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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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Efficacy of single-dose cholecalciferol in the blood pressure of patients with type 2 diabetes, hypertension and hypovitaminoses D. Sci Rep 2020; 10:19611. [PMID: 33184328 PMCID: PMC7665034 DOI: 10.1038/s41598-020-76646-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022] Open
Abstract
Observational and experimental data reinforce the concept that vitamin D is associated with the pathogenesis of arterial hypertension. We investigated the effect of a single dose of 100,000 IU of cholecalciferol, in office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM) in patients with type 2 diabetes mellitus (DM), hypertension, and hypovitaminosis D. Forty-three patients were randomized to a placebo or cholecalciferol group. BP was assessed by office measurements and 24-h ABPM, before and after intervention. At week 8, a greater decrease in median ABPM values was observed in cholecalciferol supplementation than in the placebo group for systolic 24-h (− 7.5 vs. − 1; P = 0.02), systolic daytime (− 7 vs. − 1; P = 0.007), systolic nighttime (− 7.0 vs. 3; P = 0.009), diastolic 24-h (− 3.5 vs. − 1; P = 0.037), and daytime DBP (− 5 vs. 0; P = 0.01). Office DBP was also reduced after vitamin D supplementation. A single dose of vitamin D3 improves BP in patients with type 2 diabetes, hypertension, and vitamin D insufficiency, regardless of vitamin D normalization. Vitamin D supplementation could be a valuable tool to treat patients with type 2 DM, hypertension, and hypovitaminosis D. Trial registration: Clinicaltrials.gov NCT 02204527.
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Cloutier L, Lamarre-Cliche M. Hypertension in Adults With Type 2 Diabetes: A Review of Blood Pressure Measurement Methods, Targets and Therapy. Can J Diabetes 2018; 42:188-195. [DOI: 10.1016/j.jcjd.2018.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/26/2018] [Indexed: 12/14/2022]
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Blood pressure profile is associated with microalbuminuria and retinopathy in hypertensive nondiabetic patients. Wien Klin Wochenschr 2017; 130:204-210. [PMID: 28980066 DOI: 10.1007/s00508-017-1270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 09/04/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Target organ damage is important for global cardiovascular risk assessment. The aim of this study was to explore the association between the blood pressure profile and end-organ damage in a hypertensive non-diabetic cohort. METHODS A total of 560 consecutive hypertensive nondiabetic patients (mean age: 58.2 ± 13.3 years, 221 men) were included in the study. All patients underwent thorough physical examination including fundoscopic examination. First morning urine samples were obtained from each patient and measurement of the albumin-to-creatinine ratio in first morning urine collection samples was used for diagnosis of microalbuminuria. All patients underwent a 24-h ambulatory blood pressure monitoring and were grouped as dippers and non-dippers according to the presence or absence of >10% decrease in blood pressure during the night, respectively. RESULTS The non-dipper group consisted of 247 patients with a non-dipper blood pressure profile, 31 patients with reverse dipping and 4 patients with extreme dipping. Non-dipper patients were significantly older. Coronary artery disease, cerebrovascular disease, hypertensive retinopathy and microalbuminuria were significantly more prevalent in the non-dipper patients. Non-dipping hypertension increased the risk of hypertensive retinopathy by 1.89 times (95% confidence interval, CI:1.35-2.65, p < 0.001) and the risk of microalbuminuria by 2.23 times (95% CI:1.49-3.33, p < 0.001). Non-dipping hypertension was still significantly associated with hypertensive retinopathy and microalbuminuria when adjusted by age and sex. CONCLUSION Non-dipping hypertension was associated with increased risk of hypertensive retinopathy and microalbuminuria. Blood pressure profiles should also be considered in assessing the risk for hypertensive patients.
