Nocturnal blood pressure fall as predictor of diabetic nephropathy in hypertensive patients with type 2 diabetes

Cardiovascular Diabetology

Original Investigation

Ana Carolina CB de Souza¹  João S Felício¹  Nárcia Kohlmann²  Maria T Zanella²  Oswaldo Kohlmann²  Arthur B Ribeiro² 

[1] Endocrinology Division, UFPA - Universidade Federal do Pará, Belém, Brazil;Endocrinology and Nephrology Divisions - UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil;

关键词: Obstructive Sleep Apnea;    Diabetic Nephropathy;    Urinary Albumin Excretion;    Urinary Protein Excretion;    Cardiometabolic Risk Factor;   

DOI  :  10.1186/1475-2840-9-36

 received in 2010-08-06, accepted in 2010-08-13,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundHypertensive patients with reduced blood pressure fall (BPF) at night are at higher risk of cardiovascular events (CVE).MethodsWe evaluated in hypertensive diabetic patients, if a reduced nocturnal BPF can precedes the development of diabetic nephropathy (DN). We followed 70 patients with normal urinary albumin excretion (UAE) for two years. We performed 24-hours ambulatory BP monitoring in baseline and at the end of the study.ResultsFourteen (20%) patients (GI) developed DN (N = 11) and/or CVE (n = 4). Compared to the remaining 56 patients (GII) in baseline, GI had similar diurnal systolic (SBP) and diastolic BP (DBP), but higher nocturnal SBP (138 ± 15 vs 129 ± 16 mmHg; p < 0.05) and DBP (83 ± 12 vs 75 ± 11 mmHg; p < 0,05). Basal nocturnal SBP correlated with occurrence of DN and CVE (R = 0.26; P < 0.05) and with UAE at the end of the study (r = 0.3; p < 0.05). Basal BPF (%) correlated with final UAE (r = -0.31; p < 0.05). In patients who developed DN, reductions occurred in nocturnal systolic BPF (12 ± 5 vs 3 ± 6%, p < 0,01) and diastolic BPF (15 ± 8 vs 4 ± 10%, p < 0,01) while no changes were observed in diurnal SBP (153 ± 17 vs 156 ± 16 mmHg, NS) and DBP (91 ± 9 vs 90 ± 7 mmHg, NS). Patients with final UAE < 20 μg/min, had no changes in nocturnal and diurnal BP.ConclusionsOur results suggests that elevations in nocturnal BP precedes DN and increases the risk to develop CVE in hypertensive patients with T2DM.

【 授权许可】

CC BY   
© Felício et al; licensee BioMed Central Ltd. 2010