbed BP patterns and discuss recent findings on their prevalence and outcomes. We will also address critical areas for future research to determine the true prevalence and prognosis of disturbed BP patterns, and to optimize and improve the knowledge and management of high-risk individuals with type 1 diabetes and disturbed BP patterns.
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Affiliation(s)
- Raija Lithovius
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Helsinki, Finland; Department of Nephrology, University of Helsinki and Helsinki University Hospital, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Bell DSH. Detecting and treating the protean manifestations of diabetic autonomic neuropathy. Diabetes Obes Metab 2023; 25:1162-1173. [PMID: 36748121 DOI: 10.1111/dom.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
The manifestations of diabetic autonomic neuropathy (DAN) are protean and clinically involve multiple systems, including the cardiovascular system, the gastrointestinal system, the genitourinary system as well as the sweat glands (sudomotor dysfunction) and the gallbladder. In addition, cardiac autonomic neuropathy (CAN) is associated with a correctible inability to appreciate and correct hypoglycaemia. While not a clinical problem, pupillary involvement should be the clue and the catalyst to investigate for other manifestations of DAN. This review outlines a practical approach to detecting and investigating the manifestations of DAN. Of particular importance is early detection of cardiovascular involvement where prompt therapy through glycaemic control can decrease the severity of CAN and decelerate the frequency and severity of retinopathy and nephropathy in addition to decreasing cardiovascular events and mortality. CAN also plays a role in accelerating other diabetic complications such as acute ischaemic stroke, heart failure, medial artery calcinosis, foot ulcers, peripheral artery disease and Charcot joints. Many therapies of DAN are available, which should not only decrease morbidity and mortality from DAN, but also improve the patient's quality of life. However, the therapies available are largely symptomatic.
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Mason SA, Parker L, van der Pligt P, Wadley GD. Vitamin C supplementation for diabetes management: A comprehensive narrative review. Free Radic Biol Med 2023; 194:255-283. [PMID: 36526243 DOI: 10.1016/j.freeradbiomed.2022.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
Growing evidence suggests that vitamin C supplementation may be an effective adjunct therapy in the management of people with diabetes. This paper critically reviews the current evidence on effects of vitamin C supplementation and its potential mechanisms in diabetes management. Evidence from meta-analyses of randomized controlled trials (RCTs) show favourable effects of vitamin C on glycaemic control and blood pressure that may be clinically meaningful, and mixed effects on blood lipids and endothelial function. However, evidence is mostly of low evidence certainty. Emerging evidence is promising for effects of vitamin C supplementation on some diabetes complications, particularly diabetic foot ulcers. However, there is a notable lack of robust and well-designed studies exploring effects of vitamin C as a single compound supplement on diabetes prevention and patient-important outcomes (i.e. prevention and amelioration of diabetes complications). RCTs are also required to investigate potential preventative or ameliorative effects of vitamin C on gestational diabetes outcomes. Oral vitamin C doses of 500-1000 mg per day are potentially effective, safe, and affordable for many individuals with diabetes. However, personalisation of supplementation regimens that consider factors such as vitamin C status, disease status, current glycaemic control, vitamin C intake, redox status, and genotype is important to optimize vitamin C's therapeutic effects safely. Finally, given a high prevalence of vitamin C deficiency in patients with complications, it is recommended that plasma vitamin C concentration be measured and monitored in the clinic setting.
