title: Circadian blood pressure variation in patients with type 2 diabetes--relationship to macro- and microvascular subclinical organ damage.
abstract: OBJECTIVE
  To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes.
  
  
  METHODS
  Cross-sectional data from 663 patients with type 2 diabetes, aged 55-66 years, were analysed. Nurses measured office BP and ambulatory BP during 24h. Individuals with ≥ 10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries.
  
  
  RESULTS
  We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p<0.001).
  
  
  CONCLUSIONS
  We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Pär E son
authors.initials: PE
authors.lastname: Jennersjö
authors.forename: Magnus
authors.initials: M
authors.lastname: Wijkman
authors.forename: Ann-Britt
authors.initials: AB
authors.lastname: Wiréhn
authors.forename: Toste
authors.initials: T
authors.lastname: Länne
authors.forename: Jan
authors.initials: J
authors.lastname: Engvall
authors.forename: Fredrik H
authors.initials: FH
authors.lastname: Nystrom
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Östgren
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology / Q000503:physiopathology; D001011:Aorta / Q000503:physiopathology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002339:Carotid Arteries / Q000503:physiopathology; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008365:Manometry; D008833:Microcirculation; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden