Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.
Department of Exercise Science, Arnold College of Public Health, University of South Carolina, Columbia, SC, USA.
Hypertens Res. 2018 Jan;41(1):33-38. doi: 10.1038/hr.2017.82. Epub 2017 Oct 26.
Blunted nocturnal dipping in blood pressure (BP) is associated with increased cardiovascular disease (CVD) risk in middle-aged/older adults. The prevalence of blunted nocturnal BP dipping is higher in persons with obesity and diabetes, conditions that are also associated with elevated aortic stiffness and inflammation. Therefore, we hypothesized that elevated glycemia, inflammation and aortic stiffness would be inversely associated with the magnitude of nocturnal systolic BP dipping among middle-aged/older adults with obesity at high CVD risk. Twenty-four hour ambulatory BP monitoring, aortic stiffness (carotid-femoral pulse wave velocity, CF-PWV), hemoglobin A1c (HbA1c) and inflammation (C-reactive protein, CRP) were measured in 86 middle-aged/older adults with obesity and at least one other CVD risk factor (age 40-74 years; 34 male/52 female; body mass index=36.7±0.5 kg m; HbA1c=5.7±0.04%). In the entire cohort, CRP (β=0.40±0.20, P=0.04), but not HbA1c or CF-PWV was independently associated with systolic BP dipping percent (Model R=0.07, P=0.12). In stratified (that is, presence or absence of prediabetes) multiple linear regression analysis, HbA1c (β=6.24±2.6, P=0.02) and CRP (β=0.57±0.2, P=0.01), but not CF-PWV (β=0.14± 2.6, P=0.74), were independently associated with systolic BP dipping percent (Model R=0.32, P<0.01) in obese adults with prediabetes but were absent in obese adults without prediabetes (Model R=0.01 P=0.95). However, nocturnal systolic BP dipping percent (P=0.65), CF-PWV (P=0.68) and CRP (P=0.59) were similar between participants with and without prediabetes. These data suggest that impaired long-term glycemic control and higher inflammation may contribute partly to blunted BP dipping in middle-aged/older adults with obesity-related prediabetes.
夜间血压（BP）下降减弱与中年/老年人群心血管疾病（CVD）风险增加有关。肥胖和糖尿病患者夜间血压下降减弱的发生率较高，而这些疾病也与主动脉僵硬和炎症升高有关。因此，我们假设高血糖、炎症和主动脉僵硬与肥胖且 CVD 风险高的中年/老年人群夜间收缩压下降幅度呈负相关。对 86 名肥胖且至少有一个其他 CVD 危险因素（年龄 40-74 岁；34 名男性/52 名女性；体重指数=36.7±0.5kg/m2；糖化血红蛋白（HbA1c）=5.7±0.04%）的中年/老年患者进行了 24 小时动态血压监测、主动脉僵硬（颈动脉-股动脉脉搏波速度，CF-PWV）、糖化血红蛋白（HbA1c）和炎症（C 反应蛋白，CRP）的测量。在整个队列中，CRP（β=0.40±0.20，P=0.04），而不是 HbA1c 或 CF-PWV 与收缩压下降幅度独立相关（模型 R=0.07，P=0.12）。在分层（即存在或不存在糖尿病前期）的多元线性回归分析中，HbA1c（β=6.24±2.6，P=0.02）和 CRP（β=0.57±0.2，P=0.01），但不是 CF-PWV（β=0.14±2.6，P=0.74），与肥胖伴糖尿病前期患者的收缩压下降幅度独立相关（模型 R=0.32，P<0.01），但在肥胖不伴糖尿病前期患者中不存在（模型 R=0.01，P=0.95）。然而，在有或没有糖尿病前期的患者之间，夜间收缩压下降幅度（P=0.65）、CF-PWV（P=0.68）和 CRP（P=0.59）相似。这些数据表明，中年/老年肥胖伴糖尿病前期患者的长期血糖控制受损和炎症水平升高可能部分导致血压下降减弱。