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Mateo-Gavira I, Vílchez-López FJ, García-Palacios MV, Carral-San Laureano F, Jiménez-Carmona S, Aguilar-Diosdado M. Nocturnal blood pressure is associated with the progression of microvascular complications and hypertension in patients with type 1 diabetes mellitus. J Diabetes Complications 2016; 30:1326-32. [PMID: 27306509 DOI: 10.1016/j.jdiacomp.2016.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate relationships between early alterations in blood pressure and the progression of microvascular complications of diabetes in clinically-normotensive patients with type 1 diabetes (T1DM). METHODS In a prospective observational study of 85 normotensive T1DM patients without microalbuminuria, blood pressure (BP) was monitored over 24h using the ambulatory blood pressure monitoring (ABPM) system at baseline and 7years later. Development or progression of microalbuminuria, retinopathy and hypertension was evaluated. RESULTS Initially, 20 patients (24%) were diagnosed with masked hypertension and 31 (37%) with non-dipper pattern as the only pathological findings. At 7years: 1) twenty-seven patients (32%) had progression of retinopathy related to the nocturnal diastolic blood pressure (BPD) (OR:1.122; p=0.034) and final non-dipper pattern (OR:5.857; p=0.005); 2) seven patients (10%) developed microalbuminuria for which nocturnal systolic blood pressure (BPS) was a risk factor (OR:1.129; p=0.007); 3) five of the normotensive patients (9%) progressed to hypertension; historic HbA1c (OR:2.767; p=0.046) and nocturnal BPD (OR:1.243; p=0.046) being the related risk factors. BPD level ≥65mmHg was associated with an increase in progression of retinopathy and hypertension. CONCLUSIONS In T1DM patients there is an elevated prevalence of BP alterations, detected using ABPM. Alterations in nocturnal BP predispose to development/progression of microvascular complications and overt hypertension.
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Night-time blood pressure and target organ damage: a comparative analysis of absolute blood pressure and dipping status. J Hypertens 2016; 33:2257-64. [PMID: 26425836 DOI: 10.1097/hjh.0000000000000690] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prognostic significance of abnormal circadian blood pressure (BP) patterns is well established. Research to date has focused on both nocturnal dipping and absolute night-time BP levels; however, which of these variables should be the primary target for therapy remains unclear. The aim of this study is to determine whether dipping status or absolute night-time BP levels have a stronger association with subclinical target organ damage (TOD). METHODS The Mitchelstown Cohort was established to examine cardiovascular health in an adult population sample recruited from primary care. Night-time BP was categorized by dipping status. Subclinical TOD was defined as Cornell Product left ventricular hypertrophy (LVH) voltage criteria on ECG and urine albumin : creatinine ratio (ACR) at least 1.1 mg/mmol. Multivariable logistic regression analysis was used to assess the association between night-time BP and TOD. RESULTS Of 2047 participants, 1207 (response rate 59%), underwent 24-h ambulatory BP monitoring. We excluded 161 studies due to incomplete data. Of 1046 participants, 178 (17%) had evidence of TOD. Each 10-mmHg rise in night-time SBP increased the odds of TOD. Odds ratio (OR) ACR at least 1.1 mg/mmol 1.5 [95% confidence interval (95% CI) 1.2-1.8] and OR LVH 1.4 (95% CI 1.1-1.8). CONCLUSION Absolute BP level rather than dipping status may be a superior early marker of risk associated with night-time BP. Interventional studies are required to determine whether there is a benefit in specifically targeting absolute night-time BP levels to prevent clinically important outcomes.
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Paula TP, Viana LV, Neto ATZ, Leitão CB, Gross JL, Azevedo MJ. Effects of the DASH Diet and Walking on Blood Pressure in Patients With Type 2 Diabetes and Uncontrolled Hypertension: A Randomized Controlled Trial. J Clin Hypertens (Greenwich) 2015; 17:895-901. [PMID: 26041459 PMCID: PMC8031764 DOI: 10.1111/jch.12597] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 01/19/2023]
Abstract
Data on the potential beneficial effects of combining diet and exercise on blood pressure (BP) are still scarce. A 4-week randomized controlled clinical trial was undertaken in 40 hypertensive patients with type 2 diabetes with uncontrolled blood pressure (BP) in office and daytime ambulatory BP monitoring (ABPM). Patients were assigned to follow a Dietary Approaches to Stop Hypertension (DASH) diet associated with advice to increase walking using a pedometer (intervention group) or a diet based on the American Diabetes Association recommendations (control group). The lifestyle intervention caused a greater ABPM (mm Hg) reduction in systolic 24-hour, diastolic 24-hour, nighttime systolic, daytime systolic, and daytime diastolic measurements than observed in the control group. In the intervention group there was a decrease in urinary sodium and an increase in urinary potassium, plasma aldosterone, and the number of steps per day (P<.05). The DASH diet and increased walking were associated with clinically significant reductions in ABPM values in hypertensive patients with type 2 diabetes.
