Predictors of mortality in patients with type 2 diabetes with or without diabetic nephropathy: a follow-up study

被引:88
作者
Astrup, Anne Sofie
Nielsen, Flemming S.
Rossing, Peter
Ali, Samir
Kastrup, Jens
Smidt, Ulla Meng
Parving, Hans-Henrik
机构
[1] Steno Diabet Ctr, DK-2820 Gentofte, Denmark
[2] Rigshosp, Dept Cardiol, DK-2100 Copenhagen, Denmark
[3] Rigshosp, Univ Copenhagen Hosp, Dept Med Endocrinol, DK-2100 Copenhagen, Denmark
[4] Aarhus Univ, Fac Hlth Sci, Aarhus, Denmark
关键词
D O I
10.1097/HJH.0b013e3282f06428
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Objective To evaluate the prognostic significance of cardiovascular risk factors including 24-h ambulatory blood pressure level and rhythm for all-cause mortality in type 2 diabetic patients. Methods In a prospective observational study, 104 patients with type 2 diabetes were followed: 51 patients with diabetic nephropathy and 53 patients with persistent normoalbuminuria. At baseline, 24-h ambulatory blood pressure, left ventricular hypertrophy, glomerular filtration rate and cardiac autonomic neuropathy were measured. Blood samples were taken and patients answered a World Health Organization questionnaire. Dipping was calculated as the average nocturnal reduction in systolic and diastolic blood pressure. Results Mean follow-up was 9.2 years (range 0.5-12.9). During follow-up, 54 of 104 patients died. Sixteen patients (15%) had higher blood pressure at night than during the day (reversed pattern); 14 of these patients died (88%), compared to 40 of 88 patients (45%) with reduced dipping or normal dipping; log rank P = 0.001. In a Cox regression analysis, predictors of all-cause mortality were: age, male sex, presence of left ventricular hypertrophy, glycated haemoglobin A(1c) (HbA(1c)), daytime systolic blood pressure, cardiac autonomic neuropathy, glomerular filtration rate and dipping (1% increase; hazard ratio 0.97, 95% confidence interval 0.94-0.998, P=0.033). Conclusion Type 2 diabetes patients with non-dipping of night blood pressure were at higher risk of death as compared to dippers, independent of known cardiovascular risk factors. Since non-dipping has a high prevalence in patients with diabetic nephropathy, 24-h ambulatory blood pressure should be used to assess a full risk profile and blood pressure-lowering therapy in these patients.
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页码:2479 / 2485
页数:7
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