Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes

Gennaro, Federica Di; D’Amato, Cinzia; Morganti, Roberto; Greco, Carla; Longo, Susanna; Corradini, Diana; Lauro, Davide; Spallone, Vincenza

doi:10.1038/s41371-019-0270-3

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Systematic reviews 8 , 9 suggest that rises in morning blood pressure may be related to autonomic nervous system dysregulation, and presence of CAN is associated with both loss of nocturnal dipping and high values of pressure and morning surge. In a cross-sectional study of 167 diabetic patients, Di Gennaro et al 10 found an independent association between CAN presence and high values of morning blood pressure surge. In addition, Lodhi et al 50 , in a case–control study, observed an association between increased variability of awake BP and presence of autonomic dysfunction, specifically the awake SBP standard deviation showed greater diagnostic value than nocturnal dipping.…”

Section: Discussionmentioning

confidence: 97%

“…Systematics reviews 8 , 9 suggest associations between the presence of CAN with loss of nocturnal dipping and increases in morning BP and in morning BP surge. However, in Type 1 DM (T1DM) patients, the influence of CAN in blood pressure remains unclear, since few cross-sectional and longitudinal studies address this issue 10 – 12 and there is no consensus among them 13 , 14 .…”

Section: Introductionmentioning

confidence: 99%

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High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy

Felício,

Moraes,

Lemos

et al. 2024

Sci Rep

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We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

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