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Affiliation(s)
- Tatiana P Paula
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana V Viana
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandra T Z Neto
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cristiane B Leitão
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jorge L Gross
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mirela J Azevedo
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Mattos CB, Viana LV, Paula TP, Sarmento RA, Almeida JC, Gross JL, Azevedo MJ. Increased protein intake is associated with uncontrolled blood pressure by 24-hour ambulatory blood pressure monitoring in patients with type 2 diabetes. J Am Coll Nutr 2015; 34:232-9. [PMID: 25758557 DOI: 10.1080/07315724.2014.926155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze possible associations of dietary components, especially protein intake, with blood pressure (BP) during ambulatory BP monitoring (ABPM) in patients with type 2 diabetes. METHODS In this cross-sectional study, BP of outpatients with type 2 diabetes was evaluated by 24-hour ABPM (Spacelabs 90207) and usual diet by 3-day weighed diet records. Patients were divided into 2 groups according to their daytime ABPM: uncontrolled BP (systolic BP ≥ 135 mmHg or diastolic BP ≥ 85 mmHg) and controlled BP (systolic BP < 135 mmHg and diastolic BP < 85 mmHg). Logistic regression models unadjusted and adjusted for possible confounders (covariates) were used to analyze the association of protein and uncontrolled BP. RESULTS A total of 121 patients with type 2 diabetes aged 62.3 years, 54.5% of whom were women, were studied. The uncontrolled BP group had higher glycated hemoglobin (HbA1C) values (8.4 ± 2.0 vs 7.6 ± 1.3%; p = 0.04) and consumed more protein (20.0 ± 3.8 vs 18.2 ± 3.6% of energy; p = 0.01) and meat, (2.6 [1.45, 2.95] vs 2.0 [1.49, 2.90] g/kg weight; p = 0.04) than the controlled BP group. In a multivariate analysis, protein intake (% of energy) increased the chance for uncontrolled BP (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02, 1.30; p = 0.02), adjusted for body mass index (BMI), HbA1C, low-density lipoprotein (LDL) cholesterol, number of antihypertensive medications, and ethnicity. Meat consumption higher than 3.08 g/kg weight/day more than doubled the chance for uncontrolled BP (OR = 2.53; 95% CI, 1.01, 7.60; p = 0.03). CONCLUSION High protein intake and meat consumption were associated with high daytime ABPM values in patients with type 2 diabetes. Reducing meat intake might represent an additional dietary intervention in hypertensive patients with type 2 diabetes.
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Affiliation(s)
- Carolina B Mattos
- a Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul , Porto Alegre , BRAZIL
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Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes Metab Syndr Obes 2013; 6:327-38. [PMID: 24082791 PMCID: PMC3785394 DOI: 10.2147/dmso.s51325] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension and obesity are known to contribute, directly or indirectly, to the development of long-term complications of type 2 diabetes mellitus (T2DM). Knowing the prevalence of these comorbidities is important for determining the size of the population that may benefit from strategies that reduce blood pressure and weight while controlling blood glucose. METHODS In this systematic literature review, electronic searches of PubMed, Embase, and the Cochrane Library were conducted to identify observational studies of hypertension and/or obesity prevalence in patients with T2DM throughout the world. The searches were limited to studies reported in English from January 1, 2001 to February 16, 2012. RESULTS From a total of 2,688 studies, 92 observational studies provided prevalence rates for hypertension and/or obesity specifically in adults with T2DM. Fifteen studies of specific subtypes of hypertension or subpopulations with T2DM were subsequently excluded, leaving 78 studies (in 77 articles) for inclusion in this article. Of these, 61studies reported hypertension prevalence, 44 reported obesity prevalence, and 12 reported the prevalence of hypertension with obesity. Most studies had a low risk of bias regarding diagnosis of T2DM (70/78), hypertension (59/69), or obesity (45/47). The continental regions with the most observational studies of hypertension or obesity prevalence were Europe (n = 30) and Asia (n = 26). Hypertension rates typically were high in all regions; most studies presented rates above 50%, and many presented rates above 75%. Obesity rates exceeded 30% in 38 of 44 studies and 50% in 14 of 44 studies, especially those assessing central obesity (based on waist circumference). Among obese adults, hypertension rates were at or above 70% in Asia and above 80% in Europe; rates were lower in North and South America but still above 30%. CONCLUSION Around the world, hypertension and obesity, separately or together, are common comorbidities in adults with T2DM.
