title: Blood pressure means rather than nocturnal dipping pattern are related to complications in Type 2 diabetic patients.
abstract: OBJECTIVE
  To determine whether systolic and diastolic blood pressure (BP) means, during ambulatory BP monitoring (ABPM), are more strongly correlated with microvascular complications and echocardiographic structural alterations than night-time/daytime (N/D) BP ratio.
  
  
  METHODS
  A cross-sectional study was conducted in 270 Type 2 diabetes mellitus (DM) outpatients who underwent clinical and laboratory investigations, urinary albumin excretion rate (UAER) determination, echocardiography, office and 24-h ABPM (Spacelabs 90207).
  
  
  RESULTS
  UAER, after multivariate adjustments, was associated with office BP (systolic: R(2)(a) 0.162, P < 0.001; diastolic: R(2)(a) 0.124, P < 0.001) and ABPM (24-h systolic: R(2)(a) 0.195, P < 0.001; 24-h diastolic: R(2)(a) 0.197, P < 0.001) but not with N/D BP ratios (systolic: R(2)(a) 0.062, P = 0.080; diastolic: R(2)(a) 0.063, P = 0.069). Similar results were observed for echocardiographic parameters. The presence of retinopathy was associated only with night-time BP values [systolic means: odds ratio (OR) 1.13, 95% confidence interval (CI) 1.03-1.24 and diastolic means: OR 1.21, CI 1.04-1.40 and N/D diastolic BP ratio > 0.90, OR 3.21, CI 1.65-6.25].
  
  
  CONCLUSIONS
  UAER and echocardiographic structural alterations had more consistent correlations of a greater magnitude with systolic BP means than with N/D BP ratios. The nocturnal BP values appear to be more relevant for diabetic retinopathy. BP measurement in patients with Type 2 DM should take into account the 24-h period rather than focusing on a specific time span of BP homeostasis.
authors.affiliation: Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. crisbleitao@yahoo.com.br
authors.forename: C B
authors.initials: CB
authors.lastname: Leitão
authors.forename: L H
authors.initials: LH
authors.lastname: Canani
authors.forename: C K
authors.initials: CK
authors.lastname: Kramer
authors.forename: M
authors.initials: M
authors.lastname: Moehlecke
authors.forename: L C
authors.initials: LC
authors.lastname: Pinto
authors.forename: E D
authors.initials: ED
authors.lastname: Ricardo
authors.forename: A F
authors.initials: AF
authors.lastname: Pinotti
authors.forename: J L
authors.initials: JL
authors.lastname: Gross
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged