Sinha R N, Patrick A W, Richardson L, MacFarlane I A
Diabetes Centre, Walton Hospital, Liverpool, UK.
Diabet Med. 1997 Apr;14(4):291-5. doi: 10.1002/(SICI)1096-9136(199704)14:4<291::AID-DIA349>3.0.CO;2-5.
In subjects with essential hypertension, loss of the normal nocturnal dip in blood pressure is associated with a greater risk of developing end-organ complications. In subjects with diabetes, smoking carries a similar association. To assess whether these factors may have an aetiological and synergistic role in the vascular complications of diabetes, 24-hour blood pressure monitoring was performed in insulin-dependent diabetic (IDDM) patients with normal albumin excretion (n = 19) and microalbuminuria (n = 21) of comparable age and duration of diabetes, and with no evidence of autonomic neuropathy or hypertension. The potential influence of smoking was examined by subdividing the groups, depending on smoking status. Ten of the microalbuminuric group and 9 of the normoalbuminuric group were current smokers, the remaining patients never having smoked. There was a significant difference between mean (+/-SD) daytime vs nocturnal blood pressure in patients with normal albumin excretion (114 +/- 3/70 +/- 4 vs 102 +/- 3/62 +/- 3 mmHg; p < 0.001) and microalbuminuria (109 +/- 5/75 +/- 5 vs 101 +/- 3/65 +/- 4 mmHg; p < 0.001) but mean blood pressure values did not differ significantly between the groups. A similar fall in nocturnal blood pressure was found in smokers and non-smokers with and without microalbuminuria (p < 0.001), but there was no difference between the mean blood pressure values in the different subgroups. In conclusion, normotensive IDDM patients, who do not have autonomic neuropathy, retain a significant diurnal variation in blood pressure, irrespective of smoking habit or presence of microalbuminuria.
在原发性高血压患者中，夜间血压正常的下降幅度消失与发生终末器官并发症的风险增加有关。在糖尿病患者中，吸烟也有类似的关联。为了评估这些因素在糖尿病血管并发症中是否可能具有病因学和协同作用，对年龄和糖尿病病程相当、无自主神经病变或高血压证据、白蛋白排泄正常（n = 19）和微量白蛋白尿（n = 21）的胰岛素依赖型糖尿病（IDDM）患者进行了24小时血压监测。根据吸烟状况对分组进行细分，以研究吸烟的潜在影响。微量白蛋白尿组中有10人、正常白蛋白尿组中有9人是当前吸烟者，其余患者从不吸烟。白蛋白排泄正常的患者（114±3/70±4与102±3/62±3 mmHg；p<0.001）和微量白蛋白尿患者（109±5/75±5与101±3/65±4 mmHg；p<0.001）日间与夜间平均（±标准差）血压存在显著差异，但两组间平均血压值无显著差异。无论有无微量白蛋白尿，吸烟者和非吸烟者夜间血压均有类似下降（p<0.001），但不同亚组间平均血压值无差异。总之，无自主神经病变的血压正常的IDDM患者，无论吸烟习惯或微量白蛋白尿情况如何，血压仍存在显著的昼夜变化。
