Cabezas-Cerrato Jose, Hermida Ramon Carmelo, Cabezas-Agricola Jose Manuel, Ayala Diana Elva
Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
Chronobiol Int. 2009 Jul;26(5):942-57. doi: 10.1080/07420520903044448.
This study was designed to investigate potential factors involved in the disruption of the circadian blood pressure (BP) pattern in diabetes mellitus, as well as the relation between BP, cardiac autonomic neuropathy, and estimated cardiovascular risk. We studied 101 diabetic patients (58% with type 2 diabetes; 59% men), age 21-65 yrs, evaluated by 48 h BP monitoring. We performed three autonomic tests in a single session: deep breathing, Valsalva maneuver, and standing up from a seated position. Patients were classified according to the number of abnormal tests and their 10 yr risk of coronary heart disease or stroke. The prevalence of non-dipping 24 h patterning ranged from 47.6% in type 1 to 42.4% in type 2 diabetes. The awake/asleep ratio of systolic BP (SBP) was comparable between patients with or without abnormal autonomic tests. Pulse pressure (PP) was significantly higher in patients with > or =1 abnormal autonomic test (p < 0.001). Ambulatory SBP was significantly elevated in the group with higher risk of coronary heart disease (p < 0.001). Patients with higher stroke-risk had higher SBP but lower diastolic BP, and thus an elevated ambulatory PP by 9 mmHg, compared to those with lower risk (p < 0.001). Cardiac autonomic neuropathy is not the main causal-factor for the non-dipper BP pattern in diabetes mellitus. The most significant finding from this study is the high ambulatory PP found in patients with either cardiac autonomic dysfunction or high risk for coronary heart disease or stroke. After correcting for age, this elevated PP level emerged as the main cardiovascular risk factor in diabetes mellitus.
本研究旨在调查糖尿病患者昼夜血压（BP）模式紊乱所涉及的潜在因素，以及血压、心脏自主神经病变和估计的心血管风险之间的关系。我们研究了101例糖尿病患者（58%为2型糖尿病；59%为男性），年龄在21 - 65岁之间，通过48小时血压监测进行评估。我们在一次检查中进行了三项自主神经测试：深呼吸、瓦尔萨尔瓦动作和从坐姿站立。患者根据异常测试的数量以及他们患冠心病或中风的10年风险进行分类。非勺型24小时模式的患病率在1型糖尿病中为47.6%，在2型糖尿病中为42.4%。收缩压（SBP）的清醒/睡眠比值在自主神经测试正常或异常的患者之间相当。在有≥1项异常自主神经测试的患者中，脉压（PP）显著更高（p < 0.001）。冠心病风险较高组的动态SBP显著升高（p < 0.001）。中风风险较高的患者SBP较高，但舒张压较低，因此与风险较低的患者相比，动态PP升高了9 mmHg（p < 0.001）。心脏自主神经病变不是糖尿病患者非勺型血压模式的主要因果因素。本研究最显著的发现是在有心脏自主神经功能障碍或冠心病或中风高风险的患者中发现了较高的动态PP。在校正年龄后，这种升高的PP水平成为糖尿病患者主要的心血管危险因素。
