Endocrine Abstracts

Background: The absence of blood pressure dip during sleep is a common disorder in patients on dialysis, especially those with diabetes. Non-dipping is clinically significant as a predictor of cardiovascular events and an overview of the situation is possible only during ambulatory blood pressure monitoring (AMP), especially during sleep.

Objective: Inversion of nighttime blood pressure is an indication of worse outcomes.

Methods: During our study, we examined 89 patients on hemodialysis (HD), of which 38 had diabetes and 51 did not. Hypertension was defined according to the guidelines of the European Society for Hypertension (ESH). The control group were 89 patients in the clinic for hypertension who were not dialysis patients, of which 35 had diabetes and 54 did not.

Results: Among the group of patients undergoing hemodialysis, 72% had unreguklated blood pressure. In the second group of patients who were not hemodialysis patients, 60% had unregulated blood pressure. Among the dialysis population, 71% had an inversion of blood pressure during nighttime, as opposed to 35% in the control group. In the control group, a nightly increase in blood pressure had 26% of diabetic patients and only 7% of patients who did not suffer from diabetes. Hemodialysis patients had higher median blood pressure, higher mean arterial pressure and higher pulse pressure. According to outcome, there were significant differences – none of the non-HD patients had died, nor did they have severe complications. In the HD group, 48 patients did not have complications, 24 had severe complications and 15 patients died.

Conclusion: HD patients with diabetes have a greater increase in blood pressure at night, have more complications and lethal outcomes compared to non-HD patients with diabetes. Causes are numerous, and diabetes is not the only factor of blood pressure inversion at night.