Pulse pressure and diurnal blood pressure variation: Association with micro- and macrovascular complications in type 2 diabetes

被引:78
作者
Knudsen, ST [1 ]
Poulsen, PL
Hansen, KW
Ebbehoj, E
Bek, T
Mogensen, CE
机构
[1] Aarhus Kommune Hosp, Med Dept M Diabet & Endocrinol, DK-8000 Aarhus C, Denmark
[2] Aarhus Kommune Hosp, Eye Dept, DK-8000 Aarhus C, Denmark
关键词
diabetic retinopathy; diabetic nephropathy; macrovascular disease; circadian blood pressure variation; pulse pressure; type; 2; diabetes;
D O I
10.1016/S0895-7061(01)02281-6
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Background: In nondiabetic subjects pulse pressure (PP) is an independent predictor of cardiovascular disease and microalbuminuria. Reduced circadian blood pressure (BP) variation is a potential risk factor for the development of diabetic complications. We investigated the association between retinopathy, nephropathy, macrovascular disease, PP, and diurnal BP variation in a group of type 2 diabetic patients. Methods: In 80 type 2 diabetic patients we performed 24-h ambulatory BP (AMBP) and fundus photographs. Urinary albumin excretion was evaluated by urinary albumin/creatinine ratio. Presence or absence of macrovascular disease was assessed by an independent physician. Results: Forty-nine patients had no detectable retinal changes (grade 1), 13 had grade 2 retinopathy, and 18 had more advanced retinopathy (grades 3-6). Compared to patients without retinopathy (grade 1), patients with grades and 3-6 had higher PP and blunted diurnal BP variation: night PP 55 +/- 10 mm Hg, 64 +/- 10 mm Hg, 61 +/- 15 mm Hg, P < .05 and systolic night/day ratio 89.3% +/- 7%, 94.6% +/- 8%. and 92.0% +/- 6%, P < .05 (grade 1, 2, and 3-6, respectively). Comparing nephropathy groups (45 normo-, 19 micro-. and 15 macroalbuminuric patients) results were similar: night PP 54 +/- 9 mm Hg, 57 +/- 10 mm Hg, and 70 +/- 15 mm Hg, P < .001 and systolic night/day ratio 88.9% +/- 7%, 92.0% +/- 7%, and 94.9% +/- 7%, P < .02. Likewise, compared to patients without macrovascular disease (n = 55), patients with this complication (n = 15) had higher AMBP values: night PP 57 +/- 12 mm Hg v 63 +/- 11 mm Hg, P < .05 and systolic night/day ratio 89.2% +/- 6% v 94.1% +/- 9%, P < .01. Conclusions: Increased PP and blunted diurnal BP variation are hemodynamic abnormalities associated with micro- and macrovascular complications in type 2 diabetes. Am J Hypertens 2002;15:244-250 (C) 2002 American Journal of Hypertension, Ltd.
引用
收藏
页码:244 / 250
页数:7
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