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Affiliation(s)
- Shaun A Mason
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Lewan Parker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Department of Nutrition and Dietetics, Western Health, Footscray, Australia
| | - Glenn D Wadley
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Association of Non-Dipping Blood Pressure Patterns with Diabetic Peripheral Neuropathy: A Cross-Sectional Study among a Population with Diabetes in Greece. Nutrients 2022; 15:nu15010072. [PMID: 36615728 PMCID: PMC9824387 DOI: 10.3390/nu15010072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is present in 20-50% of cases with diabetes. The pathophysiology of DPN is not yet clear regarding hypertension (HTN). The aim of this study was to assess the association between the stages of DPN and HTN in a Greek population with diabetes. We examined 102 adults for diabetic neuropathy (DPN) from November 2020 to December 2021, using the Toronto Clinical Neuropathy Scale System (TCNSS) to categorize them into two groups (no/mild DPN versus medium/severe DPN). Ambulatory blood pressure monitoring was performed to evaluate their hypertensive status. Univariate and multivariate logistic regression analyses were performed to assess the association between the stage of DPN and HTN. The multivariate analysis, considering sex, age, and dipping status, did not show statistically significant associations between stages of HTN and DPN. However, in contrast to dippers, non-dippers had an almost four-times higher risk of developing medium-to-severe DPN (odds ratio (OR) 3.93; 95% confidence interval (CI) [1.33-11.64]); females, in contrast to males, had a 65% lower risk of developing moderate/severe DPN (OR 0.35; 95%CI [0.14-0.92]). In conclusion, our findings showed no statistically significant associations between DPN and HTN; however, dipping status, hyperglycemia, and female sex were shown to play a role in the pathophysiology of DPN.
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Non-dipping pattern in early-stage diabetes: association with glycemic profile and hemodynamic parameters. J Hum Hypertens 2022; 36:805-810. [PMID: 34400769 DOI: 10.1038/s41371-021-00587-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022]
Abstract
Patients with longstanding diabetes exhibit diminished nocturnal blood pressure (BP) drop, yet this phenomenon remains understudied in the early stages of the disease. Eighty patients with newly diagnosed (<6 months) Diabetes Mellitus type 2 (T2DM) and 80 non-T2DM individuals underwent office and 24-h ambulatory BP measurements, estimation of hemodynamic parameters using impedance cardiography and blood tests. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk score was calculated. T2DM patients exhibited higher nighttime systolic blood pressure (SBP) (p = 0.028) and lower dipping (p < 0.001) compared to controls. In the total population, dipping correlated negatively with age, HbA1c, ASCVD risk score, and positively with HDL Cholesterol and Velocity Index (VI), a marker of myocardial contractility (p < 0.05). Nighttime SBP correlated positively with ASCVD risk, BMI, HbA1c, fasting glucose, eGFR, and negatively with VI (p < 0.05). After adjustment for other variables, HbA1c (p = 0.03), eGFR (p = 0.02) and VI (p = 0.004) independently predicted non-dipping. Multivariate analysis revealed HbA1c (p = 0.023), eGFR (p = 0.05), and VI (p = 0.006) as independent predictors of nighttime SBP. Patients diagnosed with T2DM concurrently present impaired circadian BP rhythm, which appears to be directly associated with impaired glycemic profile. The observed association with myocardial contractility might represent an additional mechanism for the aggravated cardiovascular risk in these patients.
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Gupta H, Vidhale T, Pustake M, Gandhi C, Roy T. Utility of ambulatory blood pressure monitoring in detection of masked hypertension and risk of hypertension mediated organ damage in normotensive patients with type 2 diabetes mellitus. Blood Press 2022; 31:50-57. [PMID: 35438026 DOI: 10.1080/08037051.2022.2061415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE In patients with diabetes, unrecognised hypertension is a serious problem risk factor for the development and progression of chronic complications. The study aimed to determine the prevalence of masked hypertension in normotensive diabetic patients, the factors affecting it, and its association with diabetes complications using ambulatory blood pressure monitoring (ABPM). MATERIALS AND METHODS A cross-sectional observational study was conducted on 150 normotensive diabetic patients. Patients were subjected to an interview and clinical examination to record demographic data, epidemiological data, and significant past history. ABPM was performed for each patient. Urine samples, echocardiogram, and ophthalmologic fundoscopy were done to check for diabetes-related complications. RESULTS The mean age of all participants was 56.7 ± 7.8 years. A total of 93 patients (62%) were males. 99 (66%) patients had masked hypertension. A total of 85 (56.7%) were non-dippers, 49 (32.7%) were dippers, 1 (0.7%) was extreme dipper and 15 (10%) were reverse dippers. Non-dipping and reverse dipping were associated with concentric left ventricular hypertrophy LVH (p < .001). Masked hypertension was associated with concentric LVH (p = .001) and nephropathy (p =.008) whereas, nocturnal hypertension was associated with concentric LVH (p = .001) and nephropathy (p =.003). CONCLUSIONS A single office blood pressure (BP) reading cannot rule out hypertension in patients with diabetes. Regardless of hypertension, clinicians should have all patients, especially patients with diabetes, undergo ABPM at least once. Masked hypertension, changes in nocturnal dipping and other phenomena that raise the risk of diabetes complications but cannot be measured by office BP can be measured by ABPM, and thus ABPM can provide a good prognostic benefit.
