论文部分内容阅读
Background: Little information is available on the reproducibility of nocturna l variations in blood pressure in type 2 diabetic hypertensive patients. Objecti ve: We aimed to compare the intrasubject short-term reproducibility of a noctur nal non-dipping pattern and the prevalence of cardiac and extracardiac signs of target organ damage, in a group of type 2 diabetic hypertensive patients and in an age/gender-matched group of non-diabetic hypertensive subjects. Methods: T hirty-six treated hypertensive patients with long-lasting type 2 diabetes(>10 years duration) consecutively attending our hospital out-patient hypertension c linic(group I; mean age, 65±9 years), and 61 untreated non-diabetic subjects w ith grade 1 and grade 2 uncomplicated essential hypertension,matched for age and gender,and chosen from patients attending an outpatient clinic(group II; mean a ge, 65±5 years), were considered for this analysis. All patients underwent bloo d sampling for routine blood chemistry, 24-h urine collection for microalbuminu ria, two 24-h periods of ambulatory blood pressure monitoring(ABPM) within a 4 -week period, echocardiography, and carotid ultrasonography. A dipping pattern was defined as a greater than 10%reduction in the average systolic and diastolic blood pressure at night compared with average daytime v alues. Results: A reproducible nocturnal dipping and non-dipping profile was fo und in 11(30.6%) and 21(58.3%) diabetic patients, respectively; while only in four(11.1%) patients was a variable dipping profile observed. Of the 23 patient s with a non-dipping pattern during the first ABPM period, 21(91.3%) also had this type of pattern during the second ABPM recording. In group II(non-diabetic hypertensive patients), 30 patients(49.2%, P< 0.05) had a dipping pattern, 13 patients(21.3%, P< 0.01)had a non-dipping profile pattern and 18 patients(29.5 %, P< 0.01) had a variable dipping pattern. Of the 20 patients with a non-dipp ing pattern during the first ABPM period, 13(65.0%) confirmed this type of patt ern during the second ABPM recording. Finally, the prevalence of left ventricula r hypertrophy(77.7 versus 41.4%, P< 0.01), carotid plaques(80.5 versus 38.3%, P< 0.01), carotid intima-media thickening(54.3 versus 44.0%, P< 0.05) and micr oalbuminuria(11.1 versus 2.0%, P< 0.01) was significantly higher in group I tha n in group II. According to a logistic regression analysis, diabetes, left ventr icular hypertrophy and carotid plaques were the main independent predictors of t he non-dipping pattern in the overall population. Conclusions: These findings i ndicate that intrasubject variability of non-dipper pattern is lower in diabeti c than in non-diabetic hypertensive patients, that classification of diabetic h ypertensive patients as dipper or non-dipper on the basis of a single ABP recor ding is more reliable than in nondiabetic patients, and that the more frequent a nd reproducible non-dipping pattern in diabetic patients is associated with a m ore prominent cardiac and extracardiac target organ damage.
Background: Little information is available on the reproducibility of nocturna l variations in blood pressure in type 2 diabetic hypertensive patients. Objecti ve: We aimed to compare the intrasubject short-term reproducibility of a noctur nal non-dipping pattern and the prevalence of cardiac and extracardiac signs of target organ damage, in a group of type 2 diabetic hypertensive patients and in an age / gender-matched group of non-diabetic hypertensive subjects. Methods: T hirty-six treated hypertensive patients with long-lasting type 2 diabetes (> 10 years duration) consecutively attending our hospital out-patient hypertension c linic (group I; mean age, 65 ± 9 years), and 61 untreated non-diabetic subjects w ith grade 1 and grade 2 uncomplicated essential hypertension, matched for age and gender , and chosen from patients attending an outpatient clinic (group II; mean a ge, 65 ± 5 years), were considered for this analysis. All patients underwent bloo d sampling for routine blood chemistry, 24 -h urine collection for microalbuminu ria, two 24-h periods of ambulatory blood pressure monitoring (ABPM) within a 4-week period, echocardiography, and carotid ultrasonography. A dipping pattern was defined as a greater than 10% reduction in the average systolic and diastolic blood pressure at night compared with average daytime v alues. Results: A reproducible nocturnal dipping and non-dipping profile was fo und in 11 (30.6%) and 21 (58.3%) diabetic patients, respectively; while only in four (11.1 %) patients was a variable dipping profile observed. Of the 23 patient s with a non-dipping pattern during the first ABPM period, 21 (91.3%) also had this type of pattern during the second ABPM recording. In group II had a non-dipping profile pattern and 18 patients (29.5%, P <0.01) had a variable dipping pattern. Of the 20 patients with a non-dipp ing pattern during the first ABPM p erFinally, the prevalence of left ventricule r hypertrophy (77.7 versus 41.4%, P <0.01), carotid plaques (80.5 versus 38.3%, P <0.01) ), carotid intima-media thickening (54.3 versus 44.0%, P <0.05) and micr oalbuminuria (11.1 versus 2.0%, P <0.01) were significantly higher in group I tha n in group II. , left ventricular hypertrophy and carotid plaques were the main independent predictors of t he non-dipping pattern in the overall population. Conclusions: These findings i ndicate that intrasubject variability of non-dipper pattern is lower in diabeti c than in non-diabetic hypertensive patients, that classification of diabetic h ypertensive patients as dipper or non-dipper on the basis of a single ABP recor ding is more reliable than in nondiabetic patients, and that the more frequent a nd reproducible non-dipping pattern in diabetic patients is associated witha m ore prominent cardiac and extracardiac target organ damage.