title: Nighttime blood pressure, nighttime glucose values, and target-organ damages in treated type 2 diabetes patients.
abstract: OBJECTIVE
  The associations between nighttime blood pressure (BP) and cardiovascular risk are well established. However, the associations between nighttime glucose values, including nocturnal hypoglycemia, and cardiovascular risk in diabetes remain unclear.
  
  
  METHODS
  In this cross-sectional study of 49 treated type 2 diabetes patients (mean, 67.3 years; 61.0% men; mean treatment duration, 9.4 years), we performed 24-h continuous glucose monitoring simultaneously with BP monitoring, and evaluated several target-organ damages (echocardiographic left ventricular mass index [LVMI], urinary albumin excretion [UAE], carotid-artery intima-media thickness [IMT], and brachial-ankle pulse wave velocity [baPWV]).
  
  
  RESULTS
  Nighttime average systolic BP values were independently associated with the extent of LVMI, log-transformed UAE, or baPWV (all P < 0.05). In contrast, nighttime average glucose values, rather than daytime glucose values or glucose variability, were independently associated with the extent of common carotid-artery IMT (CCA-IMT) or baPWV (all P < 0.05). We divided the study participants into 3 groups according to the nighttime glucose values (a group with nighttime average glucose values <161 mg/dl [reference], a group with nocturnal hypoglycemia [<70 mg/dl at least one point during sleep], and a group with nighttime average glucose values ≥161 mg/dl), and compared the extent of target-organ damages among them. Patients with nighttime average glucose values ≥161 mg/dl, but not those with nocturnal hypoglycemia, had the highest values of CCA-IMT or baPWV among the 3 groups, and the differences remained significant even after adjustment for covariates (both trend P < 0.05 by ANCOVA).
  
  
  CONCLUSIONS
  Among treated type 2 diabetes, high nighttime BP and/or glucose values were associated with a high degree of cardiovascular remodeling.
authors: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. yyano@jichi.jp
authors: Yuichiro
authors: Y
authors: Yano
authors: Manabu
authors: M
authors: Hayakawa
authors: Kazuo
authors: K
authors: Kuroki
authors: Hiroaki
authors: H
authors: Ueno
authors: Sho-ichi
authors: S
authors: Yamagishi
authors: Masayoshi
authors: M
authors: Takeuchi
authors: Takuma
authors: T
authors: Eto
authors: Naoto
authors: N
authors: Nagata
authors: Masamitsu
authors: M
authors: Nakazato
authors: Kazuyuki
authors: K
authors: Shimada
authors: Kazuomi
authors: K
authors: Kario
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D002940:Circadian Rhythm; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D007003:Hypoglycemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012307:Risk Factors
chemical_list: D001786:Blood Glucose