Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes

Hjortkjær, Henrik Øder; Persson, Frederik; Theilade, Simone; Winther, Signe Abitz; Tofte, Nete; Ahluwalia, Tarunveer S.; Rossing, Peter

doi:10.1016/j.jdiacomp.2022.108270

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…The present study showed that patients with DKD and dipping blood pressure status have better glycemic control and less proteinuria than patients with DKD and non-dipping or reverse-dipping statuses. In a recent study, the non-dipping pattern was found to be a risk factor for kidney disease and mortality in patients with type 1 diabetes mellitus [11]. The situation is similar in patients with type 2 diabetes, and cardiovascular mortality and renal involvement are increased in patients without a dipping pattern [12][13][14].…”

Section: Discussionmentioning

confidence: 94%

Comparison of Proteinuria and Glycemic Parameters According to Dipping Status in Patients with Hypertension and Diabetic Kidney Disease

Tunca

2023

JOJUN

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Objective: In this study, we aimed to compare glycemic regulation parameters and proteinuria in patients with hypertension and diabetic kidney disease (DKD) in terms of 24-h ambulatory blood pressure monitoring (ABPM) groups. Material-Methods: We retrospectively scanned all patients with DKD and who have ABPM for any reason. Patients were divided into three groups; dippers, non-dippers, and reverse-dippers. Groups were compared in terms of glycemic regulation parameters and proteinuria.

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Section: Discussionmentioning

confidence: 94%

Comparison of Proteinuria and Glycemic Parameters According to Dipping Status in Patients with Hypertension and Diabetic Kidney Disease

Tunca

2023

JOJUN

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“…These changes can be reversed by melatonin [ 57 , 58 ], highlighting the importance of pineal melatonin in the circadian optimization of pancreatic β-cell function. Circadian dysregulation is also intimately linked to a diverse array of T1DM symptomatology [ 59 ], including nocturnal non-dipping blood pressure increasing kidney disease [ 60 ], cardiac autonomic neuropathy [ 61 ], platelet morphology [ 62 ], microvascular complications [ 63 ], and patterned immune activity [ 64 ], whilst circadian variation in basal insulin requirement can be an early marker of autoimmune polyendocrine syndromes in T1DM [ 65 ]. Such data highlight the role of alterations in the circadian rhythm in T1DM pathophysiology.…”

Section: Wider T1dm Pathophysiologymentioning

confidence: 99%

Type I Diabetes Pathoetiology and Pathophysiology: Roles of the Gut Microbiome, Pancreatic Cellular Interactions, and the ‘Bystander’ Activation of Memory CD8+ T Cells

Anderson¹

2023

IJMS

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Type 1 diabetes mellitus (T1DM) arises from the failure of pancreatic β-cells to produce adequate insulin, usually as a consequence of extensive pancreatic β-cell destruction. T1DM is classed as an immune-mediated condition. However, the processes that drive pancreatic β-cell apoptosis remain to be determined, resulting in a failure to prevent ongoing cellular destruction. Alteration in mitochondrial function is clearly the major pathophysiological process underpinning pancreatic β-cell loss in T1DM. As with many medical conditions, there is a growing interest in T1DM as to the role of the gut microbiome, including the interactions of gut bacteria with Candida albicans fungal infection. Gut dysbiosis and gut permeability are intimately associated with raised levels of circulating lipopolysaccharide and suppressed butyrate levels, which can act to dysregulate immune responses and systemic mitochondrial function. This manuscript reviews broad bodies of data on T1DM pathophysiology, highlighting the importance of alterations in the mitochondrial melatonergic pathway of pancreatic β-cells in driving mitochondrial dysfunction. The suppression of mitochondrial melatonin makes pancreatic β-cells susceptible to oxidative stress and dysfunctional mitophagy, partly mediated by the loss of melatonin’s induction of PTEN-induced kinase 1 (PINK1), thereby suppressing mitophagy and increasing autoimmune associated major histocompatibility complex (MHC)-1. The immediate precursor to melatonin, N-acetylserotonin (NAS), is a brain-derived neurotrophic factor (BDNF) mimic, via the activation of the BDNF receptor, TrkB. As both the full-length and truncated TrkB play powerful roles in pancreatic β-cell function and survival, NAS is another important aspect of the melatonergic pathway relevant to pancreatic β-cell destruction in T1DM. The incorporation of the mitochondrial melatonergic pathway in T1DM pathophysiology integrates wide bodies of previously disparate data on pancreatic intercellular processes. The suppression of Akkermansia muciniphila, Lactobacillus johnsonii, butyrate, and the shikimate pathway—including by bacteriophages—contributes to not only pancreatic β-cell apoptosis, but also to the bystander activation of CD8+ T cells, which increases their effector function and prevents their deselection in the thymus. The gut microbiome is therefore a significant determinant of the mitochondrial dysfunction driving pancreatic β-cell loss as well as ‘autoimmune’ effects derived from cytotoxic CD8+ T cells. This has significant future research and treatment implications.

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“…This is considered a non-dipping BP pattern, which was first described by O’Brien et al [ 3 ]. The non-dipping phenotype has been shown to be an independent risk factor for CV events in hypertensive patients and in different populations [ 3 – 7 ]. Non-dipping has also been associated with metabolic abnormalities [ 8 ], end organ damage [ 7 , 9 , 10 ] and new-onset diabetes [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study

Lempiäinen,

Ylitalo,

Huikuri

et al. 2024

J Hum Hypertens

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Non-dipping blood pressure (BP) pattern is a predictor for cardiovascular (CV) events and mortality. We evaluated dipping status change and its association with incidence of non-fatal CV events in middle-aged subjects. The OPERA study was carried out during the years 1991–1993, with a follow-up study 21.7 years later. In this study, we included 452 participants with 24-h ambulatory BP measurements (ABPM) available in both surveys. The study population was divided into four groups according to the dipping pattern change: dipping–dipping (n = 152/33.6%), dipping–non-dipping (n = 198/43.8%), non-dipping–dipping (n = 20/4.4%), and non-dipping–non-dipping (n = 82/18.1%). Sixty-five participants experienced a CV event (14.4%) during the 21.7 (SD 0.8) years of follow-up. The incidence of events was highest (28%) in the non-dipping–non-dipping group, and lowest (6.6%) in the dipping–dipping group (p < 0.001). In Cox regression analyses the covariates were age, sex, total cholesterol, hypertension and use of antihypertensive medication, systolic office BP and ambulatory mean or nighttime systolic BP, as well as the change in the variables during the follow-up period. After adjustments, the association of the non-dipping–non-dipping pattern with CV events compared with the dipping–dipping pattern remained significant (HR 4.01; 95% CI 1.89–8.67, p < 0.001). In summary, non-dipping–non-dipping pattern was associated with non-fatal CV events in the long term, and the effect was independent of the conventional risk factors including office and ambulatory BP levels.

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Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes

Cited by 12 publications

References 38 publications

Comparison of Proteinuria and Glycemic Parameters According to Dipping Status in Patients with Hypertension and Diabetic Kidney Disease

Comparison of Proteinuria and Glycemic Parameters According to Dipping Status in Patients with Hypertension and Diabetic Kidney Disease

Type I Diabetes Pathoetiology and Pathophysiology: Roles of the Gut Microbiome, Pancreatic Cellular Interactions, and the ‘Bystander’ Activation of Memory CD8+ T Cells

Non-dipping blood pressure pattern is associated with cardiovascular events in a 21-year follow-up study

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