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Affiliation(s)
- Hemant Gupta
- Department of Internal Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, India
| | - Tushar Vidhale
- Department of Internal Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, India
| | - Manas Pustake
- Department of Internal Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, India
| | - Charmi Gandhi
- Department of Internal Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, India
| | - Tanmoy Roy
- Department of Internal Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Byculla, India
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Silva AFRD, Cruz RC, Albuquerque NLSD, Silva VMD, Araujo TLD. Blood pressure variability in individuals with diabetes mellitus: a scoping review. Rev Bras Enferm 2022; 75:e20210804. [DOI: 10.1590/0034-7167-2021-0804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: to map methods and devices used to assess very short-, short-, medium-, and long-term pressure variability in adults with type 1 or 2 diabetes mellitus. Methods: scoping review conducted in January and February 2021 in MEDLINE, Web of Science, CINAHL, LILACS, PubMed, and Embase databases. Studies conducted within the last ten years analyzing pressure variability in adult and older patients with diabetes mellitus type 1 or 2 were included. Studies that used discontinued devices were excluded. Results: the sample was composed of 25 articles published since 2017, with the majority developed in Japan (n=11); with the predominance of the oscillometric method (n=22); the most used devices were from the Omron® brand (n=14); the most detected type was long-term variability (n=10). Conclusions: we observed the increasing application of the oscillometric method for pressure variability analysis with various brands and models of automatic devices.
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12
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ALP Ç, DOGRU MT, DEMİR V. Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions. Turk J Med Sci 2021; 51:3030-3037. [PMID: 34590797 PMCID: PMC10734825 DOI: 10.3906/sag-2105-177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 12/13/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Hypertensive patients have shown autonomic dysfunction that is closely associated with the measurements of heart rate variability (HRV) and heart rate turbulence (HRT). We aimed to show the alterations of HRV and HRT measurements in patients with both dipper and non-dipper hypertension. Materials and methods This was a retrospective study consisting of one hundred and twenty-three participants (mean age ± SD, 55.7 ± 14.8 years; range, 18–90 years). The participants were divided into two groups: Group1: The patients with dipper hypertension, Group2: The patients with non-dipper hypertension. Two cardiologists performed HRV and HRT using 24-h electrocardiography (ECG) Holter and ambulatory blood pressure monitoring (ABPM) of patients. Results The results indicated that patients in group 2 had higher low frequency power/high frequency power ratio (LF/HF), lower high frequency power (HF) , root mean square of standard deviation (RMSSD) values than group 1 (p = 0.007, p = 0.008, and p = 0.002, respectively). Group 2 also showed higher heart rate turbulence onset (HRTTO) and lower heart rate turbulence slope (HRTTS) values than Group 1 (p = 0.004, p = 0.001, respectively). We performed multivariate analysis and observed that HRTTS and HRTTO have statistically significant associations with the presence of dipper or non-dipper hypertension [F = 7.755, p = 0.001], LF/HF [F = 7.868, p = 0.001], and HF [F = 4.081, p = 0.020]. Conclusion This study shows a statistically significant difference in HRT measurements between dipper and non-dipper hypertensive patients. Deteriorated autonomic circadian rhythm and autonomic functions may contribute to these results.
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Affiliation(s)
- Çağlar ALP
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkey
| | - Mehmet Tolga DOGRU
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkey
| | - Vahit DEMİR
- Department of Cardiology, Yozgat City Hospital, Yozgat
Turkey
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13
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Possible Preventative/Rehabilitative Role of Gliflozins in OSA and T2DM. A Systematic Literature Review-Based Hypothesis. Adv Ther 2021; 38:4195-4214. [PMID: 34273093 PMCID: PMC8342338 DOI: 10.1007/s12325-021-01791-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is characterized by frequent apnoea episodes during sleep due to upper airway obstruction. The present review summarizes current knowledge on inter-relationships between OSA and type 2 diabetes mellitus (T2DM) and suggests the former as a possible target for sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Based on pathophysiological mechanisms underlying OSA onset and renal SGLT-2 effects, we suggest that SGLT-2i indications might expand beyond current ones, including glucose, lipids, uric acid, blood pressure, and body weight control as well as chronic heart failure and kidney disease prevention.
