IS THERE A RELATIONSHIP BETWEEN NON-DIPPER PATTERN AND CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH DIABETES?

Abstract

Objective: To determine the influence of diabetes mellitus (DM) on circadian blood pressure rhythm and to investigate is there a relationship between non-dipper pattern (ND) and cardiovascular events (coronary artery disease - CAD, stroke) in patients with DM and arterial hypertension. Design and method: 184 consecutive hypertensive pts (92 men and 92 women, mean age 63.21 ± 12.62) were divided in two groups: 58 pts with type 2 diabetes mellitus (DM group) and 126 pts without diabetes (no-DM group). In all pts ambulatory blood pressure monitoring (AMBP) were performed. The values obtained by AMBP were compared between groups. ND pattern was defined as the absence of normal nocturnal fall of blood pressure (less than 10% and more than 20% compared to daily values). Results: Patients in DM group had higher systolic blood pressure (129.7 ± 17.4 vs 119.9 ± 11.5 mmHg, p = 0.001), higher values of the pulse pressure (58.7 ± 11.9 vs. 49.5 ± 9.0, p < 0.001) and larger burden of high blood pressure during AMBP (51.7% vs 22.2%, p = 0.001) in comparison to pts in no-DM group. Hyperlipidemia (84,5% vs. 70,6%; p < 0,05) and CAD (27,6% vs. 12,7%; p < 0,05) were more common in the DM than in no-DM group. Out of 184 hypertensive pts 129 pts were nod-dippers. There was borderline significant association between the ND pattern and CAD (20.9% vs. 9.1%, p = 0.058) but without significant association with stroke (6,2% vs 1,2%, p = 0.283). Prevalence of ND pattern was higher in DM group but without significant difference compared to no-DM group (75,9% vs 67,5%, ns). In patients with DM there was no significant association between ND pattern and CAD (31,8% vs 14,3%, p = 0,308) compared to dippers. Also, there was no significant association between ND pattern and stroke in pts with DM (6,8% vs 7,1%, ns). Conclusions: Our study showed that hypertensive pts with DM have inadequate regulation of blood pressure which results in higher values of systolic and pulse pressure and higher prevalence of non-dipping pattern than in hypertensive pts without DM, but failed to prove that there is a relationship between non-dipping pattern and cardiovascular events in patients with DM.