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Affiliation(s)
- Ann D Colosia
- RTI Health Solutions, Research Triangle Park, NC, USA
- Correspondence: Ann D Colosia, RTI Health Solutions, 3040 Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194, USA, Tel +1 919 541 6000, Fax +1 919 541 7222, Email
| | | | - Shahnaz Khan
- RTI Health Solutions, Research Triangle Park, NC, USA
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Możdżan M, Wierzbowska-Drabik K, Kurpesa M, Trzos E, Rechciński T, Broncel M, Kasprzak JD. Echocardiographic indices of left ventricular hypertrophy and diastolic function in hypertensive patients with preserved LVEF classified as dippers and non-dippers. Arch Med Sci 2013; 9:268-75. [PMID: 23671437 PMCID: PMC3648830 DOI: 10.5114/aoms.2013.34534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/26/2011] [Accepted: 10/17/2011] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Long-lasting arterial hypertension causes left ventricular hypertrophy (LVH) and impairs left ventricular diastolic function. Our aim was to compare echocardiographic parameters between hypertensive patients defined as dippers and non-dippers during ambulatory blood pressure (BP) monitoring. MATERIAL AND METHODS We analysed 61 consecutive subjects with treated hypertension undergoing 24-h BP monitoring and transthoracic echocardiographic examination and included in the study patients with preserved left ventricular ejection fraction (EF ≥ 50%). Echocardiographic and arterial pressure parameters were compared between the group classified as dippers (n = 26, 57 ±13 years, 16 males) and non-dippers (n = 35, 60 ±12 years, 24 males) according to present or absent decrease of BP during the night > 10%. Echocardiographic data were compared between both groups and control subjects without hypertension. RESULTS Dippers had lower average systolic, diastolic and mean arterial pressure during the night hours but did not differ according to the mean pressure calculated from a 24-hour period. All echocardiographic parameters were similar in dippers and non-dippers. All patients with arterial hypertension presented with larger dimension of both ventricles and left atrium, thicker left ventricular walls, higher LV mass and mass index and preserved EF and E/A ratio as compared with normotensive controls. Normal geometry, concentric remodelling and eccentric hypertrophy were similarly distributed in both groups. Concentric hypertrophy was more prevalent in non-dippers as compared to the dippers (71.4% vs. 38.5%, p < 0.043). CONCLUSIONS The concentric type of LVH is the prevalent pattern in non-dippers. Non-dipping blood pressure pattern may be responsible for the development of left ventricular concentric hypertrophy secondary to hypertension.
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Affiliation(s)
- Monika Możdżan
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
| | | | - Małgorzata Kurpesa
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
| | - Ewa Trzos
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
| | - Tomasz Rechciński
- 2 Chair and Department of Cardiology, Medical University of Lodz, Poland
| | - Marlena Broncel
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
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Abstract
This article is a review of 25 publications on ambulatory blood pressure monitoring (ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure (BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients’ BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular (CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different age groups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.
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Cardoso CRL, Leite NC, Muxfeldt ES, Salles GF. Thresholds of ambulatory blood pressure associated with chronic complications in type 2 diabetes. Am J Hypertens 2012; 25:82-8. [PMID: 21956528 DOI: 10.1038/ajh.2011.168] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diagnostic cut-off values for ambulatory blood pressure monitoring (ABPM) in diabetic patients are not established. The aim was to investigate associations between office and ambulatory blood pressures (BPs) and diabetic chronic complications and to establish optimal threshold ambulatory BP values regarding the likehood of having microvascular complications in type 2 diabetes. METHODS In a cross-sectional design, clinical, laboratory, and 24-h ABPM data were obtained in 550 type 2 diabetic patients. Multivariate logistic regression assessed the associations between office and ambulatory BPs and diabetic micro and macrovascular complications. Optimal threshold values for ambulatory BPs (daytime, night-time, and 24 h) were established by examining the best combination of systolic (SBP) and diastolic BP (DBP) that maximized the odds ratios (ORs) of having each microvascular complication. RESULTS After multivariate adjustment for all potential confounders, ambulatory SBPs were more strongly associated with diabetic complications than office BPs, except for retinopathy and nephropathy, in which both were equivalent. In general, night-time BPs were stronger correlates than daytime BPs. The optimal threshold ambulatory BP values were 125/75 mm Hg for daytime, 110/65 mm Hg for night-time, and 120/75 mm Hg for the 24-h period, with odds ranging from 1.7- to 2.3-fold of having each microvascular complication. CONCLUSIONS Except for retinopathy and advanced nephropathy, ambulatory BPs are better correlates of chronic complications than office BPs in type 2 diabetes. The association of microvascular complications with lower ambulatory BP levels than those reported as normal for nondiabetic patients may indicate that lower cut-off values for ambulatory BPs might be considered in type 2 diabetic patients.
