Document Detail

Non-dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus.
MedLine Citation:
PMID:  10872534     Owner:  NLM     Status:  MEDLINE    
AIMS: To assess the relevance of circadian blood pressure variation to future morbidity and mortality in patients with diabetes mellitus. METHODS: A retrospective descriptive 4 year follow-up study of data collected after ambulatory blood pressure monitoring in a clinic setting. RESULTS: Seventy-five patients (46 male; 29 female) of whom 41 % had Type 1 diabetes and 59% Type 2 were followed up for a median of 42 months (11-56). The median creatinine for the whole group at baseline was 101 (56-501) micromol/l. The median circadian blood pressures for the total study population were 147 (110-194)/87 (66-109) mmHg during daytime and 132 (86-190)/77 (50-122) mmHg during night-time. Half of the patients exhibited a fall in night-time pressures to 10% lower than daytime pressures (dippers). Dippers were younger, 47 (32-75) years, than non-dippers, 57 (35-79) years, P = 0.03. Over time, dippers had a lower mortality than non-dippers, with 8% deaths in the cohort of dippers, 26% deaths in the cohort of non-dippers, P = 0.04. Cox regression analysis revealed significant contributions from age, duration of diabetes and baseline renal function to subsequent mortality in non-dippers. Analysing current degree of renal impairment and original dipper status together revealed that, of those patients whose creatinine remained normal, 7% of patients whose blood pressure dipped had subsequently died and 10% of non-dipping patients had died; of those patients whose creatinine unequivocally rose, 10% of dipping patients had died and 42% of non-dipping patients had died, P = 0.03 CONCLUSIONS: Loss of circadian variation in blood pressure is associated with an increased mortality rate, regardless of diabetes type. The combination of non-dipping and subsequent renal impairment leads to the highest mortality rate. The study suggests a role for ambulatory blood pressure monitoring in day-to-day clinical practice to select patients with nephropathy who are at greatest risk, in an effort to alter outcome.
N D Sturrock; E George; N Pound; J Stevenson; G M Peck; H Sowter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  17     ISSN:  0742-3071     ISO Abbreviation:  Diabet. Med.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-10-03     Completed Date:  2000-10-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  360-4     Citation Subset:  IM    
Department of Diabetes and Endocrinology, Nottingham City Hospital NHS Trust, UK.
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MeSH Terms
Blood Pressure*
Cardiovascular Diseases / etiology,  physiopathology
Circadian Rhythm*
Diabetes Mellitus, Type 1 / mortality*,  physiopathology
Diabetes Mellitus, Type 2 / mortality*,  physiopathology
Diabetic Angiopathies / etiology,  physiopathology
Diabetic Nephropathies / physiopathology*
Middle Aged
Retrospective Studies
Risk Factors

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

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