Ambulatory blood pressure and diabetes: targeting nondipping.
A reduced fall in nocturnal blood pressure (BP) (i.e. non-dipping) has been related to an increase in target organ damage and cardiovascular (CV) events. Numerous studies have shown that non-dipping is highly prevalent in patients with type 1 and 2 diabetes mellitus. In this paper we reviewed recent literature and our personal data on the prevalence and clinical correlates of abnormal diurnal BP rhythm in diabetic patients; in particular we examined the association of this condition with renal, cardiac, and vascular pre-clinical organ damage as well as CV prognosis. A consistent body of evidence based on cross-sectional and longitudinal studies indicates that the lack of the physiologic nocturnal fall in BP may be considered a true clinical trait, a reliable marker of preclinical CV and renal disease and an independent predictor of future CV events. Thus, in the diabetic setting ambulatory BP monitoring (ABPM) should be regarded as a pivotal tool for improving CV risk stratification and therapeutic interventions.
Cuspidi
Cesare
C
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy. cesare.cuspidi@unimib.it
Vaccarella
Alvaro
A
Leonetti
Gastone
G
Sala
Carla
C
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult