title: The importance of night-time systolic blood pressure in diabetic patients: Dublin Outcome Study.
abstract: OBJECTIVE
  Diabetic patients exhibit a higher cardiovascular risk compared to people without diabetes. The use of ambulatory blood pressure monitoring (ABPM) is gaining popularity in this population. Night-time SBP has consistently been shown to be a potent predictor of cardiovascular risk in the normal population. We studied the predictive value of night-time ABPM in a cohort of diabetic patients.
  
  
  METHODS
  At baseline, when not on antihypertensive medication, 11 291 patients (5326 men, mean age 54.6 years) underwent ABPM. Using a computerized national registry of death, mortality outcome was ascertained. Among 859 diabetic patients with a mean follow-up of 5.3 years, there were 74 deaths.
  
  
  RESULTS
  Compared to people without diabetes, those with diabetes had daytime and night-time SBP of 146.4 vs. 145.1 (P = NS) and 131.2 vs. 126.4  mmHg (P < 0.0001), respectively. As a consequence, more diabetic patients had a non-dipping night-time SBP profile (47.4 vs. 35.5%; P =  < 0.0001). In a Cox proportional-hazards model, night-time SBP was an independent predictor of cardiovascular mortality in diabetic patients after adjustment for sex, age, smoking history, previous cardiovascular events, BMI and daytime SBP. The resultant hazard ratio for a 10-mmHg increase in night-time SBP for total cardiovascular, stroke and cardiac mortality was 1.32 (1.12-1.69), 1.95 (1.18-3.20) and 1.24 (0.99-1.56), respectively.
  
  
  CONCLUSIONS
  Night-time SBP is a significant predictor of cardiovascular mortality in patients with diabetes.
authors.affiliation: aInstitute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK bDepartment of Endocrinology and Diabetes Mellitus, Connolly Hospital, Blanchardstown, Dublin 15 cDepartment of Medicine for Elderly, Connolly Hospital, Blanchardstown, Dublin 15 dConway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.
authors.forename: Mohd S
authors.initials: MS
authors.lastname: Draman
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Lelane
authors.initials: L
authors.lastname: van der Poel
authors.forename: Tommy Kyaw
authors.initials: TK
authors.lastname: Tun
authors.forename: John H
authors.initials: JH
authors.lastname: McDermott
authors.forename: Seamus
authors.initials: S
authors.lastname: Sreenan
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents