Nightly BP increase associated with increasing mortality risk in adults with diabetes
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Among adults with diabetes, increasing BP at night was associated with an almost doubled increase in mortality risk, according to new results presented at the American Heart Association’s Hypertension Scientific Sessions.
“Previous studies have shown that nondipping is linked to kidney and cardiovascular disease in healthy individuals and in people with hypertension or type 1 or type 2 diabetes,” Martina Chiriacò, MD, investigator in the department of clinical and experimental medicine at the University of Pisa, Italy, said in a press release. “However, the long-term effects of nondipping on death among people with diabetes remains unclear, and information on reverse dippers is extremely scarce.”
The study included 349 patients (mean age, 57 years; 52% women) with type 1 (n = 65) or type 2 (n = 284) diabetes from Pisa, Italy. All patients had available 24-hour ambulatory BP and heart rate variability monitoring. Researchers defined dipping BP as a 10% or more decline, nondipping BP as a less than 10% decline and reverse dipping BP as a 0.1% or more increase in average nightly systolic BP compared with average daytime systolic BP. Median follow-up was 21 years.
During the study period, 39% of patients died, whereas 166 patients were categorized as BP dippers, 144 as nondippers and 39 as reverse BP dippers.
Nondippers and reverse dippers, compared with dippers, demonstrated a progressively higher prevalence of cardiac autonomic neuropathy (16% and 31%, respectively vs. 11%), low heart rate variability (53% and 62% vs. 45%), 24-hour hypertension (60% and 67% vs. 40%), isolated nocturnal hypertension (27% and 49% vs. 5%), postural hypotension (26% and 43% vs. 14%) and a lower prevalence of white-coat hypertension (17% and 13% vs. 31%).
Compared with dippers, nondippers and reverse dippers demonstrated a progressively lower overall mean survival after baseline (18.6 years vs. 17.5 and 16.1 years, respectively). In addition, after adjusting for age, sex, BMI, office systolic BP, plasma glucose and diabetes duration and type, reverse dippers had increased risk for all-cause mortality (HR = 2.3; 95% CI, 1.4-3.8).
Those with low heart rate variability demonstrated a reduced mean overall survival compared with those with higher heart rate variability (16.9 vs. 18.8). However, these patients demonstrated a similar adjusted risk for death compared with those with high heart rate variability (HR = 1.3; 95% CI, 0.9-1.9).
Researchers observed no significant interactions between BP patterns, heart rate variability and diabetes type on overall survival.
“It is important that health care professionals look for abnormal blood pressure dipping patterns in people with type 1 or type 2 diabetes,” Chiriacò said. “There are strategies to reduce blood pressure during the night.”
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Chiriacò M, et al. Presentation T1. Presented at: American Heart Association’s Hypertension Scientific Sessions; Sept. 27-29, 2021 (virtual meeting).
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