Some controversy still exists about factors involved in the abnormal circadian pattern of blood pressure (BP) in diabetes, while prognostic value of non-dipping condition is being increasingly recognised. This study was aimed at evaluating the relative influence of autonomic neuropathy (AN) and albumin excretion on 24-h BP profile in type I and type 2 diabetes. We measured AN cardiovascular tests, 24-h ambulatory BP, and urinary albumin excretion rate (UAE) in 47 type 1 and 34 type 2 normotensive non-proteinuric diabetic patients. In type I diabetic patients day-night differences (Delta) in systolic and diastolic BP were lower in those with AN than in those without (3 +/- 9 vs 10 +/- 6%, P < 0.01, and 8 <plus/minus> 9 vs 16 +/- 6%, P < 0.001), and in univariate regression analysis they were inversely related to both autonomic score, index of degree of AN (r = -0.61, P < 0.001 and r = -0.65, P <0.001), and to 24-h UAE (r = -0.39, P < 0.01 and r = -0.46, P < 0.001). In type 1 diabetic patients AN was also associated with lower nocturnal decrease in UAE (patients with AN vs without AN: -37 <plus/minus> 214 vs 49 +/- 37%, P < 0.05), and with a stronger relationship between simultaneous 24-h UAE and 24-h BP (for systolic BP patients with AN vs without AN: r = 0.62, P < 0.01 vs r = 0.28, NS). In type 2 diabetic patients Delta systolic BP was reduced in patients with AN compared to those without (4 +/- 7 vs 10 +/- 4%, P < 0.01), and it was related only to autonomic score (r = -0.42, P r 0.01). Using a stepwise regression analysis, in type 1 diabetic patients autonomic score was the variable of primary importance for <Delta> BP, while in type 2 diabetic patients it was the unique determinant not only of Delta systolic EP but also of 24-h systolic BP. in conclusion, AN is the pivotal factor of blunted nocturnal fall In BP in both type 1 and type 2 diabetic patients. In type 1 diabetic patients AN is associated with attenuated circadian pattern of albuminuria and with a steeper relationship between albuminuria and BP, in type 2 diabetic patients AN is the only factor related to elevated 24-h BP levels. Longitudinal studies are needed to establish the potential role of autonomic dysfunction as a progression promoter for nephropathy and hypertension in type 1 and type 2 diabetes respectively.

Spallone, V., Maiello, M.r., Cicconetti, E., Pannone, A., Barini, A., Gambardella, S., et al. (2001). Factors determining the 24-h blood pressure profile in normotensive patients with type 1 and type 2 diabetes. JOURNAL OF HUMAN HYPERTENSION, 15(4), 239-246.

Factors determining the 24-h blood pressure profile in normotensive patients with type 1 and type 2 diabetes

SPALLONE, VINCENZA;GAMBARDELLA, SERGIO;MENZINGER DI PREUSSENTHAL, GUIDO ENRICO
2001-04-01

Abstract

Some controversy still exists about factors involved in the abnormal circadian pattern of blood pressure (BP) in diabetes, while prognostic value of non-dipping condition is being increasingly recognised. This study was aimed at evaluating the relative influence of autonomic neuropathy (AN) and albumin excretion on 24-h BP profile in type I and type 2 diabetes. We measured AN cardiovascular tests, 24-h ambulatory BP, and urinary albumin excretion rate (UAE) in 47 type 1 and 34 type 2 normotensive non-proteinuric diabetic patients. In type I diabetic patients day-night differences (Delta) in systolic and diastolic BP were lower in those with AN than in those without (3 +/- 9 vs 10 +/- 6%, P < 0.01, and 8 9 vs 16 +/- 6%, P < 0.001), and in univariate regression analysis they were inversely related to both autonomic score, index of degree of AN (r = -0.61, P < 0.001 and r = -0.65, P <0.001), and to 24-h UAE (r = -0.39, P < 0.01 and r = -0.46, P < 0.001). In type 1 diabetic patients AN was also associated with lower nocturnal decrease in UAE (patients with AN vs without AN: -37 214 vs 49 +/- 37%, P < 0.05), and with a stronger relationship between simultaneous 24-h UAE and 24-h BP (for systolic BP patients with AN vs without AN: r = 0.62, P < 0.01 vs r = 0.28, NS). In type 2 diabetic patients Delta systolic BP was reduced in patients with AN compared to those without (4 +/- 7 vs 10 +/- 4%, P < 0.01), and it was related only to autonomic score (r = -0.42, P r 0.01). Using a stepwise regression analysis, in type 1 diabetic patients autonomic score was the variable of primary importance for BP, while in type 2 diabetic patients it was the unique determinant not only of Delta systolic EP but also of 24-h systolic BP. in conclusion, AN is the pivotal factor of blunted nocturnal fall In BP in both type 1 and type 2 diabetic patients. In type 1 diabetic patients AN is associated with attenuated circadian pattern of albuminuria and with a steeper relationship between albuminuria and BP, in type 2 diabetic patients AN is the only factor related to elevated 24-h BP levels. Longitudinal studies are needed to establish the potential role of autonomic dysfunction as a progression promoter for nephropathy and hypertension in type 1 and type 2 diabetes respectively.
apr-2001
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/13 - ENDOCRINOLOGIA
English
Con Impact Factor ISI
autonomic dysfunction; autonomic neuropathy; blood pressure monitoring; circadian rhythm; diabetes mellitus; Albuminuria; Blood Pressure;
http://www.nature.com/jhh/journal/v15/n4/abs/1001170a.html
Spallone, V., Maiello, M.r., Cicconetti, E., Pannone, A., Barini, A., Gambardella, S., et al. (2001). Factors determining the 24-h blood pressure profile in normotensive patients with type 1 and type 2 diabetes. JOURNAL OF HUMAN HYPERTENSION, 15(4), 239-246.
Spallone, V; Maiello, Mr; Cicconetti, E; Pannone, A; Barini, A; Gambardella, S; MENZINGER DI PREUSSENTHAL, Ge
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/53765
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