Endocrine Abstracts

Introduction: Arterial hypertension is a major risk factor for micro- and macrovascular complications in type 2 diabetes. Several factors are known to influence blood pressure profile in diabetic patients, such as age, sex, body weight, diabetes duration, insulin dosage, metabolic control, and microalbuminuria. Ambulatory blood pressure monitoring (ABPM) permits the observation of blood pressure throughout day and night. ABPM is better related to end organ damage and cardiovascular morbidity from hypertension than office blood pressure readings. We used our database to study risk factors for abnormal 24-h blood pressure regulation and microalbuminuria in type 2 diabetic patients.

Methods: ABPM was performed in 102 diabetics. Individual least median squares (LMS)-SDSs were calculated for diurnal and nocturnal systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure according to normalized values. The nocturnal blood pressure reduction (dipping) was calculated for SBP as well as DBP.

Results: In diabetics, NBP in particular was significantly elevated (SBP +0.51, DBP +0.58, MAP +0.80 LMS-SD) and dipping of SBP, DBP, and MAP was significantly reduced (P<0.0001). Age, diabetes duration, sex BMI, A1C, and insulin dose were related to altered blood pressure profiles; dipping, however, was only affected by age, female sex, and A1C. The presence of microalbuminuria was associated with nocturnal DBP (P<0.0001) and diastolic dipping (P<0.01).

Conclusions: Our observations revealed a clear link between the quality of metabolic control and altered blood pressure regulation even in patients with short diabetes duration. Nocturnal blood pressure in particular seems to mainly contribute to diabetes complications such as microalbuminuria.