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14
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Çoner A, Akbay E, Akıncı S, Özyıldız G, Gençtoy G, Müderrisoğlu H. Determinants of reverse dipping blood pressure in normotensive, non-diabetic population with an office measurement below 130/85mmHg. Clin Exp Hypertens 2021; 43:647-652. [PMID: 34151642 DOI: 10.1080/10641963.2021.1925685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The role of dipping blood pressure pattern in normotensives is unclear. The study aims to search the circadian blood pressure rhythm and the clinical determinants related to reverse dipping pattern in a strictly selected, normotensive population.Methods: The study population was divided into three groups depending on the nocturnal dipping pattern as dipping, non-dipping, and reverse dipping. Basal clinical characteristics, anthropometric measurements, and spot urine samples from the first-morning void were collected. Clinical determinants related to the presence of reverse dipping pattern were tested by the Multiple Binary Logistic Regression analysis.Results: A total of 233 participants were involved in the study population (median age 45 years [40-50]). Dipping pattern was detected in 55.4%, non-dipping pattern in 33.0%, and reverse dipping pattern in 11.6% of the study population. There was no difference between the groups in terms of basal clinical features. Albumin-to-creatinine ratio (ACR) (p < .001) and hs-CRP levels (p = .006) were also statistically significant across the groups. ACR (HR: 1.195, 95% CI: 1.067-1.338, p = .002) and hs-CRP (HR: 2.438, 95% CI: 1.023-5.808, p = .044) were found to be related to the presence of reverse dipping blood pressure pattern.Conclusions: The absence of nocturnal physiological dipping is seen at a remarkable rate in the normotensive Turkish population. ACR and hs-CRP are the clinical determinants related to the presence of reverse dipping blood pressure pattern.
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Affiliation(s)
- Ali Çoner
- Department of Cardiology, Baskent University Hospital Alanya Application and Research Center, Alanya/Antalya, Turkey
| | - Ertan Akbay
- Department of Cardiology, Baskent University Hospital Alanya Application and Research Center, Alanya/Antalya, Turkey
| | - Sinan Akıncı
- Department of Cardiology, Baskent University Hospital Alanya Application and Research Center, Alanya/Antalya, Turkey
| | - Gökhan Özyıldız
- Department of Cardiology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Gültekin Gençtoy
- Department of Nephrology, Baskent University Hospital Alanya Application and Research Center, Alanya/Antalya, Turkey
| | - Haldun Müderrisoğlu
- Department of Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
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Li Y, Deng B, Guo Y, Peng Q, Hu T, Xia K. Association between glycated hemoglobin and ambulatory blood pressure or heart rate in hypertensive patients. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:488-496. [PMID: 34148885 PMCID: PMC10930215 DOI: 10.11817/j.issn.1672-7347.2021.200750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the association between glycosylated hemoglobin (HbA1c) and ambulatory blood pressure or heart rate in hypertensive patients. METHODS A total of 585 patients, who performed ambulatory blood pressure monitoring (ABPM) from September 2018 to April 2019 in Xiangya Hospital, Central South University, were enrolled and assigned into 2 groups (470 in a hypertensive group and 115 in a normal group). HbA1c levels were compared. According to the HbA1c level, the hypertensive group was divided into 2 subgroups: A high HbA1c group (HbA1c≥6.1%, n=142) and a normal HbA1c group (HbA1c<6.1%, n=328). Whole basic data and ABPM parameter were compared among the groups. Pearson/Spearman correlation analysis was applied to study the association between HbA1c and BPV. Multivariate logistic regression was used to explore the influential factors for HbA1c (≥6.1%) and continuous increase of HbA1c in different hypertensive populations, respectively. RESULTS The hypertensive group had higher HbA1c level than the normal group [(6.1±1.3)% vs (5.1±1.7)%, P<0.05]. In hypertensive patients, nocturnal systolic blood pressure [(131.1±19.2) mmHg vs (122.5±19.2) mmHg], nocturnal systolic blood pressure load [62.5% (15.5%-100%) vs 28.6% (0-75%)], and daytime heart rate [(74.3±11.6) min-1 vs (71.2±11.4) min-1] of the high HbA1c group were higher than those in the normal HbA1c group (all P<0.05). Pearson/Spearman correlation analysis showed that HbA1c was positively correlated with systolic blood pressure and blood pressure load (both P<0.05). Logistic regression analysis showed that nocturnal systolic pressure load was the risk factor for the increase of HbA1c level (OR=1.025, 95% CI 1.003 to 1.048, P<0.05). Multiple linear regression showed that nocturnal systolic pressure load was still positively correlated with HbA1c in total, tertiary, and hypertensive patients without treatment (β=0.155, β=0.171, β=0.384, respectively, all P<0.05). CONCLUSIONS In hypertensive patients, HbA1c is positively correlated with ambulate blood pressure, blood pressure load, and heart rate, and it has no correlation with blood pressure variability, heart rate variability, or morning blood pressure.
