Nocturnal Hypertension and Special - Period Hypertension in Type 1 Diabetes Mellitus

Abstract

Nocturnal Hypertension and Special - Period Hypertension in Type 1 Diabetes MellitusBackground: One of the unique aspects of continuous ambulatory arterial-tension monitoring is the ability of recording the diurnal variations. The patients suffering from Type 1 Diabetes Mellitus (T1DM) may present higher nocturnal values of arterial tension and this rise can be determined by hyperinsulinism. The first hours in the morning (6 a.m. - 9 a.m.), the so-called special period, is correlated with a rise in the incidence of cardiovascular events and a rise in plasmatic catecholamine and of platelet aggregability. The main goal of this study is to analyze the particularities of the tensional profile with regard to nocturnal behavior and behavior in the special period, reported to glycemic variations. Material and method: The study analysed 351 patients known with T1DM, who have been suffering from this disease for more than 10 years, who were in the records of the Center of Diabetes, Nutrition and Metabolic Diseases of Iaşi and Suceava. The patients were assesssed from a tensional and glycemic point of view, by continuous blood-tension (ABPM) and glycemia (CGMS) monitoring. Results: The occurrence of nocturnal hypertension in patients suffering T1DM is by 29.24 higher than in the case of hypertensive persons compared to the risk presented by the persons without blood hypertension. The continuous recording of blood hypertension during the asymptomatic hypoglycemia period showed increased values both for systolic blood tension and for diastolic one (p<0.05). The hypertension risk is by 3.24 higher during the hypoglycemia period compared to the normoglycemic one. Tension variations during the special period were noticed in 87 patients who have been suffering from diabetes mellitus for 19.75 ± 4.57 years. These tension values are higher than the nocturnal ones, but lower than the diurnal ones. Conclusions: Hypoglycemia duration and magnitude induces increased tension values which adds another hemodynamic stress factor to the patient suffering from T1DM. In T1DM, in the first morning hours, in particular conditions, we can notice increased tension values, higher in patients with blood hypertension, which induces a stressed cardiovascular risk. Tension value increase during the special period overlaps the morning hyperglycemias. Therefore, there appears an apparently invisible impact on the cardiovascular condition of diabetes mellitus.