Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Atherosclerosis. 2013 Mar;227(1):135-9. doi: 10.1016/j.atherosclerosis.2012.12.006. Epub 2013 Jan 2.
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.
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]).
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).
Among treated type 2 diabetes, high nighttime BP and/or glucose values were associated with a high degree of cardiovascular remodeling.
夜间血压（BP）与心血管风险之间的关联已得到充分证实。然而，糖尿病患者夜间血糖值（包括夜间低血糖）与心血管风险之间的关联仍不清楚。
在这项对 49 例接受治疗的 2 型糖尿病患者（平均年龄 67.3 岁，61.0%为男性，平均治疗时间为 9.4 年）的横断面研究中，我们同时进行了 24 小时连续血糖监测和 BP 监测，并评估了几种靶器官损伤（超声心动图左心室质量指数[LVMI]、尿白蛋白排泄率[UAE]、颈动脉内膜中层厚度[IMT]和肱踝脉搏波速度[baPWV]）。
夜间平均收缩压与 LVMI、log 转换后的 UAE 或 baPWV 的程度独立相关（均 P<0.05）。相反，夜间平均血糖值而不是日间血糖值或血糖变异性与颈总动脉 IMT 或 baPWV 的程度独立相关（均 P<0.05）。我们根据夜间血糖值将研究参与者分为 3 组（夜间平均血糖值<161mg/dl[参考值]的组、至少有一点睡眠期间发生夜间低血糖[<70mg/dl]的组和夜间平均血糖值≥161mg/dl 的组），并比较了它们之间靶器官损伤的程度。夜间平均血糖值≥161mg/dl 的患者，而不是夜间低血糖的患者，在这 3 组中颈总动脉 IMT 或 baPWV 的值最高，即使在调整了协变量后，差异仍然显著（两者的趋势 P<0.05，ANCOVA）。
在接受治疗的 2 型糖尿病患者中，夜间高 BP 和/或血糖值与心血管重构程度较高有关。
