Short-term reproducibility of a non-dipping pattern in type 2 diabetic hypertensive patients

Cesare Cuspidi, Stefano Meani, Laura Lonati, Veronica Fusi, Cristiana Valerio, Carla Sala, Gaia Magnaghi, Meilikemu Maisaidi, Alberto Zanchetti

Research output: Contribution to journalArticle

Abstract

Background: Little information is available on the reproducibility of nocturnal variations in blood pressure in type 2 diabetic hypertensive patients. Objective: We aimed to compare the intrasubject short-term reproducibility of a nocturnal non-dipping pattern and the prevalence of cardiac and extracardiac signs of target organ damage, in a group of type 2 diabetic hypertensive patients and in an age/gender-matched group of non-diabetic hypertensive subjects. Methods: Thirty-six treated hypertensive patients with long-lasting type 2 diabetes (> 10 years duration) consecutively attending our hospital out-patient hypertension clinic (group I; mean age, 65 ± 9 years), and 61 untreated non-diabetic subjects with grade 1 and grade 2 uncomplicated essential hypertension, matched for age and gender, and chosen from patients attending an outpatient clinic (group II; mean age, 65 ± 5 years), were considered for this analysis. All patients underwent blood sampling for routine blood chemistry, 24-h urine collection for microalbuminuria, two 24-h periods of ambulatory blood pressure monitoring (ABPM) within a 4-week period, echocardiography, and carotid ultrasonography. A dipping pattern was defined as a greater than 10% reduction in the average systolic and diastolic blood pressure at night compared with average daytime values. Results: A reproducible nocturnal dipping and non-dipping profile was found in 11 (30.6%) and 21 (58.3%) diabetic patients, respectively; while only in four (11.1%) patients was a variable dipping profile observed. Of the 23 patients with a non-dipping pattern during the first ABPM period, 21 (91.3%) also had this type of pattern during the second ABPM recording. In group II (non-diabetic hypertensive patients), 30 patients (49.2%, P <0.05) had a dipping pattern, 13 patients (21.3%, P <0.01) had a non-dipping profile pattern and 18 patients (29.5%, P <0.01) had a variable dipping pattern. Of the 20 patients with a non-dipping pattern during the first ABPM period, 13 (65.0%) confirmed this type of pattern during the second ABPM recording. Finally, the prevalence of left ventricular hypertrophy (77.7 versus 41.4%, P <0.01), carotid plaques (80.5 versus 38.3%, P <0.01), carotid intima-media thickening (54.3 versus 44.0%, P <0.05) and microalbuminuria (11.1 versus 2.0%, P <0.01) was significantly higher in group I than in group II. According to a logistic regression analysis, diabetes, left ventricular hypertrophy and carotid plaques were the main independent predictors of the non-dipping (pattern in the overall population. Conclusions: These findings indicate that intrasubject variability of non-dipper pattern is lower in diabetic than in non-diabetic hypertensive patients, that classification of diabetic hypertensive patients as dipper or non-dipper on the basis of a single ABP recording is more reliable than in non-diabetic patients, and that the more frequent and reproducible non-dipping (pattern in diabetic patients is associated with a more prominent cardiac and extracardiac target organ damage.

Original languageEnglish
Pages (from-to)647-653
Number of pages7
JournalJournal of Hypertension
Volume24
Issue number4
DOIs
Publication statusPublished - Apr 2006

Keywords

  • Diabetes
  • Hypertension
  • Non-dipping reproducibility
  • Target organ damage

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine

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    Cuspidi, C., Meani, S., Lonati, L., Fusi, V., Valerio, C., Sala, C., Magnaghi, G., Maisaidi, M., & Zanchetti, A. (2006). Short-term reproducibility of a non-dipping pattern in type 2 diabetic hypertensive patients. Journal of Hypertension, 24(4), 647-653. https://doi.org/10.1097/01.hjh.0000217846.65089.19