Abstract
BackgroundAim of this study is to investigate a possible association of hypoglycemic episodes and arterial hypertension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypoglycemic episodes than their counterparts without hypertensive crisis on admission.MethodsIn a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous glucose monitoring, 24-h blood-pressure- and Holter electrocardiogram recordings, and to laboratory tests including plasma catecholamines.Results53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher body-mass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more documented hypoglycemic episodes (0.8 ± 0.5 per 24 h) than Group-2 patients (0.2 ± 0.3 per 24 h), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 h). Plasma norepinephrine and mean arterial blood pressure were higher Group-1 and Group-3 patients than in control patients of Group 2. At discharge, the daily cumulative insulin dose was reduced in Group-1 (− 18.4 ± 24.9 units) and in Group-3 patients (− 18.6 ± 22.7 units), but remained unchanged in Group-2 control patients (− 2.9 ± 15.6 units).ConclusionsAn association between hypoglycemic events and uncontrolled hypertension was found in this study.
Highlights
Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hyper‐ tension
An association between hypoglycemia and arterial hypertension has been demonstrated in a small cohort study of type-1- and type-2-diabetes patients on a continuous glucose monitoring, while concurrently performing a 24-h ambulatory blood pressure monitoring (ABPM) [9]
Given the correlation between hypoglycemia and arterial hypertension, we hypothesized that consecutively hospitalized insulin-treated diabetes patients with hypertensive crisis on admission have a propensity for hypoglycemic episodes in post-admission continuous glucose monitoring (CGM)
Summary
Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hyper‐ tension. Randomized clinical trials have proven that the use of intensive insulin therapy to target normal glycated hemoglobin A1c (HbA1c) did not offer cardiovascular benefits [1] and have been shown to even increase the cardiovascular mortality for type-2-diabetes patients [2] The reason for this lack of benefit or even excess mortality seen, With the advent of skin-based CGM, the more inclusive term “glycopenia” reflects a shortage of glucose in tissues such as the skin or the brain. Given the correlation between hypoglycemia and arterial hypertension, we hypothesized that consecutively hospitalized insulin-treated diabetes patients with hypertensive crisis on admission have a propensity for hypoglycemic episodes in post-admission continuous glucose monitoring (CGM). Plasma norepinephrine concentrations are expected to be elevated both in insulin-treated diabetes patients with hypertensive crisis and in diabetes patients with hypoglycemia on admission. The results of this study may highlight a possible association between uncontrolled arterial hypertension and a propensity of hypoglycemic events
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