Circadian rhythm of blood pressure in normotensive NIDDM subjects. Its relationship to microvascular complications.
OBJECTIVE
To investigate the relationship between circadian rhythm of mean blood pressure (MBP) and microvascular complications in non-insulin-dependent diabetes mellitus (NIDDM) subjects.


METHODS
Seventy-six normotensive NIDDM subjects without azotemia were studied under ordinary hospital conditions with a noninvasive ambulatory blood pressure monitoring device. Time series data were analyzed by the cosinor method.


RESULTS
Fifty-four subjects had a circadian MBP rhythm similar to that of 34 age-matched nondiabetic control subjects, with a peak value in the afternoon (group 1). In contrast, 22 had a reversed circadian MBP rhythm, with a peak value during the night (group 2). Obvious complications were found in 65% of group 1 and in all of group 2. The prevalence of retinopathy and somatic neuropathy and the degree of retinopathy were similar in the two groups. The prevalence and degree of autonomic neuropathy (postural hypotension and reduced beat-to-beat heart-rate variation) and nephropathy were greater in group 2 than group 1. Linear discriminant analysis revealed a correlation between the reversed circadian MBP rhythm and postural hypotension (F = 32.2, P less than 0.001) and overt nephropathy (F = 5.1, P less than 0.05) but not with beat-to-beat heart-rate variation (F = 0.17, NS).


CONCLUSIONS
These results suggest that in the hospitalized normotensive NIDDM subjects, there are normal and reversed circadian MBP rhythms and that the reversal of normal circadian MBP rhythm may be related to the degree of postural hypotension and/or nephropathy.
Nakano
S
S
Department of Internal Medicine, Kanazawa Medical University, Ishikawa, Japan.
Uchida
K
K
Kigoshi
T
T
Azukizawa
S
S
Iwasaki
R
R
Kaneko
M
M
Morimoto
S
S
D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002940:Circadian Rhythm; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012016:Reference Values; D012964:Sodium / Q000097:blood
D001786:Blood Glucose; D003404:Creatinine; D006442:Glycated Hemoglobin; D011188:Potassium; D012964:Sodium