Trandolapril restores circadian blood pressure variation in normoalbuminuric normotensive type 1 diabetic patients

A large proportion, From 30% to 50%, of diabetic patients frequently manifests loss of the normal diurnal variation of blood pressure, i.e. their blood pressure does not show at least 10% fall at night (non-dippers). It has been demonstrated that non-dippers are at increased risk of end-organ damage, in particular, renal and cardiovascular complications. As no reliable means of reversing impaired blood pressure variation has been established so far, we aimed at assessing the effect of a long-acting angiotensin-converting enzyme (ACE) inhibitor trandolapril on the disturbed circadian blood pressure rhythm in diabetics without hypertension or nephropathy. A total of 18 type 1 diabetes patients (8 male, 10 female), aged 33.5 +/- 4.8, with duration of diabetes 5.8 +/- 2.8 years and HbA(1c), 6.6 +/- 0.4% (range 5.8-7.1%) were enrolled into the study. Ten well-matched type 1 diabetes patients served as an untreated control group. Twenty-four-hour ambulatory blood pressure measurements (ABPM) were performed thrice in each subject: before trandolapril, 2 mg once daily in the morning, was started; after the first dose of the drug; and after 2 weeks of the treatment. Mean (+/- S.D.) values of systolic, diastolic blood pressure, night fall in systolic, and diastolic blood pressure in the treatment group were (1) at baseline: 124.0 +/- 5.8 mm Hg, 89.3 +/- 4.2 mm Hg, 3.0 +/- 2.2%, 5.1 +/- 3.8%; (2) after the first dose: 16.1 +/- 7.6 mm Hg (P <.01 vs. baseline), 82.6 <plus/minus> 6.7 mm Hg (P <.01 vs. baseline), 4.2 <plus/minus> 2.6%, 4.7 +/- 2.5%; and (3) after 14-day treatment: 116.6 +/- 8.1 mm Hg (P<.01 vs. baseline), 76.9 <plus/minus> 9.6 mm Hg (P <.01 vs. baseline), 17.6 <plus/minus> 6.9% (P <.01 vs. baseline and after 24-h values), 19.4 <plus/minus> 8.0% (P <.01 vs, baseline and after 24-h values), respectively. ABPM results for the untreated controls were similar in all three measurements. In conclusion, within 14 days of trandolapril treatment, circadian blood pressure variation was successfully restored in normoalbuminuric normotensive insulin-dependent diabetic patients. <(c)> 2001 Elsevier Science Inc. All rights reserved.