Diabetes mellitus is associated with high sleep-time systolic blood pressure and non-dipping pattern

Aung, Aye-Thandar; Chan, Siew Pang; Kyaing, Than-Than; Lee, Chi‐Hang

doi:10.1080/00325481.2020.1745537

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Diabetes is associated with higher nocturnal SBP and a nondipping BP pattern [35]. Autonomic nervous dysfunction appears to be responsible for the higher prevalence of these phenotypes among patients with diabetes when compared with nondiabetic individuals, and microvascular disease, reduced baroreflex sensitivity and hyperglycaemia have been also proposed as potential contributors [64,65].…”

Section: Clinical Relevance Of Nocturnal Hypertension and Nondippingmentioning

confidence: 99%

“…Antioscillatory influences by the baroreflex during the day and night may also play a role [34]. These mechanisms may be further influenced by conditions such as diabetes, obesity, obstructive sleep apnoea (OSA), chronic kidney disease (CKD), and by extrinsic factors such as daylight exposure and melatonin excretion [27,33,[35][36][37][38]. Moreover, extrinsic behavioural factors and especially individuals' activities and arousal status play a major role in the 24-h BP variation pattern [3,25,26,[39][40][41].…”

Section: Pathophysiologymentioning

confidence: 99%

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Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Stergiou

Brunström

MacDonald

et al. 2022

Journal of Hypertension

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Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

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Section: Clinical Relevance Of Nocturnal Hypertension and Nondippingmentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Stergiou

Brunström

MacDonald

et al. 2022

Journal of Hypertension

View full text Add to dashboard Cite

show abstract

“…Emerging evidence has revealed that the non-dipping BP pattern is associated with adverse cardiovascular risks and events in both normal and HTN participants compared to the dipping pattern ( 15 – 18 ). Numerous cross-sectional studies have shown a high prevalence of non-dipping phenomenon in diabetes and even in early-stage diabetes ( 19 – 21 ). A recently prospective study with 21-year follow-up documented an independent association between non-dipping BP pattern and risk of new-onset diabetes in a randomly selected Finnish (n=449), originally middle-aged population with/without HTN ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Non-dipping blood pressure pattern is associated with higher risk of new-onset diabetes in hypertensive patients with obstructive sleep apnea: UROSAH data

Luo

Li²,

Zhu³

et al. 2023

Front. Endocrinol.

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ObjectiveImpairment of circadian blood pressure (BP) patterns has been associated with cardiovascular risks and events in individuals with hypertension and in general populations, which are more likely to be found in obstructive sleep apnea (OSA). The aim of this study was to investigate the association of non-dipping BP pattern with new-onset diabetes in hypertensive patients with OSA, based on Urumqi Research on Sleep Apnea and Hypertension (UROSAH) data.Materials and methodsThis retrospective cohort study included 1841 hypertensive patients at least 18 years of age, who were diagnosed with OSA without baseline diabetes and had adequate ambulatory blood pressure monitoring (ABPM) data at enrollment. The exposure of interest for the present study was the circadian BP patterns, including non-dipping and dipping BP pattern, and the study outcome was defined as the time from baseline to new-onset diabetes. The associations between circadian BP patterns and new-onset diabetes were assessed using Cox proportional hazard models.ResultsAmong 1841 participants (mean age: 48.8 ± 10.5 years, 69.1% male), during the total follow-up of 12172 person-years with a median follow-up of 6.9 (inter quartile range: 6.0-8.0) years, 217 participants developed new-onset diabetes with an incidence rate of 17.8 per 1000 person-years. The proportion of non-dippers and dippers at enrollment in this cohort was 58.8% and 41.2%, respectively. Non-dippers were associated with higher risk of new-onset diabetes compared with dippers (full adjusted hazard ratio [HR]=1.53, 95% confidence interval [CI]: 1.14-2.06, P=0.005). Multiple subgroup and sensitivity analyses yielded similar results. We further explored the association of systolic and diastolic BP patterns with new-onset diabetes separately, and found that diastolic BP non-dippers were associated with higher risk of new-onset diabetes (full adjusted HR=1.54, 95% CI: 1.12-2.10, P=0.008), whereas for systolic BP non-dippers, the association was nonsignificant after adjusted the confounding covariates (full adjusted HR=1.35, 95% CI: 0.98-1.86, P=0.070).ConclusionsNon-dipping BP pattern is associated with an approximately 1.5-fold higher risk of new-onset diabetes in hypertensive patients with OSA, suggesting that non-dipping BP pattern may be an important clinical implication for the early prevention of diabetes in hypertensive patients with OSA.

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Aneurysmal subarachnoid hemorrhage occurring during sleep: Clinical characteristics and risk factors

Inamasu,

Akiyama,

Akaji

et al. 2024

Journal of Stroke and Cerebrovascular Diseases

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Diabetes mellitus is associated with high sleep-time systolic blood pressure and non-dipping pattern

Cited by 5 publications

References 30 publications

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Non-dipping blood pressure pattern is associated with higher risk of new-onset diabetes in hypertensive patients with obstructive sleep apnea: UROSAH data

Aneurysmal subarachnoid hemorrhage occurring during sleep: Clinical characteristics and risk factors

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