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Elevated night-time BP increases CV event risk in hypertensive diabetics
18 August 2010
MedWire News: Patients with diabetes and hypertension have an increased risk for adverse cardiovascular events (CVE) and/or albuminuria if they have higher nocturnal than daytime blood pressure (BP), a Brazilian study suggests.
Joao Felício (Universidade Federal do Pará, Belém) and colleagues explain that autonomic neuropathy – which can arise from a state of hyperglycemia – may account for the nocturnal BP elevation observed in some patients with diabetes.
The researchers performed baseline and 2-year, 24-hour ambulatory BP measurement on 70 hypertensive patients with diabetes.
All patients had normal urinary albumin excretion (UAE), urinary protein excretion (UPE), and excretion glomerular filtration rate (eGFR) at baseline.
Over a 2-year follow-up period, 11 patients developed diabetic nephropathy (DN) and four suffered a CVE, defined as myocardial infarction, stroke, or angina.
Writing in the journal Cardiovascular Diabetology, the team reports that all patients had similar daytime systolic and diastolic BP.
However, the findings for night-time BP differed, with higher systolic and diastolic BP among the patients with DN or CVE compared with those without these conditions, at 138 versus 129 mmHg, and 83 versus 75 mmHg, respectively.
Basal nocturnal systolic BP was positively associated with DN, CVE, and end-of-study UAE, however, a fall in basal systolic and diastolic nocturnal BP was negatively associated with end-of-study UAE.
Patients who developed DN had smaller nocturnal BP reductions compared with those without DN, with a mean systolic and diastolic BP reduction of 3 versus 12 mmHg, and 4 versus 15 mmHg, respectively.
Felício et al conclude that the lack of normal nocturnal BP fall associated with increased risk for CVE and DN may be due to “other conditions, such as obstructive sleep apnea and renal failure with fluid retention.”
They therefore call for other studies to investigate the mechanism by which nocturnal BP changes arise in patients with diabetes.
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