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Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes. Hypertens Res 2011; 34:1185-9. [DOI: 10.1038/hr.2011.100] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kramer CK, Leitao CB, Canani LH, Gross JL. Afternoon blood pressure increase: a blood pressure pattern associated with microvascular complications in type 2 diabetes mellitus. Am J Hypertens 2011; 24:64-9. [PMID: 20847726 DOI: 10.1038/ajh.2010.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Minor blood pressure (BP) alterations detected by ambulatory BP monitoring (ABPM) was associated with microvascular disease in type 2 diabetes mellitus (DM). We examined whether a previously described afternoon BP peak is linked to hypertension status and associated with microvascular complications. METHODS A cross-sectional study was conducted with 207 type 2 DM patients (56 years, 52.7% men). ABPM was determined by oscillometry. RESULTS An increase in both systolic and diastolic BP occurred in the afternoon; the same pattern was observed across hypertension categories (normotensive, prehypertensive, or hypertensive). We calculated BP increase for the period between 2 and 8 PM as the difference between mean BP at 8 PM and mean BP at 2 PM (calculated by the average of four measurements in each hour). The cohort was then divided into two groups (afternoon BP increase below or above the group's median). The prevalence of diabetic retinopathy (DR) was higher in those with afternoon increment above the group median for both systolic (50 vs. 30%, P = 0.004) and diastolic (47 vs. 33%, P = 0.04) BP. For systolic BP, this result was maintained after adjustments for age, gender, A1c test, DM duration, total cholesterol, and 24-h systolic BP. Afternoon BP increments for both systolic and diastolic BP correlated significantly with urinary albumin excretion rate (UAER) after adjusting for 24-h BP (systolic: r = 0.17, P = 0.01; diastolic: r = 0.16, P = 0.02). However, when adjusted for all covariates, these correlations were no longer significant. CONCLUSIONS An increment in afternoon BP was observed in type 2 diabetic patients regardless of hypertension status; that increment was associated with higher prevalence of DR but not diabetic nephropathy independently of measured confounders.
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Tsioufis C, Andrikou I, Thomopoulos C, Syrseloudis D, Stergiou G, Stefanadis C. Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes. J Hum Hypertens 2010; 25:281-93. [DOI: 10.1038/jhh.2010.113] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Charvat J, Chlumsky J, Szabo M, Zakovicova E, Zamrazil V. The association of masked hypertension in treated type 2 diabetic patients with carotid artery IMT. Diabetes Res Clin Pract 2010; 89:239-42. [PMID: 20554071 DOI: 10.1016/j.diabres.2010.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/13/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the association of masked hypertension (MH) in treated type 2 diabetic patients without history of cardiovascular disease with carotid artery target organ damage. METHODS Sixty-four type 2 diabetic patients treated for hypertension with office BP below 140/90 mm Hg were examined by 24-h BP monitoring and carotid sonography. MH was diagnosed if daily mean ambulatory BP was >or=135/85 mm Hg. The association of MH with carotid artery parameters was evaluated. RESULTS The average age of patients was 62+/-5 years. Twenty-four patients had MH (37.5%). Carotid artery IMT was 0.74+/-0.08 mm in patients with MH and 0.69+/-0.06 mm without MH (p=0.03). The distensibility of common carotid artery was 0.24+/-0.07 mmHg(-1) in patients with MH and 0.29+/-0.1mm Hg(-1) without MH (p=0.14). After adjustment for age, gender, smoking, duration of diabetes, BMI and clinic blood pressure (BP) values the association of MH with carotid artery IMT was sustained. CONCLUSION Masked hypertension in treated type 2 diabetic patients is associated with carotid artery IMT.
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Affiliation(s)
- Jiri Charvat
- Medical department of 2nd Faculty Hospital of Charles University in Prague, Prague, Czech Republic.