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Affiliation(s)
- Yuan Li
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Bin Deng
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuxuan Guo
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qingling Peng
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tao Hu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ke Xia
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
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16
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A systematic review and meta-analysis of the serum lipid profile in prediction of diabetic neuropathy. Sci Rep 2021; 11:499. [PMID: 33436718 PMCID: PMC7804465 DOI: 10.1038/s41598-020-79276-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
Whether the lipid profile in diabetic patients is associated with diabetic neuropathy (DN) development remains ambiguous, as does the predictive value of serum lipid levels in the risk of DN. Here, we performed the first meta-analysis designed to investigate the relationship between DN and the serum levels of triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL). Candidate studies were comprehensively identified by searching PubMed, Embase, Cochrane Library and Web of Science databases up to May 2020. Observational methodological meta-analysis was conducted to assess the relationships of TG, TC, HDL, and LDL levels with DN. Changes in blood lipids were used to estimate the effect size. The results were pooled using a random-effects or fixed-effects model. Potential sources of heterogeneity were explored by subgroup analysis. Various outcomes were included, and statistical analyses were performed using STATA (Version 12.0). Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. The Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality. I2 statistics were calculated to evaluate statistical heterogeneity. Funnel plots were utilized to test for publication bias. A sensitivity analysis was performed by omitting each study one by one. Thirty-nine clinical trials containing 32,668 patients were included in the meta-analysis. The results demonstrated that DN patients showed higher TG and lower HDL levels (MD = 0.34, 95% CI: 0.20–0.48 for TG; MD = -0.05, 95% CI: -0.08–-0.02, I2 = 81.3% for HDL) than controls. Subgroup analysis showed that patients with type 1 diabetes mellitus (T1DM) neuropathy had elevated TG levels in their serum (MD = 0.25, 95% CI: 0.16–0.35,I2 = 64.4% for T1DM). However, only patients with T1DM neuropathy had reduced serum HDL levels, and there was no significant difference in serum HDL levels between patients with T2DM neuropathy and controls (MD = -0.07, 95% CI: -0.10–-0.03, I2 = 12.4% for T1DM; MD = -0.02, 95% CI: -0.07–0.03, I2 = 80.2% for T2DM). TC and LDL levels were not significantly different between DN patients and controls (MD = -0.03, 95% CI: -0.14–0.09, I2 = 82.9% for TC; MD = -0.00, 95% CI: -0.08–0.08, I2 = 78.9% for LDL). In addition, compared with mild or painless DN patients, those with moderate or severe pain DN pain had significantly reduced serum TC and LDL levels (MD = -0.31, 95% CI: -0.49–-0.13, I2 = 0% for TC; MD = -0.19, 95% CI: -0.32–-0.08, I2 = 0% for LDL). TG levels and HDL levels did not vary considerably between patients with mild or painless DN and those with moderate or severe DN pain patients (MD = 0.12, 95% CI: -0.28–0.51, I2 = 83.2% for TG; MD = -0.07, 95% CI:-0.14–0.01, I2 = 58.8% for HDL). Furthermore, people with higher TG and LDL levels had higher risk of DN (OR = 1.36, 95% CI: 1.20–1.54, I2 = 86.1% for TG and OR = 1.10, 95% CI: 1.02–1.19, I2 = 17.8% for LDL). Conversely, high serum HDL levels reduced the risk of DN (OR = 0.85, 95% CI: 0.75–0.96, I2 = 72.6%), while TC levels made no significant difference with the risk of DN (OR = 1.02, 95% CI: 1.00–1.04, I2 = 84.7%). This meta-analysis indicated that serum lipid profile changes are among the biological characteristics of DN. Lipid levels should be explored as routine laboratory markers for predicting the risk of DN, as they will help clinicians choose appropriate therapies, and thus optimize the use of available resources.
