To assess the variation in nocturnal blood pressure among diabetic hypertensives

Anandamuni Manyam; Neha Gattu; Subramanyam Rao Basutkar; D Yashilha; J S Kumar; R Padmanabhan

doi:10.53730/ijhs.v6nS2.8533

Authors

Anandamuni Manyam Post Graduate Medicine, SRM Medical College & Research Centre
Neha Gattu Post graduate medicine, SRM Medical College & Research Centre
Subramanyam Rao Basutkar Post graduate medicine, SRM Medical College & Research Centre
Yashilha D Post graduate Medicine, SRM Medical College & Research Centre
J S Kumar Professor medicine, SRM Medical College & Research Centre
R Padmanabhan Professor and HOD Department of Nephrology, SRM Medical College & Research Centre

Keywords:

nocturnal blood, diabetic hypertensives, non diabetic hypertensive

Abstract

This research proposes the there is a strong co-relation among altered circadian rhythm in both diabetic hypertensive and non diabetic hypertensive groups. This study also shows there is statistically significant relation between absence of dipping status and left ventricular hypertrophy as evidenced by ECHO suggesting participants are at risk of developing cardiovascular diseases. This study also found that ABPM SBP, DBP, PP and MAP have significant correlation with dipping status. Hence early Identification of altered circadian variation of BP can help in diagnosing, proper risk stratification and plan of modification of treatment plan.

Downloads

Download data is not yet available.

References

O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. Journal of hypertension. 2013;31(9):1731-68.

Dadlani A, Madan K, Sawhney J. Ambulatory blood pressure monitoring in clinical practice. Indian heart journal. 2018.

Townsend RR, Machin I, Ren J, Trujillo A, Kawaguchi M, Vijapurkar U, et al. Reductions in mean 24‐hour ambulatory blood pressure after 6‐week Treatment with canagliflozin in patients with type 2 diabetes mellitus and hypertension. The Journal of Clinical Hypertension. 2016;18(1):43-52.

Ohara M, Kohata Y, Nagaike H, Koshibu M, Gima H, Hiromura M, et al. Association of glucose and blood pressure unpredictability on oxidative stress in patients with type 2 diabetes mellitus and hypertension: a cross-sectional study. Diabetology & metabolic syndrome. 2019;11(1):29.

Eguchi K, Pickering TG, Hoshide S, Ishikawa J, Ishikawa S, Schwartz JE, et al. Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes. American journal of hypertension. 2008;21(4):443-50.

Group AS. Effects of intensive blood-pressure control in type 2 diabetes mellitus. New England Journal of Medicine. 2010;362(17):1575-85.

Stergiou GS, Parati G, McManus RJ, Head GA, Myers MG, Whelton PK. Guidelines for blood pressure measurement: development over 30 years. The Journal of Clinical Hypertension. 2018;20(7):1089-91.

O'Brien E, White WB, Parati G, Dolan E. Ambulatory blood pressure monitoring in the 21st century. The Journal of Clinical Hypertension. 2018;20(7):1108-11.

Grossman E. Ambulatory blood pressure monitoring in the diagnosis and management of hypertension. Diabetes Care. 2013;36(Supplement 2):S307-S11.

Najafi MT, Khaloo P, Alemi H, Jaafarinia A, Blaha MJ, Mirbolouk M, et al. Ambulatory blood pressure monitoring and diabetes complications: Targeting morning blood pressure surge and nocturnal dipping. Medicine. 2018;97(38).

Bakris G. Similarities and differences between the ACC/AHA and ESH/ESC guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults: a perspective. Circulation research. 2019;124(7):969-71.

Bromfield SG, Shimbo D, Bertoni AG, Sims M, Carson AP, Muntner P. Ambulatory blood pressure monitoring phenotypes among individuals with and without diabetes taking antihypertensive medication: the Jackson Heart Study. Journal of human hypertension. 2016;30(12):731.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European heart journal. 2018;39(33):3021-104.

