Document Detail

Prognostic value of nocturnal blood pressure and reverse-dipping status on the occurrence of cardiovascular events in hypertensive diabetic patients.
MedLine Citation:
PMID:  18926758     Owner:  NLM     Status:  MEDLINE    
AIM: To assess whether reverse-dipping status is associated with cardiovascular (CV) events such as CV death, myocardial infarction (MI) or stroke in diabetic patients with hypertension. METHODS: A total of 97 diabetic patients underwent their first ambulatory blood pressure monitoring (ABPM 1). "Reverse dippers" were defined as patients with a nighttime systolic and/or diastolic blood pressure (BP) greater than daytime systolic and/or diastolic BP. Other patients were called "others". A second ABPM (ABPM 2) was done after a median delay of 2.6 years. Patients were then followed for a further 2.9-year median period (total median follow-up: 5.5 years). RESULTS: After ABPM 1, CV events occurred in 53% of the reverse dippers (n=15) and in 29% of the others (n=82). Kaplan-Meier curves showed significant differences between the two groups (P=0.003). Mean nighttime systolic BP on ABPM 1 was 148+/-23 mmHg and 142+/-19 mmHg in patients who did and did not experience a CV event, respectively. With Cox analysis adjusted for confounders, a 10 mmHg increase in nighttime systolic BP was associated with a 35% increase in the risk of a CV event (hazard ratio [HR]: 1.35, P=0.003). The HR for a CV event in reverse- versus nonreverse-dipping status was 2.79 (P=0.023). After ABPM 2, the relationship between the reverse-dipping status and occurrence of CV events was no longer evident (P=0.678). Nighttime systolic BP remained predictive of CV events (P=0.001). CONCLUSION: These findings suggest that nighttime systolic BP per se appeared to be a stronger predictor of an excess risk of CV events compared with reverse-dipping status.
B Bouhanick; V Bongard; J Amar; S Bousquel; B Chamontin
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Publication Detail:
Type:  Journal Article     Date:  2008-10-15
Journal Detail:
Title:  Diabetes & metabolism     Volume:  34     ISSN:  1262-3636     ISO Abbreviation:  Diabetes Metab.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-08     Completed Date:  2009-02-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607599     Medline TA:  Diabetes Metab     Country:  France    
Other Details:
Languages:  eng     Pagination:  560-7     Citation Subset:  IM    
Service de médecine interne et HTA, CHU de Rangueil, TSA 50032, 31059 Toulouse cedex 09, France.
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MeSH Terms
Blood Pressure / physiology*
Blood Pressure Determination
Cardiovascular Diseases / epidemiology
Circadian Rhythm / physiology*
Creatinine / blood
Diabetes Complications / blood,  physiopathology*
Diabetic Angiopathies / epidemiology
Diabetic Nephropathies / epidemiology,  physiopathology
Diastole / physiology
Hemoglobin A, Glycosylated / metabolism
Hypertension / blood,  physiopathology*
Middle Aged
Pilot Projects
Predictive Value of Tests
Sleep Apnea Syndromes / physiopathology
Systole / physiology
Reg. No./Substance:
0/Hemoglobin A, Glycosylated; 60-27-5/Creatinine

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