Pulse pressure and systolic night–day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

Laugesen, Esben; Rossen, Niklas B.; Poulsen, Per Løgstrup; Hansen, Klavs Würgler; Ebbehøj, Eva; Knudsen, Søren Tang

doi:10.1038/jhh.2011.9

Cited by 12 publications

(6 citation statements)

References 31 publications

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“…Similar to prior studies, [13,14,18] our present study also shows that in diabetic hypertensive patients, ABP is superior to CBP in relation to prevalent CVD. The novel finding of our present study is that aldosterone excess may be the underlying mechanism contributing to the association between ambulatory SBP and prevalent CVD in diabetic hypertensive populations.…”

Section: Discussionsupporting

confidence: 91%

Relationship and associated mechanisms between ambulatory blood pressure and clinic blood pressure with prevalent cardiovascular disease in diabetic hypertensive patients

Hao

Li²,

Sun³

et al. 2017

Medicine

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The present study was to compare the association between ambulatory blood pressure (ABP) and clinic BP (CBP) with prevalent cardiovascular diseases (CVD); and the underlying mechanism would also be investigated concurrently.Diabetic hypertensive patients were enrolled and divided into 2 groups based on presence of CVD. Twenty-four hour-ABP monitoring was performed and between-group differences were evaluated and logistic regression analysis was conducted.A total of 568 diabetic hypertensive patients were enrolled, and the mean age was 60.8 years, male accounted for 67.8%. Mean durations of diabetes mellitus and hypertension were 6.1 ± 2.7 and 5.4 ± 3.3 years, respectively, and 20.6% had prevalent CVD. Compared to patients without CVD, patients with CVD had significantly higher body mass index (BMI), plasma aldosterone concentration (PAC), and serum sodium level. No significant between-group differences in CBP were observed. However, 24 hour-SBP, daytime-SBP and nighttime-SBP were all significantly higher in patients with CVD compared to those without CVD. Pearson correlation analysis showed that BMI was positively correlated with PAC and serum sodium level. Logistic regression analyses showed that the association between clinic SBP and DBP with CVD were progressively attenuated to nonsignificant. In contrast, both ambulatory SBP and DBP were independently associated with CVD. However, after being further adjusted for PAC, no significant association was observed between ambulatory SBP and CVD.In diabetic hypertensive patients, ABP is superior to CBP in relation to CVD. The association between ambulatory SBP and CVD may be dependent on aldosterone excess.

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Section: Discussionsupporting

confidence: 91%

Relationship and associated mechanisms between ambulatory blood pressure and clinic blood pressure with prevalent cardiovascular disease in diabetic hypertensive patients

Hao

Li²,

Sun³

et al. 2017

Medicine

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“…Moreover, a blunted nocturnal BP fall precedes micro-and macro-vascular complications of diabetes [20][21][33][34]79]. So far, however, an abnormal rhythm has been generally understood as a nondipper pattern [(awake BP mean -asleep BP mean)/awake BP mean x 100 < 10%] since the circadian rhythm of BP has rarely been stylised by cosinor analysis [22,44,[49][50]77].…”

Section: What Are the Adverse Consequences That May Results From An Almentioning

confidence: 99%

Circadian Rhythm of Blood Pressure in Diabetes Mellitus: Evidence, Mechanisms and Implications

Matteucci

Giampietro²

2012

CDR

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Circadian misalignment has been implicated in the development of diabetes mellitus and cardiovascular disease. Circadian rhythms of blood pressure (BP) and heart rate (HR) have long been known and the mechanisms controlling them have been actively investigated in physiology and disease. In this respect, the introduction of 24-hour ambulatory blood pressure monitoring (ABPM) has enabled a more accurate assessment of circadian BP patterns in order to solve diagnostic uncertainty or to establish dipper status. However, attention has been mainly focused on measures of extent (midline estimating statistic of rhythm, MESOR, and amplitude) rather than timing (acrophase) of changes within a cycle. The review summarises 1) evidence for altered characteristics of BP rhythm (in particular, phase shifts along the time axis) in animal and human diabetes mellitus, 2) the mechanisms that have been supposed to underlie the observed changes in cardiovascular function before diabetes onset and during progression of the disease, and 3) the adverse consequences that may result from an altered circadian BP rhythm.

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“…PP increases with age and is typically more increased in patients with type 2 diabetes. 25 The elevated PPs at baseline and the association with fibulin-1 indicate the presence of vascular fibrosis and arterial stiffness in the present study population. The reductions in both PP and plasma fibulin-1 levels after low-dose spironolactone treatment further support our hypothesis that the antihypertensive effect of the mineralocorticoid receptor blocker may in part be mediated by a regression of vascular remodeling.…”

Section: Discussionmentioning

confidence: 55%

Low-dose spironolactone reduces plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension

et al. 2014

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Diabetic patients with hypertension are at particularly high risk of vascular damage and consequently cardiovascular and renal disease. Fibulin-1, an extracellular matrix glycoprotein, is increased in arterial tissue and plasma from individuals with type 2 diabetes. This study aimed to evaluate whether antihypertensive treatment with spironolactone changes plasma fibulin-1 levels. In a multicenter, double-blind, randomized, placebo-controlled study, 119 patients with type 2 diabetes and resistant hypertension were included. A dose of spironolactone 25 mg or matching placebo was added to previous treatment at randomization. Blood pressure (BP) and plasma fibulin-1 were measured at baseline and at 16 weeks follow-up. Overall, 112 patients completed the study. All measures of BP were reduced in the spironolactone group at follow-up. Plasma fibulin-1 was significantly reduced after spironolactone treatment (P=0.009), but increased after placebo (P=0.017). Baseline plasma fibulin-1 correlated with BP and estimated glomerular filtration rate. Increased levels of plasma fibulin-1 (P=0.004) were observed in diabetic participants reporting erectile dysfunction as compared with participants who did not. Treatment with low-dose spironolactone reduced plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension. This supports the hypothesis that the antihypertensive effect of the mineralocorticoid receptor blocker in part may be due to regression of vascular remodeling.

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Pulse pressure and systolic night–day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

Cited by 12 publications

References 31 publications

Relationship and associated mechanisms between ambulatory blood pressure and clinic blood pressure with prevalent cardiovascular disease in diabetic hypertensive patients

Relationship and associated mechanisms between ambulatory blood pressure and clinic blood pressure with prevalent cardiovascular disease in diabetic hypertensive patients

Circadian Rhythm of Blood Pressure in Diabetes Mellitus: Evidence, Mechanisms and Implications

Low-dose spironolactone reduces plasma fibulin-1 levels in patients with type 2 diabetes and resistant hypertension

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