Lyhne JM, Laugesen E, Høyem P, Cichosz S, Christiansen JS, Knudsen ST, et al. Morning blood pressure surge and target organ damage in newly diagnosed type 2 diabetic patients: a cross sectional study. BMC endocrine disorders. 2015;15(1):77.

Turner JR, Viera AJ, Shimbo D. Ambulatory blood pressure monitoring in clinical practice: a review. The American journal of medicine. 2015;128(1):14-20.

Mancia G, Bombelli M, Cuspidi C, Facchetti R, Grassi G. Cardiovascular risk associated with white-coat hypertension: pro side of the argument. Hypertension. 2017;70(4):668-75.

Cuspidi C, Rescaldani M, Tadic M, Sala C, Grassi G, Mancia G. White-coat hypertension, as defined by ambulatory blood pressure monitoring, and subclinical cardiac organ damage: a meta-analysis. Journal of hypertension. 2015;33(1):24-32.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Practice guidelines for the management of arterial hypertension: ESH-ESC The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood pressure. 2014;23(1):3-16.

Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2018;71(19):e127-e248.

Draman MS, Dolan E, van der Poel L, Tun TK, McDermott JH, Sreenan S, et al. The importance of night-time systolic blood pressure in diabetic patients: Dublin Outcome Study. Journal of hypertension. 2015;33(7):1373-7.

Bloomfield D, Park A. Night time blood pressure dip. World journal of cardiology. 2015;7(7):373.

O'Brien E, Kario K, Staessen JA, de la Sierra A, Ohkubo T. Patterns of ambulatory blood pressure: clinical relevance and application. The Journal of Clinical Hypertension. 2018;20(7):1112-5.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European heart journal. 2012;33(13):1635-701.

Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. The journal of clinical hypertension. 2014;16(1):14-26.

Hermida RC, Moya A, Ayala DE. Ambulatory blood pressure monitoring in diabetes for the assessment and control of vascular risk. Endocrinología y Nutrición (English Edition). 2015;62(8):400-10.

Oh SW, Han SY, Han KH, Cha R-h, Kim S, Yoon SA, et al. Morning hypertension and night non-dipping in patients with diabetes and chronic kidney disease. Hypertension Research. 2015;38(12):889.

Vilchez-Lopez FJ, Mateo-Gavira I, Larran-Escandon L, Montero-Galvan A, Ortego-Rojo J, Garcia-Palacios MV, et al., editors. Nocturnal blood pressure is related to the development of microalbuminuria and established hypertension in patients with type 1 diabetes. 17th European Congress of Endocrinology; 2015: BioScientifica.

Mulè G, Calcaterra I, Costanzo M, Morreale M, D'ignoto F, Castiglia A, et al. Average real unpredictability of 24-h systolic blood pressure is associated with microalbuminuria in patients with primary hypertension. Journal of human hypertension. 2016;30(3):164.

Satoh M, Asayama K, Kikuya M, Inoue R, Metoki H, Hosaka M, et al. Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure MeasurementsNovelty and Significance. Hypertension. 2016;67(1):48-55.

Lurbe E, Redon J. The Role of ABPM in Evaluation of Hypertensive Target-Organ Damage. Pediatric Hypertension. 2018:727-40.

Collard D, Brouwer TF, Peters RJ, Vogt L, van den Born B-JH. Creatinine rise during blood pressure therapy and the risk of adverse clinical outcomes in patients with type 2 diabetes mellitus: a post hoc analysis of the ACCORD-BP randomized controlled trial. Hypertension. 2018;72(6):1337-44.

Oh J, Lee CJ, Kim IC, Lee SH, Kang SM, Choi D, et al. Association of morning hypertension subtype with vascular target organ damage and central hemodynamics. Journal of the American Heart Association. 2017;6(2):e005424.

Zappe DH, Crikelair N, Kandra A, Palatini P. Time of administration important? Morning versus evening dosing of valsartan. Journal of hypertension. 2015;33(2):385.

Eguchi K. Ambulatory blood pressure monitoring in diabetes and obesity—a review. International journal of hypertension. 2011;2011.

