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非杓型血压与口服葡萄糖耐量试验期间不同糖代谢谱的关系。

Association between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test.

机构信息

Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy.

Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy.

出版信息

Intern Emerg Med. 2024 Jan;19(1):81-89. doi: 10.1007/s11739-023-03442-1. Epub 2023 Oct 6.

Abstract

It is known that, a not physiological blood pressure (BP) circadian pattern has been associated with increased risk of organ damage and cardiovascular (CV) event. The aim of this study was to assess the association between circadian BP pattern and glucometabolic phenotypes occurring after oral glucose tolerance test (OGTT). We recruited 810 hypertensive Caucasian patients. All participants underwent to OGTT, laboratory test and 24-h ambulatory BP monitoring (ABPM). The analysis of collected data allowed classifying patients based on nocturnal BP profiles into four categories: dippers, non-dippers, extreme dippers, and reverse dippers. Considering the dipping pattern, the proportion of non-dippers in normal glucose tolerance patients with 1-h glucose ≥ 155 mg/dL (NGT ≥ 155) (36.4%) was higher than NGT < 155 (29.6%) and impaired glucose tolerance (IGT) (34.8%), but lower than type 2 diabetes group (T2DM) (52.6%) (p = 0.001). The proportion of dippers was lower in NGT ≥ 155 (47%) and T2DM (34.6%), when compared with NGT < 155 (53.8%) and IGT (51.2%) (p = 0.017). From logistic regression analysis, 1-h glucose ≥ 155 increased the risk of a pathological nocturnal drop in BP by 74%, (OR = 1.740, 95% CI 1.254-2.415, p < 0.0001). In addition, the improvement in 1 unit of Matsuda was responsible for a 3.5% risk decrease (OR = 0.965, 95% CI 0.958-0.971, p < 0.0001), while e-GFR determined a 0.9% risk reduction of nocturnal BP drop (OR = 0.991, 95% CI 0.984-0.999, p = 0.020). Our data demonstrated the existence, in newly diagnosed hypertensive patients, of an association between circadian BP profile and altered glycemic response during OGTT, in particular NGT ≥ 155 subjects are associated with a non-dipper BP pattern, this is clinically relevant because may explain, at least in part, the increased CV risk in this setting of patients.

摘要

已知,非生理性血压(BP)昼夜节律模式与器官损伤和心血管(CV)事件风险增加有关。本研究旨在评估口服葡萄糖耐量试验(OGTT)后昼夜 BP 模式与糖代谢表型之间的关系。我们招募了 810 名高血压白种人患者。所有参与者均接受 OGTT、实验室检查和 24 小时动态血压监测(ABPM)。对收集的数据进行分析,根据夜间 BP 谱将患者分为 4 类:杓型、非杓型、超杓型和反杓型。考虑到降压模式,1 小时血糖≥155mg/dL(NGT≥155)(36.4%)的正常糖耐量患者中非杓型的比例(36.4%)高于 NGT<155(29.6%)和糖耐量受损(IGT)(34.8%),但低于 2 型糖尿病组(T2DM)(52.6%)(p=0.001)。与 NGT<155(53.8%)和 IGT(51.2%)相比,NGT≥155(47%)和 T2DM(34.6%)的杓型比例较低(p=0.017)。从逻辑回归分析中,1 小时血糖≥155 使 BP 夜间病理性下降的风险增加了 74%(OR=1.740,95%CI 1.254-2.415,p<0.0001)。此外,Matsuda 评分增加 1 个单位,使夜间 BP 下降的风险降低 3.5%(OR=0.965,95%CI 0.958-0.971,p<0.0001),而 e-GFR 使夜间 BP 下降的风险降低 0.9%(OR=0.991,95%CI 0.984-0.999,p=0.020)。我们的数据表明,在新诊断的高血压患者中,昼夜 BP 谱与 OGTT 期间血糖反应改变之间存在关联,特别是 NGT≥155 患者与非杓型 BP 模式相关,这在临床上具有重要意义,因为这至少可以部分解释该患者群体中 CV 风险增加的原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8e3c/10827950/214be46be280/11739_2023_3442_Fig1_HTML.jpg

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