Arterial Hypertension Determined by Ambulatory Blood Pressure Profiles

Dost, Axel; Klinkert, Christoph; Kapellen, Thomas; Lemmer, Andreas; Naeke, Andrea; Grabert, M.; Kreuder, Joachim; Holl, Reinhard W.

doi:10.2337/dc07-0824

Cited by 99 publications

(71 citation statements)

References 30 publications

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“…This supports our hypothesis that rises in ACR, even within the normal range, may parallel similar progressive increases in ABP. The associations between ACR and ABP at baseline were not explained by HbA 1c or BMI, although both these factors were independent contributors of ABP, in line with the findings of previous studies [24,30,31]. Similarly, SBP and DBP were independently associated with future changes in ACR during the subsequent follow-up period.…”

Section: Discussionsupporting

confidence: 79%

“…To characterise the circadian BP rhythm, the percentage of nocturnal fall in SBP and DBP was calculated using the formula: [daytime SBP (or DBP) −night-time SBP (or DBP)]/ [daytime SBP (or DBP)]×100. Patients were classified as dippers if their daytime SBP and/or DBP decreased by at least 10% during the night; all other patients were classified as non-dippers [24].…”

Section: Methodsmentioning

confidence: 99%

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Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

et al. 2009

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Aims/hypothesis The relationship between BP and microalbuminuria in young people with type 1 diabetes is not completely clear. As microalbuminuria is preceded by a gradual rise in albumin excretion within the normal range, we hypothesised that ambulatory BP (ABP) may be closely related to albumin excretion and progression to microalbuminuria. Results All ABPM variables were significantly related to baseline log 10 ACR (p<0.001). After the ABPM evaluation, 287 patients were followed for a median of 2.2 (1.0-5.5) years. ABP at baseline was independently related to mean ACR during follow-up. Nineteen initially normoalbuminuric patients developed microalbuminuria after 2.0 (0.2-4.0) years and their baseline daytime DBP was higher than in normoalbuminuric patients (p<0.001). After adjusting for baseline ACR and HbA 1c , there was an 11% increased risk of microalbuminuria for each 1 mmHg increase in daytime DBP. Forty-eight per cent of patients were non-dippers for SBP and 60% for DBP; however, ACR was not different between dippers and non-dippers and there were no differences in the nocturnal fall in BP between normoalbuminuric and future microalbuminuric patients. Conclusions/interpretation In this cohort of young people with type 1 diabetes, ABP was significantly related to ACR, and daytime DBP was independently associated with progression to microalbuminuria. Increasing albumin excretion, even in the normal range, may be associated with parallel rises in BP. Methods

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Section: Discussionsupporting

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

et al. 2009

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“…1 Obese adolescents are at higher risk of reduced nocturnal dipping 2 and individuals with a nondipping pattern may be at increased risk of BP-related complications compared with those with a normal dipping pattern; among children and adolescents with type 1 diabetes, a high nocturnal BP is associated with both cardiac hypertrophy 3 and renal dysfunction. 4,5 In normotensive adults, failed nocturnal dipping is associated with cardiac hypertrophy. 6 Failed nocturnal dipping also increases the risk for all-cause mortality among adults.…”

Section: Introductionmentioning

confidence: 99%

“…Experimentally evoked hyperinsulinemia has been found to decrease dipping among healthy and normal-weight adults. 8 Among children, chronic poor glycemic control may place patients with type 1 diabetes at risk for higher nocturnal BP 4 and fasting insulin (fS-insulin) or HOMA is positively associated with sleep BP among obese children. 9 Obese, but otherwise healthy, adolescents are at higher risk of unfavorable glucose metabolism 10 as well as reduced nocturnal BP dipping 2 compared with normal-weight peers.…”

Section: Introductionmentioning

confidence: 99%

Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents

Westerståhl

Marcus

2009

Int J Obes

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Objective: The purpose of this study was to analyze the relationship between insulin-glucose metabolism, nocturnal blood pressure (BP) dipping and cardiac left ventricular mass (LVM) in obese adolescents without diabetes. Methods: A cohort of 206 obese adolescents (mean age 15.4 years (s.d. 1.6), mean body mass index (BMI) 38 kg m -2 (s.d. 5.8), 53% girls) under clinical care were included in the study. Body fat was assessed by dual X-ray absorptiometry (DEXA). Blood samples were drawn for analyses of fasting insulin (fS-insulin), fasting glucose and glycosylated hemoglobin Alc. Homeostatic model assessment index (HOMA index) was calculated. Insulin sensitivity and acute insulin response (AIR) were calculated from the performed frequently sampled intravenous glucose tolerance test. An ambulatory BP measurement was performed and 24 h daytime and nighttime values were calculated. Non-dipping was defined as a nocturnal BP reduction of o10%. Ultrasound was used to measure heart LVM and LVM index (LVMI) was calculated (LVM Â height À2.7 ). Results: Systolic non-dipping was present in 50% (n ¼ 103) of the subjects. Systolic and diastolic dipping was negatively associated with measures of insulin metabolism (HOMA index, fS-insulin and AIR). These associations were present independently of gender, age, daytime BP or body mass index standard deviation score. Dipping (P ¼ 0.7-0.9) or measures of insulin-glucose metabolism (P ¼ 0.3-1.0) were not associated with LVMI in this population. Conclusion: Non-dipping is common among obese adolescents. We found a negative association between nocturnal BP fall (dipping) and measures of insulin metabolism independently of the degree of obesity or daytime BP level among severely obese, non-diabetic adolescents without diagnosed hypertension. Our findings suggest the importance of keeping the insulin levels under observation even in allegedly healthy obese adolescents in clinical care, as a part of the prevention of morbidity associated with obesity.