Reshetnik A, Toller M, Zidek W, van der Giet M. [PP. 06.29] DAY-TO-DAY UNPREDICTABILITY OF THE MEAN SYSTOLIC AND DIASTOLIC PRESSURE IN AMBULANT BLOOD PRESSURE MONITORING. Journal of Hypertension. 2017;35:e137.

Liu X, Faini A, Bilo G, Dolan E, O’Brien E, Parati G, editors. Determinants of different blood pressure unpredictability indices in untreated hypertensive patients. Data from the Dublin study. 26th European meeting on Hypertension and Cardiovascular pretection; 2016.

Bilo G, Dolan E, Facchetti R, O’Brien E, Parati G. [OP. 1C. 05] DIFFERENT PROGNOSTIC RELEVANCE OF 24-HOUR SYSTOLIC AND DIASTOLIC BLOOD PRESSURE UNPREDICTABILITY IN DIFFERENT AGE STRATA. DUBLIN OUTCOME STUDY. Journal of Hypertension. 2017;35:e9.

Ando D, Hirawa N, Yasuda G. Relation between circadian blood pressure rhythm and serum albumin level in non-diabetic patients with proteinuria. Blood pressure. 2016;25(1):44-50.

Tessier DM, Meneilly GS, Moleski L, Trottier L, Lanthier L. Influence of blood pressure and other clinical variables on long-term mortality in a cohort of elderly subjects with type 2 diabetes. Canadian journal of diabetes. 2016;40(1):12-6.

Xu H, Huang X, Risérus U, Cederholm T, Sjögren P, Lindholm B, et al. Albuminuria, renal dysfunction and circadian blood pressure rhythm in older men: a population-based longitudinal cohort study. Clinical kidney journal. 2015;8(5):560-6.

Pop C, Manea V, Pruna L, Cozma M, Pop L. Study of circadian blood pressure and rest heart rate variation in hypertensive diabetic type 2 patients: value of 24-hours ambulatory blood pressure monitoring. 2019.

Cardoso C, Leite N, Moram C, Salles G. Long-term visit-to-visit glycemic unpredictability as predictor of micro-and macrovascular complications in patients with type 2 diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study. Cardiovascular diabetology. 2018;17(1):33.

Chiriacò M, Pateras K, Virdis A, Charakida M, Kyriakopoulou D, Nannipieri M, et al. Association between blood pressure unpredictability, cardiovascular disease and mortality in type 2 diabetes: A systematic review and meta‐analysis. Diabetes, Obesity and Metabolism. 2019.

Gunawan F, Ng HY, Gilfillan C, Anpalahan M. Ambulatory Blood Pressure Monitoring in Type 2 Diabetes Mellitus: A Cross-sectional Study. Current hypertension reviews. 2019;15(2):135-43.

Salama MAM, Hasan YESM, Farag MAARA, Salam A. The Relation of Left Ventricular Diastolic Dysfunction and Increased Left Ventricular Mass with Blood Pressure Unpredictability in Non-Established Hypertensive Patients. The Egyptian Journal of Hospital Medicine. 2019;75(6):3013-7.

Seeman T, Hradský O, Gilík J. Nocturnal blood pressure non-dipping is not associated with increased left ventricular mass index in hypertensive children without end-stage renal failure. European journal of pediatrics. 2016;175(8):1091-7.

Niiranen TJ, Mäki J, Puukka P, Karanko H, Jula AM. Office, Home, and Ambulatory Blood Pressures as Predictors of Cardiovascular RiskNovelty and Significance. Hypertension. 2014;64(2):281-6.

Gabbs M, Wicklow B, McGavock J, Sellers E, Blydt-Hansen T, Kroeker K, et al. High Rates of Ambulatory and Nocturnal Hypertension in Youth with Type 2 Diabetes. Canadian Journal of Diabetes. 2018;42(5):S11.