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Sakhuja S, Booth JN, Anstey DE, Jaeger BC, Lewis CE, Lloyd-Jones DM, Schwartz JE, Shimbo D, Shikany JM, Sims M, Muntner P. Using Predicted Atherosclerotic Cardiovascular Disease Risk for Discrimination of Awake or Nocturnal Hypertension. Am J Hypertens 2020; 33:1011-1020. [PMID: 32657334 PMCID: PMC7608525 DOI: 10.1093/ajh/hpaa099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 04/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40-79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015-2016 (n = 716) and the baseline Jackson Heart Study exam in 2000-2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.
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Affiliation(s)
- Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- CTI Clinical Trials and Consulting, Inc., Covington, Kentucky, USA
| | - David E Anstey
- Department of Medicine, Columbia University, New York, New York, USA
| | - Byron C Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joseph E Schwartz
- Department of Medicine, Columbia University, New York, New York, USA
- Stony Brook University, Stony Brook, New York, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York, USA
| | - James M Shikany
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Abstract
: Extreme dipping (i.e. a marked blood pressure fall during night-time period) is an alteration of circadian blood pressure (BP) rhythm frequently observed in the setting of systemic hypertension as well as in the general population. Some reports have suggested that cardiovascular prognosis in extreme dippers (ED) is similar as in dippers, whereas other studies have documented either a better or worse prognosis in ED. Available information on clinical and prognostic implications of ED is scanty and data provided by studies are controversial. Furthermore, a comprehensive report summarizing the key features of this BP pattern is lacking. The present review focuses on a number of issues concerning ED pattern such as the prevalence and clinical correlates, mechanisms underlying this BP phenotype association with hypertension mediated organ damage (HMOD) and prognostic value in predicting cardiovascular events and all-cause mortality. The reported prevalence of this BP rhythm alteration ranges from 5% to 30%, depending on diagnostic criteria, clinical and demographic characteristics of subjects. Most studies targeting the association of this condition with HMOD failed to find consistent findings in support of an adverse impact of ED on vascular, renal of cardiac structure and function. Available data on ED as compared to low risk reference group (i.e. dippers) do not allow to conclude that high BP variability resulting from a marked BP fall at night adversely affects cardiovascular prognosis at the community level and in the general hypertensive population. Thus, further studies aimed to assess the prognostic significance of ED as well as the impact of therapeutic interventions aimed to normalize this circadian BP pattern, are highly needed.
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19
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Almeida FAD. Nocturnal Blood Pressure Dipping and the Autonomic Nervous System. Arq Bras Cardiol 2020; 114:716-717. [PMID: 32491000 DOI: 10.36660/abc.20200280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Chang L, Garcia-Barrio MT, Chen YE. Perivascular Adipose Tissue Regulates Vascular Function by Targeting Vascular Smooth Muscle Cells. Arterioscler Thromb Vasc Biol 2020; 40:1094-1109. [PMID: 32188271 DOI: 10.1161/atvbaha.120.312464] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Adipose tissues are present at multiple locations in the body. Most blood vessels are surrounded with adipose tissue which is referred to as perivascular adipose tissue (PVAT). Similarly to adipose tissues at other locations, PVAT harbors many types of cells which produce and secrete adipokines and other undetermined factors which locally modulate PVAT metabolism and vascular function. Uncoupling protein-1, which is considered as a brown fat marker, is also expressed in PVAT of rodents and humans. Thus, compared with other adipose tissues in the visceral area, PVAT displays brown-like characteristics. PVAT shows a distinct function in the cardiovascular system compared with adipose tissues in other depots which are not adjacent to the vascular tree. Growing and extensive studies have demonstrated that presence of normal PVAT is required to maintain the vasculature in a functional status. However, excessive accumulation of dysfunctional PVAT leads to vascular disorders, partially through alteration of its secretome which, in turn, affects vascular smooth muscle cells and endothelial cells. In this review, we highlight the cross talk between PVAT and vascular smooth muscle cells and its roles in vascular remodeling and blood pressure regulation.