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“…High blood pressure, occurring in about half of diabetic patients, has a worse prognosis and is an important risk factor of their early death (1). Studies in type 1 children and adolescents have showed that the increase in blood pressure values can precede microalbuminuria and appreciated marker of diabetic renal disease (2).…”

Section: Introductionmentioning

confidence: 99%

Hypertension in type 1 diabetic patients-the influence of body composition and body mass index: an observational study

Sm¹,

Battah²

2012

Anadolu Kardiyol Derg

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ÖZETAmaç: Tip 1 diyabetli hastalarda kan basıncına vücut yapısının ve kitle indeksinin etkisini tahmin etmektir. Yöntemler: Bu kesitsel gözlemsel çalışmaya Tip 1 diyabetli 45 hasta, sağlıklı yaş ve cinsiyeti eşleştirilmiş, 30 gönüllü dahil edildi. Bütün hastalar ve kontroller için kan basıncı antropometrik ölçümler ve vücut bileşimi için de çift X-ray absorbsiyometri (DXA) yapıldı. İstatistiksel analiz için t-testi, tek yön ANOVA ve çoklu regresyon analizleri kullanıldı. Bulgular: Yirmi diyabetli hastanın (%44.4) hipertansiyonu vardı. Hipertansif diyabetik hastalarda önemli derecede daha yüksek toplam yağ kitlesi yüzdesi, yumuşak doku yağ kütle yüzdesi, karın yağı yüzdeleri, yağlı/yağsız oranını hipertansif olmayanlar izledi, en azı da kontrollerde idi (p=0.0001). Diyabetli hastalarda çoklu regresyon analizi, abdominal yağ yüzdesinin, ortalama arteryel kan basıncı (β-5.8, %95 GA: 3.7-8.0, p=0.0001) ve sistolik kan basıncı (β-8.6, 95% GA: 5.4-11.9, p=0.0001) ile ilişkili tek parametre olduğunu gösterdi. Aksine, abdominal yağ oranı yüzdesi (β-2.7, %95 GA: 0.9-4.5, p=0.006), diyabetin süresi (β-2.5, %95 GA: 1.4-3.5, p=0.0001), yağlı/yağsız oranı (β-11.7, %95 GA: 1.5-21.9, p=0.03) diyastolik kan basıncı ile ilişkili idi. Sonuç: Diyabet özellikle vücutta abdominal yağda artışa yol açar. Bu da insülin direncinin artmasına ve yağsız kitlenin azalmasına neden olur. Tip 1 diyabetli hastalarda kan basıncı vücut kitle indeksi, standart sapma puanına ve yağ kütlesine bağlıdır. Abdominal yağ dokusu, ortalama arteryel ve sistolik kan basıncı ile ilgili tek faktördür. (Anadolu Kardiyol Derg 2012; 12: 60-4) Anahtar kelimeler: Kan basıncı, diyabet, vücut yapısı, regresyon analizi ABSTRACT Objective: To estimate the influence of body composition and body mass index on blood pressure in type 1 diabetic patients. Methods: This cross-sectional, observational study included 45 type 1 diabetic patients and 30 age and sex matched healthy volunteers. Blood pressure, anthropometric measurements, and body composition by dual X-ray absorptiometry (DXA) were done for all patients and controls. T-test, one way ANOVA and multiple regressions were used for statistical analyses. Results: Twenty diabetic patients (44.4%) had hypertension. Hypertensive diabetic patients had the highest total fat mass %, soft tissue fat mass %, abdomen fat % and fat/lean ratio followed by non hypertensives and the least was the controls (p=0.0001). Abdominal fat % was the only parameter significantly associated with mean arterial blood pressure (β-5.8, 95% CI: 3.7-8.0, p=0.0001) and systolic blood pressure (β-8.6, 95% CI: 5.4-11.9, p=0.0001) by stepwise multiple regression analysis in the diabetic patients. In the contrary, abdominal fat % (β-2.7, 95% CI: 0.9-4.5, p=0.006), duration of diabetes (β-2.5, 95% CI: 1.4-3.5, p=0.0001) and fat/ lean ratio (β-11.7, 95% CI: 1.5-21.9, p=0.03) were related to diastolic blood pressure. Conclusion: Diabetes is associated with an increase in body fat especially abdominal, which leads to an increase in insulin resistance and dec...

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Arterial Hypertension Determined by Ambulatory Blood Pressure Profiles

Cited by 99 publications

References 30 publications

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

Ambulatory blood pressure measurements are related to albumin excretion and are predictive for risk of microalbuminuria in young people with type 1 diabetes

Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents

Hypertension in type 1 diabetic patients-the influence of body composition and body mass index: an observational study

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