Twenty‐four Hour Blood Pressure and Heart Rate Profiles of Diabetic Patients with Abnormal Cardiovascular Reflexes

Abstract

Twenty-four hour ambulatory blood pressure and heart rate profiles of 24 patients with diabetes were monitored in order to assess the effect of autonomic neuropathy on 24-h haemodynamic profiles. Eighteen patients had abnormal cardiovascular reflexes. Mean arterial pressure rose at night in six of the patients with autonomic neuropathy and fell by less than or equal to 5 mmHg in seven. In the remaining five patients with autonomic neuropathy and in the six diabetic patients with normal cardiovascular reflexes, the fall in nocturnal mean arterial pressure was comparable to that of 11 non-diabetic patients with essential hypertension. Median 24-h mean arterial pressure was similar in all four groups of diabetic patients. Prevalence of autonomic symptoms was not related to the change in blood pressure in those with autonomic neuropathy. Twenty-seven months after monitoring, three fatal and five severe non-fatal cardiovascular or renal events had occurred in four of the six patients with a rise in nocturnal blood pressure, compared with one non-fatal event in those with a small fall and no severe events in those with a pronounced fall (p = 0.02). Blood pressure rises at night in certain diabetic patients with abnormal cardiovascular reflexes and the nocturnal rise appears to be associated with a poor prognosis.

Abnormal nocturnal blood pressure fall in normotensive adolescents with insulin-dependent diabetes is ameliorated following glycemic improvement

“…Altered 24-h BP profiles have been found in adult diabetic patients which appear to be related to the presence of autonomic neuropathy (2,3). A decrease in nocturnal BP fall has also been observed in insulin-dependent diabetic patients with different degrees of diabetic nephropathy (4,5).…”

“…The nocturnal decline in blood pressure (BP) and heart rate (HR) in healthy subjects is thought to be the result of dominating parasympathetic tone during sleep (1,2). Altered 24-h BP profiles have been found in adult diabetic patients which appear to be related to the presence of autonomic neuropathy (2,3).…”

“…The lack of a nocturnal decline in BP during sleep is clinically significant and is associated with a greater prevalence of the development of hypertension, particularly in patients with diabetes mellitus (2,8). Besides being an important cardiovascular risk factor, hypertension represents a major determinant of the progression of diabetic nephropathy toward end-stage renal failure (9,10).…”

Reversed circadian blood pressure rhythm is associated with occurrences of both fatal and nonfatal vascular events in NIDDM subjects.

“…That reversal of circadian BP rhythm may be related to postural hypotension and/or advanced diabetic nephropathy (16). H o w e v e r, long-term follow-up studies for NIDDM subjects in relation to circadian BP rhythms are sparse, so that the prognostic significance of the ambulatory BP pattern is not clear (17). In this study, we followed up NIDDM subjects with normal and reversed circadian BP rhythms, examined their prognoses, and determined the predictive factors of various fatal and nonfatal vascular events.…”

Ambulatory Blood Pressure Level Rather than Dipper/Nondipper Status Predicts Vascular Events in Type 2 Diabetic Subjects

“…In support of our observations, Sturrock et al (8) recently demonstrated that the combination of nondipping and subsequent renal impairment led to a higher mortality rate irrespective of diabetes type. These follow-up studies focused on the night-to-day pattern of BP variability, although the nighttime BP levels in diabetic subjects who had a poor outcome were shown to be consistently higher than the daytime BP levels (6)(7)(8).…”