Relationshipof 24-hour blood pressure profile to the durationof diabetes and to disturbances in renalhaemodynamics in hypertensive diabetic patients

Purpose: The aim of the study was: 1) to determine the 24-hour ambulatory blood pressure monitoring (ABPM) profiles in 437 hypertensive patients (36-60 yrs): 309 patients with diabetes mellitus (Gr.HD) and 128 patients without carbohydrate metabolism disturbance (Gr.H); 2) to examine the changes of ABPM pattern depending on diabetes duration; 3) to assess the potential role of ABPM parameters together with non-haemodynamic factors as determinants of the intrarenal vascular resistance.
Methods: The analysis of ABPM profiles in dependence of diabetes duration was performed in 128 specially formed. pairs of patients of Gr.H and Gr.HD who have the same duration of arterial hypertension . The comparison of ABPM parameters without examination of duration of disease was performed in 309 patients of Gr.HD, in 90 patients of Gr.H and in 34 healthy subjects. Renal blood flow velocities profiles was detected by duplex scanning and resistance index in the arcuate intrarenal arteries were calculated. 24-hour ambulatory BP recordings were performed using a SpaceLabs 90207 recorder. Plasma levels of the lipids, glucose and HbA₍ were estimated. Serum concentration of insulin, aldosterone, Cortisol and blood renin activity were measured by RIA method. All the investigated clinical, instrumental and laboratory parameters were included into the multiple linear regression analysis.
Results and conclusions: Compared with pts of Gr.H, pts of Gr.HD demonstrated marked indirect signs of neurogumoral activation and the insufficient decrease of nocturnal BP whereas patients of Gr.H showed higher level and prolonged
АРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯ ТОМ 14 № 1 2008 77
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diastolic hypertension at daytime. There was earlier increase in systolic BP variability, rate of morning systolic BP rise and formation of systolic BP circadian rhythm disturbance (in average 5-7yrs) in diabetic pts. Opposite to pts of Gr.H, disproportional increase of systolic BP was characteristic of diabetics already in 3-5yrs after clinical manifestation of the disease that resulted in higher level of nighttime pulse BP in average in 7yrs and of 24-h pulse BP - in 16yrs. In the final regression model that explained 40% variation of resistive index in the arcuate intrarenal arteries (adjusted multiple R2=0,3978), the most important determinants were nocturnal pulse BP (standardized coefficient beta=0,556, P<0,0001) and postprandial insulinemia (0,409, P=0,0001).

Twenty four hour ambulatory blood pressure monitoring , pulse BP , disturbance of circadian rhythm of blood pressure , intrarenal resistance , hypertension , diabetes mellitus

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