[A circadian profile of arterial pressure in hypertensive patients with diabetes mellitus: relation with affected renal circulation].
OBJECTIVE
To study a circadian profile of blood pressure (BP) in normotensive patients with diabetes mellitus type 2 (DM-2) and hypertensive patients with DM-2; to examine BP circadian rhythm disorders for correlation with dopplerographic indices of intrarenal blood circulation.


METHODS
A total of 35 normotensive diabetics and 309 hypertensive diabetics were examined. Control groups consisted of 90 patients with essential hypertension (EH) and normal carbohydrate tolerance (CT) and 34 healthy subjects, respectively. Patients with hypertension and DM-2 and EH patients had no differences by duration of hypertension and office BP. The following methods of examination were used: outpatient 24-h BP monitoring, tests for glycemia, insulinemia and microalbuminuria (MAU), duplex scanning with colour impulse doppler mapping of blood flow in the arcuate intrarenal arteries to measure intrarenal resistance.


RESULTS
A circadian BP profile in normotensive diabetics is characterized by insufficient fall of nocturnal BP and indirect signs of neurohumoral hyperactivation--high mean diurnal variability and morning rise of systolic BP. Hypertensive diabetics had more pronounced neurohumoral hyperactivation, lower drop of nocturnal BP. EH patients with normal CT had higher and longer diastolic diurnal hypertension. In combination of hypertension with DM-2 pulse blood pressure (PBP) rises earlier, in duration of hypertension up to 10 years nocturnal PBP rise was more pronounced. Circadian PBP rose significantly later.


CONCLUSIONS
Stepwise regression analysis has revealed that a nocturnal PBP rise in line with postprandial insulinemia contributes significantly to growth of intrarenal vascular resistance in combination of hypertension with DM-2.
Karpov
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Koshel'skaia
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D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012079:Renal Circulation / Q000502:physiology*; D012720:Severity of Illness Index; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance / Q000502:physiology