Kim Y-S, Davis SC, Stok WJ, van Ittersum FJ, van Lieshout JJ. Impaired nocturnal blood pressure dipping in patients with type 2 diabetes mellitus. Hypertension Research. 2019;42(1):59.

Serhiyenko VA, Mankovsky BN, Serhiyenko LМ, Serhiyenko AA. The effect of OMEGA-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy. Diabetes mellitus. 2019;22(1):62-9.

Cardoso CR, Leite NC, Bacan G, Ataíde DS, Gorgonio LK, Salles GF. Prognostic Importance of Resistant Hypertension in Patients With Type 2 Diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study. Diabetes Care. 2019:dc191534.

Duggal A, Bal B, Singh N. Study of dipping and non-dipping patterns in patients of type 2 diabetes mellitus with hypertension and its association with microalbuminuria. Ann Int Med Den Res. 2017;3(2):20-4.

Fogari R, Zoppi A, Malamani GD, Lazzari P, Destro M, Corradi L. Ambulatory blood pressure monitoring in normotensive and hypertensive type 2 diabetics prevalence of impaired diurnal blood pressure patterns. American journal of hypertension. 1993;6(1):1-7.

Cuspidi C, Sala C, Tadic M, Gherbesi E, De Giorgi A, Grassi G, et al. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: an updated review. The Journal of Clinical Hypertension. 2017;19(7):713-21.

Chiriacò M, Pateras K, Virdis A, Kyriakopoulou D, Kontogiannis C, Emdin M, et al. ASSOCIATION BETWEEN BLOOD PRESSURE UNPREDICTABILITY, CARDIOVASCULAR DISEASE AND ALL-CAUSE MORTALITY IN TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS. Journal of Hypertension. 2019;37.

Spallone V. Blood pressure unpredictability and autonomic dysfunction. Current diabetes reports. 2018;18(12):137.

Meyer ML, Gotman NM, Soliman EZ, Whitsel EA, Arens R, Cai J, et al. Association of glucose homeostasis measures with heart rate unpredictability among Hispanic/Latino adults without diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cardiovascular diabetology. 2016;15(1):45.

Trivedi GY, Saboo B, Singh RB, Maheshwari A, Sharma K, Verma N. Can decreased heart rate unpredictability be a marker of autonomic dysfunction, metabolic syndrome and diabetes? Journal of Diabetology. 2019;10(2):48.

Hanefeld M, Engelmann K, Appelt D, Sandner D, Weigmann I, Ganz X, et al. Intra-individual unpredictability and circadian rhythm of vascular endothelial growth factors in subjects with normal glucose tolerance and type 2 diabetes. PloS one. 2017;12(10):e0184234.

Mokhtar RH, Masri MA, Kasim HH, Ayob A. The Clinical Significance of Circadian Rhythm and Blood Pressure Unpredictability. Malaysian Journal of Science Health & Technology. 2018;1(1).

Shen J, Li Z-M, He L-Z, Deng R-S, Liu J-G, Shen Y-S. Comparison of ambulatory blood pressure and clinic blood pressure in relation to cardiovascular diseases in diabetic patients. Medicine. 2017;96(33).

Rahman A, Hasan AU, Nishiyama A, Kobori H. Altered circadian timing system-mediated non-dipping pattern of blood pressure and associated cardiovascular disorders in metabolic and kidney diseases. International journal of molecular sciences. 2018;19(2):400.

Hao Z, Li G, Sun Y, Liu Y. Relationship and associated mechanisms between ambulatory blood pressure and clinic blood pressure with prevalent cardiovascular disease in diabetic hypertensive patients. Medicine. 2017;96(16).

Shim IK, Cho K-I, Kim H-S, Heo J-H, Cha TJ. Impact of gender on the association of epicardial fat thickness, obesity, and circadian blood pressure pattern in hypertensive patients. Journal of diabetes research. 2015;2015.

Hermida RC, Ayala DE, Fernández JR, Mojón A, Smolensky MH. Hypertension: new perspective on its definition and clinical management by bedtime therapy substantially reduces cardiovascular disease risk. European journal of clinical investigation. 2018;48(5):e12909.

Kulakov V, Starostina E, Troitskaya E, Villevalde S, Kobalava Z. [PP. 12.25] TREATMENT WITH AZILSARTAN MEDOXOMIL IMPROVED DIPPING STATUS IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS. Journal of Hypertension. 2017;35:e193.

Hermida RC, Ayala DE, Mojón A, Fernández JR. Bedtime ingestion of hypertension medications reduces the risk of new-onset type 2 diabetes: a randomised controlled trial. Diabetologia. 2016;59(2):255-65.

Lempiäinen PA, Vasunta R-L, Bloigu R, Kesäniemi YA, Ukkola OH. Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up. Blood pressure. 2019:1-9.

Mitu O, Roca M, Gurzu B, Magdalena M, Constantin L, Jitaru A, et al. Predictors of the blood pressure non-dipping profile in newly diagnosed hypertensive patients. 2016.

Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension. 2005;45(4):602-7.

Heo JH, Im Cho K, Lee JW, Kim HS, Im SI. RELATION OF BLOOD PRESSURE UNPREDICTABILITY AND OBESITY IN PATIENTS WITH HYPERTENSION DIAGNOSED WITH AMBULATORY BLOOD PRESSURE MONITORING. Journal of the American College of Cardiology. 2015;65(10 Supplement):A1401.

Yan B, Peng L, Han D, Sun L, Dong Q, Yang P, et al. Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients. Medicine. 2015;94(10).

Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Extreme dipping: is the cardiovascular risk increased? an unsolved issue. Journal of hypertension. 2019;37(10):1917-26.

Abdalla M, Caughey MC, Tanner RM, Booth III JN, Diaz KM, Anstey DE, et al. Associations of blood pressure dipping patterns with left ventricular mass and left ventricular hypertrophy in blacks: the Jackson Heart Study. Journal of the American Heart Association. 2017;6(4):e004847.

Bakris GL, Gaxiola E, Messerli FH, Mancia G, Erdine S, Cooper-DeHoff R, et al. Clinical outcomes in the diabetes cohort of the INternational VErapamil SR-Trandolapril study. Hypertension. 2004;44(5):637-42.

Lee TC, Cavalcanti RB, McDonald EG, Pilote L, Brophy JM. Diastolic hypotension may attenuate benefits from intensive systolic targets: Secondary analysis of a randomized controlled trial. The American journal of medicine. 2018;131(10):1228-33. e1.

Mace-Brickman T, Leduc W, Hiremath S, Ruzicka M, McCormick BB. Diastolic hypotension in a tertiary care hypertension clinic: have we gone too far? Canadian Journal of Cardiology. 2016;32(5):695-700.

Ruzicka M, Edwards C, McCormick B, Hiremath S. Thus far and no further: should diastolic hypotension limit intensive blood pressure lowering? Current treatment options in cardiovascular medicine. 2017;19(10):80.

Buda VA, Ciobanu DM, Roman G. Pulse pressure is more relevant than systolic and diastolic blood pressure in patients with type 2 diabetes and cardiovascular disease. Clujul Medical. 2018;91(4):408.

Nargesi AA, Esteghamati S, Heidari B, Hafezi-Nejad N, Sheikhbahaei S, Pajouhi A, et al. Nonlinear relation between pulse pressure and coronary heart disease in patients with type 2 diabetes or hypertension. Journal of hypertension. 2016;34(5):974-80.

Cardoso CR, Leite NC, Salles GC, Ferreira MT, Salles GF. Aortic stiffness and ambulatory blood pressure as predictors of diabetic kidney disease: a competing risks analysis from the Rio de Janeiro Type 2 Diabetes Cohort Study. Diabetologia. 2018;61(2):455-65.

Cuspidi C, Facchetti R, Bombelli M, Sala C, Tadic M, Grassi G, et al. Night-time heart rate nondipping: clinical and prognostic significance in the general population. Journal of hypertension. 2018;36(6)