Endocrine Abstracts

Introduction: Elevated blood pressure levels are more frequently observed in diabetic patients, than in the general population. Ambulatory blood pressure monitoring (ABPM) is better correlated with target organ damage from hypertension (HT) than clinic blood pressure readings. The correlation between ABPM and urinary albumin excretion rate (UAER) in diabetes mellitus (DM) has been found to be stronger than the correlation between clinic blood pressure (BP) and UAER.

Aim: To investigate the relation between echocardiographic parameters and 24-h ABPM in normoalbuminuric pre-hypertensive diabetic patients, without clinical evidence of nephropathy or cardiovascular autonomic neuropathy.

Methods: In our study have been enrolled 40 adult patients, 20 of them diagnosed with type 1 DM (T1DM) and 20 others with type 2 DM (T2DM). They categorized as dippers and non-dippers on the basis of 24-h ambulatory blood pressure measurement and their echocardiographic parameters were compared. An oscillometric portable monitor took 24-h BP measurements automatically. A comprehensive echocardiographic evaluation was performed focusing on the left ventricular (LV) dimensions, LV mass index (LVMI), relative wall thickness (RWT), left atrial (LA) dimension and LV ejection fraction.

Results: Of the 20 T1DM pre-hypertensive patients, 9 were categorized as dippers and 11 as non-dippers, while of the 20 T2DM pre-hypertensive patients, 12 were categorized as dippers and 8 as non-dippers. There were no differences between the dippers and the non-dippers T1DM pre-hypertensive patients about the age, gender, body mass index (BMI) and clinical and ABPM for average day-time systolic and diastolic blood pressure levels. According to type 2 diabetic pre-hypertensive patients, there were differences about all above parameters. LV internal diameters, LV septal and posterior wall thicknesses, LV ejection fraction (LVEF) were all similar in both groups. Left atrial diameter and LVMI were found higher in the non-dippers diabetic patients. RWT resulted higher in the non-dippers patients.

Conclusion: Among pre-hypertensive normoalbuminuric diabetic patients evaluated by ABPM, echocardiographic parameters disorders resulted more frequent in T2DM. The most important conclusion of this study was that non-dippers had higher LVMI and left atrial dimensions compared with dippers. This may be a predictor of worse long term cardiovascular outcomes in non-dippers.