Journal Article

Is there an association between non-dipping blood pressure and measures of glucose variability in type 1 diabetes?

Jaiswal, Mamta, Mizokami-Stout, Kara, Ang, Lynn, Pop-Busui, Rodica

2018

Overview

To assess the relationship between glucose variability (GV) and non-dipping of blood pressure (BP) as a marker of cardiovascular autonomic neuropathy (CAN) among patients with type 1 diabetes (T1D). Forty-one subjects with T1D (age 34 ± 13 years, duration 13 ± 6 years, HbA1c 8 ± 1.2%) without cardiovascular disease, dyslipidemia, or hypertension at baseline were enrolled in a 3-year observational cohort study. Subjects were phenotyped for CAN with heart rate variability, cardiovascular autonomic reflex tests, and 24-h BP profiles at baseline and during follow-up. Non-dipping was defined as nocturnal systolic and diastolic BP fall of ≤10%. Reverse dipping BP was defined as a <0% change in the day to night for systolic and diastolic BP. Indices of GV were derived from 5-day continuous glucose monitoring obtained at 3-month intervals, and serum inflammatory biomarkers in all subjects. At baseline 10% of the T1D subjects were non-dippers. The dippers and non-dippers were similar in age, diabetes duration, glucose control, traditional cardiovascular risk factors, GV and inflammatory markers. No significant correlations were found at baseline between non-dipping nocturnal blood pressure and measures of GV. At 3 years there were no differences in risk factor profile of subjects who were non-dippers over time (progressors) and those who were dippers (non-progressors). In a cohort of contemporary patients with T1D following the current standard of care in diabetes, the prevalence of non-dipping is relatively low. There were no clear phenotypes that explained the difference in the risk for non-dipping, including GV. Ambulatory blood pressure monitoring could be used as a tool for improved CVD risk stratification and development of therapeutic interventions in these patients.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Age / Autonomic Nervous System - physiopathology / Autonomic Nervous System Diseases - blood / Autonomic Nervous System Diseases - etiology / Autonomic Nervous System Diseases - physiopathology / Biomarkers / Blood Glucose - analysis / Blood Glucose - metabolism / Blood Glucose Self-Monitoring / Blood pressure / Blood Pressure - physiology / Blood Pressure Monitoring, Ambulatory / Blood pressure variability / Cardiovascular autonomic neuropathy / Cardiovascular Diseases - blood / Cardiovascular Diseases - complications / Cardiovascular Diseases - epidemiology / Cardiovascular Diseases - physiopathology / Cohort Studies / Diabetes / Diabetes Mellitus, Type 1 - blood / Diabetes Mellitus, Type 1 - complications / Diabetes Mellitus, Type 1 - epidemiology / Diabetes Mellitus, Type 1 - physiopathology / Diabetic Angiopathies - blood / Diabetic Angiopathies - epidemiology / Diabetic Angiopathies - physiopathology / Diabetic Neuropathies - blood / Diabetic Neuropathies - epidemiology / Diabetic Neuropathies - physiopathology / Female / Glucose monitoring / Glucose variability / Humans / Hyperglycemia / Hypertension / Hypertension - blood / Hypertension - diagnosis / Hypertension - epidemiology / Hypertension - etiology / Hypoglycemia / Male / Middle Aged / Mortality / Non-dipping blood pressure / Risk Factors / Triglycerides / Tumor necrosis factor-TNF / Type 1 diabetes / Young Adult