title: Night time blood pressure variability is a strong predictor for cardiovascular events in patients with type 2 diabetes.
abstract: BACKGROUND
  We aimed this study to test the hypothesis that short-term blood pressure (BP) variability and abnormal patterns of diurnal BP variation, evaluated by ambulatory BP (ABP), predicts risk of incident cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM).
  
  
  METHODS
  ABP monitoring (ABPM) was performed in 300 patients with uncomplicated T2DM without known CVD and without BP medications, who were followed for 54 +/- 20 months. The relationships of different measures of BP variability, the presence of abnormal patterns of diurnal BP variation (nondipper, riser, or morning BP surge) and the standard deviations of awake and asleep ABP were determined. Cox proportional hazards models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) before and after controlling for various covariates.
  
  
  RESULTS
  The mean age was 67.8 +/- 9.6 years, 48% were male, 253 (84%) had a diagnosis of hypertension, and the mean of the standard deviations of awake systolic BP/diastolic BP (SBP/DBP) were 18 +/- 6/11 +/- 4 mm Hg, and those of sleep SBP/DBP were 13 +/- 5/9 +/- 3 mm Hg. During follow-up, there were 29 cardiovascular events. In multivariable analyses, the standard deviations of sleep SBP (HR = 1.08; 95% CI, 1.01-1.16, P < 0.05) and sleep DBP (HR = 1.13; 1.04-1.23, P < 0.01) were independently associated with incident CVD. Neither the nondipper and riser patterns nor the morning BP surge were associated with incident CVD events independently of clinic and 24-h BP levels.
  
  
  CONCLUSIONS
  Abnormal diurnal BP variation was not a predictor of CVD in patients with T2DM. Night time BP variability was an independent predictor of future incidence of CVD, suggesting that this measure could reflect pathophysiology of T2DM.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan. ke112@jichi.ac.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Eguchi
authors.forename: Joji
authors.initials: J
authors.lastname: Ishikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Pickering
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000368:Aged; 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 / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*