Document Detail

Afternoon blood pressure increase: a blood pressure pattern associated with microvascular complications in type 2 diabetes mellitus.
MedLine Citation:
PMID:  20847726     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Minor blood pressure (BP) alterations detected by ambulatory BP monitoring (ABPM) was associated with microvascular disease in type 2 diabetes mellitus (DM). We examined whether a previously described afternoon BP peak is linked to hypertension status and associated with microvascular complications.
METHODS: A cross-sectional study was conducted with 207 type 2 DM patients (56 years, 52.7% men). ABPM was determined by oscillometry.
RESULTS: An increase in both systolic and diastolic BP occurred in the afternoon; the same pattern was observed across hypertension categories (normotensive, prehypertensive, or hypertensive). We calculated BP increase for the period between 2 and 8 PM as the difference between mean BP at 8 PM and mean BP at 2 PM (calculated by the average of four measurements in each hour). The cohort was then divided into two groups (afternoon BP increase below or above the group's median). The prevalence of diabetic retinopathy (DR) was higher in those with afternoon increment above the group median for both systolic (50 vs. 30%, P = 0.004) and diastolic (47 vs. 33%, P = 0.04) BP. For systolic BP, this result was maintained after adjustments for age, gender, A1c test, DM duration, total cholesterol, and 24-h systolic BP. Afternoon BP increments for both systolic and diastolic BP correlated significantly with urinary albumin excretion rate (UAER) after adjusting for 24-h BP (systolic: r = 0.17, P = 0.01; diastolic: r = 0.16, P = 0.02). However, when adjusted for all covariates, these correlations were no longer significant.
CONCLUSIONS: An increment in afternoon BP was observed in type 2 diabetic patients regardless of hypertension status; that increment was associated with higher prevalence of DR but not diabetic nephropathy independently of measured confounders.
Caroline K Kramer; Cristiane B Leitão; Luís H Canani; Jorge L Gross
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-16
Journal Detail:
Title:  American journal of hypertension     Volume:  24     ISSN:  1941-7225     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-17     Completed Date:  2011-02-11     Revised Date:  2011-06-30    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  64-9     Citation Subset:  IM    
Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
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MeSH Terms
Albuminuria / physiopathology
Blood Pressure*
Circadian Rhythm*
Cross-Sectional Studies
Diabetes Mellitus, Type 2 / complications*,  physiopathology
Diabetic Nephropathies / physiopathology
Hypertension / etiology*
Microvessels / physiopathology
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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