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Rodrigues TC, Canani LH, Viatroski RS, Hoffmann LH, Esteves JF, Gross JL. Masked hypertension, nocturnal blood pressure and retinopathy in normotensive patients with type 1 diabetes. Diabetes Res Clin Pract 2010; 87:240-5. [PMID: 19926157 DOI: 10.1016/j.diabres.2009.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 09/18/2009] [Accepted: 10/26/2009] [Indexed: 11/30/2022]
Abstract
AIM To analyze the prevalence of masked hypertension and its possible association with microvascular complications in patients with type 1 diabetes (T1D). METHODS A cross-sectional study was conducted in 188 consecutive normotensive patients at the office with T1D without renal replacement therapy or previous renal transplant. All patients were assessed regarding the presence of diabetic retinopathy (DR) (direct and indirect fundoscopy), urinary albumin excretion rate (immunoturbidimetry), and ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207). RESULTS Masked hypertension was observed in 14 (13.6%) out of 103 clinical normotensive patients and in 7.4% of the entire cohort. Twenty-three percent of patients with clinical normotension had masked nocturnal hypertension. DR was associated with night systolic and diastolic BP [OR of each 5mmHg change 1.41 (95%CI: 1.09-1.83, P=0.009) and 1.40 (95%CI: 1.02-1.93, P=0.04), respectively] and with masked nocturnal hypertension [OR: 3.23 (95%CI: 1.29-8.11, P=0.01)]. CONCLUSIONS In T1D patients with clinic BP<130/80mmHg, masked hypertension and especially masked nocturnal hypertension are present. Normotensive patients with nocturnal BP>120/70mmHg have higher presence of DR, and only will be identified through ABPM.
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Affiliation(s)
- Ticiana C Rodrigues
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
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Esteves J, da Rosa CM, Kramer CK, Osowski LE, Milano S, Canani LH. Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation. Diabetol Metab Syndr 2009; 1:13. [PMID: 19825149 PMCID: PMC2764562 DOI: 10.1186/1758-5996-1-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 10/05/2009] [Indexed: 11/29/2022] Open
Abstract
The main risk factors for the development and progression of diabetic retinopathy (DR) are chronic hyperglycemia, disease duration and systemic blood pressure. So far chronic hyperglycemia is the strongest evidence concerning the risk of developing DR. However there are some patients with poor metabolic control who never develop this diabetic complication. We present a case of a 73-year-old woman with type 1 diabetes mellitus, diagnosed 69 years ago. The patient is 73 years old, with no evidence of DR, despite poor glycemic control and several risk factors for DR. This case suggests the presence of a possible protection factor, which could be genetic.
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Affiliation(s)
- Jorge Esteves
- Ophtalmology and otorhinolaryngology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Endocrinology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Carolina Maurente da Rosa
- Ophtalmology and otorhinolaryngology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Luiz Eduardo Osowski
- Ophtalmology and otorhinolaryngology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Stéfano Milano
- Ophtalmology and otorhinolaryngology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Luís Henrique Canani
- Endocrinology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Kramer CK, Leitão CB, Canani LH, Ricardo ED, Pinto LC, Valiatti FB, Gross JL. Late afternoon blood pressure increase is associated with diabetic retinopathy in normotensive type 2 diabetes mellitus patients. Diabetes Res Clin Pract 2009; 84:e12-4. [PMID: 19181416 DOI: 10.1016/j.diabres.2008.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 12/16/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
Abstract
AIMS To identify if the variability of blood pressure (BP) is associated with diabetic retinopathy (DR) in normotensive type 2 DM patients. METHODS Sixty-five normotensive type 2 DM patients that had 24-h ambulatory BP monitoring (ABPM) were grouped according any degree of DR. RESULTS Fourteen (21%) patients had DR. Office BP and 24-h BP parameters did not differ between groups. At late afternoon period, patients with DR had higher increment in both systolic (11.3+/-12.7mmHg vs. 1.0+/-11.4mmHg, P=0.006) and diastolic (6.7+/-8.6mmHg vs. -0.73+/-10.0mmHg, P=0.017) BP levels than those without. Multivariate logistic analyses were performed with DR as a dependent variable. Each 1mmHg increment in systolic BP at the late afternoon period was associated with a 10.2% increase in DR prevalence [OR 1.102 (CI 95% 1.011-1.202, P=0.027)], after adjustments for A1C test, DM duration, age, albuminuria and current smoking. CONCLUSIONS In conclusion, in normotensive type 2 DM patients, BP increase at late afternoon is associated to DR independently from confounder factors or other ABPM parameters.
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Affiliation(s)
- Caroline Kaercher Kramer
- Endocrine Division of Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Prédio 12, 4 degrees andar, 90035-003, Porto Alegre, RS, Brazil.
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