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Affiliation(s)
- Lin Chang
- From the Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor
| | - Minerva T Garcia-Barrio
- From the Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor
| | - Y Eugene Chen
- From the Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor
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21
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Ash GI. Revisions of Medicare reimbursement policy for ambulatory blood pressure monitoring and the role of qualitative analysis. J Clin Hypertens (Greenwich) 2019; 21:1810-1812. [PMID: 31642575 DOI: 10.1111/jch.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Garrett I Ash
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine Center for Medical Informatics, New Haven, CT, USA
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22
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Di Gennaro F, D'Amato C, Morganti R, Greco C, Longo S, Corradini D, Lauro D, Spallone V. Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes. J Hum Hypertens 2019; 34:495-504. [PMID: 31624311 DOI: 10.1038/s41371-019-0270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/09/2022]
Abstract
Although vascular and autonomic nervous system have been involved in the regulation of morning surge in blood pressure (MBPS), data on clinical correlates of MBPS in diabetic population are scarce, in particular with regard to diabetic complications. This study was aimed at investigating predictors and correlates of MBPS in diabetes. In a cross-sectional study including 167 patients with diabetes (age 58.5 ± 11.1 years, duration 15.9 ± 12.1 years), clinical variables, diabetic and neuropathic complications, and MBPS (using 24-h ambulatory blood pressure monitoring) were measured. The upper quartile of MBPS (>30.5 mmHg) was associated with higher values of waist circumference (P = 0.027), triglycerides (P = 0.021), and Michigan Diabetic Neuropathy Score (P = 0.042), with lower HDL cholesterol (P = 0.030), and with the presence of cardiovascular autonomic neuropathy (CAN) (P = 0.016) and peripheral vascular disease (PVD) (P < 0.0001). In a logistic regression analysis, PVD (odds ratio: 10.2, P = 0.001), CAN (odds ratio: 6.09, P = 0.016), and diastolic blood pressure (BP) (odds ratio: 1.06, P = 0.022) predicted MBPS upper quartile (r2 = 0.20, P = 0.0005). In a multiple regression analysis, PVD (P = 0.002) and diastolic BP (P = 0.003) were the only determinants of MBPS (r2 = 0.20). MBPS upper quartile was associated with BP dipping (systolic BP day-night reduction > 10%) (P = 0.012), and MBPS was positively related to systolic (rho = 0.41, P < 0.0001) and diastolic BP day-night reduction. In conclusion, metabolic syndrome stigmata, diastolic BP, CAN and PVD are the main predictors of MBPS in the diabetic population. Excessive MBPS and nondipping are not concurrent 24-h BP alterations. Autonomic dysfunction might exert an exacerbating effect on MBPS phenomenon.
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Affiliation(s)
- Federica Di Gennaro
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia D'Amato
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Morganti
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carla Greco
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Longo
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diana Corradini
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenza Spallone
- Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Climie RE, van Sloten TT, Bruno RM, Taddei S, Empana JP, Stehouwer CD, Sharman JE, Boutouyrie P, Laurent S. Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension. Hypertension 2019; 73:1138-1149. [DOI: 10.1161/hypertensionaha.118.11769] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rachel E. Climie
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.)
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Thomas T. van Sloten
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - Rosa-Maria Bruno
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Jean-Philippe Empana
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Pierre Boutouyrie
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
| | - Stéphane Laurent
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
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