Abnormal Dipping Pattern of Blood Pressure in Diabetics-A Study.

UNLABELLED

Autonomic neuropathy is a significant complication of long term Type 2 DM which contributes to the diurnal variation of BP. Non dipping pattern is when the nocturnal dipping is less than normal. Non dippers are associated with increased target organ damage and increased risk of cardiovascular mortality. The pattern of blood pressure variation and dipping is found using Ambulatory blood pressure monitor (ABPM). This study aims to study the variation in dipping pattern as recorded by ABPM in patients with Type 2 Diabetes.

MATERIAL

50 patients with a history of diabetes for at least 5 years patients were selected and subjected for ambulatory blood pressure monitoring and assessment of glycemic status.50 normal subjects were enrolled as controls.

OBSERVATION

In our study we found that 22 (44%) of patients in the diabetic and 38 (76%) among patients in the normal group were normal dippers. 17(34%) patients in the diabetic group and 12 (24%) patients in the non diabetic group were non dippers. 11(22%) in the diabetic group were reverse dippers while none of the patients in the normal were reverse dippers. The difference between the distribution of the dippers, non dippers and reverse dippers between the two groups was statistically significant. (p<0.001).Patients having diabetes for more than 10 years had increased incidences of abnormal dipping (77.8%) as compared to patients with diabetes of 5 to 10 years (43.8%). This difference showed a statistical significance(p=0.02).The incidence of reverse dipping was more in patients with a Hba1c of more than 9% (n=10, 34.5%) when compared to patients who had a Hba1c of 7-9% (n=1, 4.8%).

CONCLUSION

A majority of patients with diabetes were found to have an abnormal pattern of blood pressure that included non-dipping and reverse dipping patterns. Duration of diabetes and severity of Hba1C had a direct correlation with abnormal pattern of blood pressure variability that included non-dippers and reverse dippers. Thus, ambulatory blood pressure monitoring is an important tool to assess the blood pressure variability can be used regularly to assess the complications of diabetes namely autonomic neuropathy and renal dysfunction.