Nakano S, Fukuda M, Hotta F, Ito T, Ishii T, Kitazawa M, Nishizawa M, Kigoshi T, Uchida K
Department of Internal Medicine, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
Diabetes. 1998 Sep;47(9):1501-6. doi: 10.2337/diabetes.47.9.1501.
To assess the significance of reversed circadian blood pressure (BP) rhythms as a predictive factor of vascular events in NIDDM, vital status after an average 4-year follow-up was determined in 325 NIDDM subjects in whom the circadian BP profile had been monitored between 1988 and 1996. Circadian BP rhythm was analyzed by the COSINOR (a compound word for cosine and vector) method, as previously described. After exclusion of 37 dropped-out subjects, 288 were recruited to the further analysis, of which 201 had a normal circadian BP rhythm (group N) and the remaining 87 had a reversed one (group R). There was no difference in sex, HbA1c, the prevalence of smokers, serum lipids, or serum electrolytes between groups N and R at baseline, whereas age, the prevalence of hypertension, serum creatinine, and diabetic complications were more pronounced in group R than in group N. During the follow-up period (which averaged 52 months in group N and 36 months in group R), fatal and nonfatal vascular (cerebrovascular, cardiovascular, peripheral vascular arteries, and retinal artery) events occurred in 20 subjects in group N and 56 in group R. Unadjusted survival times and event-free times were estimated by the Kaplan-Meier product-limit method, and there was a significant difference in both unadjusted survival and event-free survival rates between groups N and R (P < 0.001 each; log-rank test). The Cox proportional-hazards model adjusted for age, sex, circadian BP pattern, duration of diabetes, therapy for diabetes, various diabetic complications, and hypertension demonstrated that circadian BP pattern and age exhibited significant, high adjusted relative risks for fatal events, and that diabetic nephropathy, postural hypotension, and hypertension as well as circadian BP pattern exhibited significant, high adjusted relative risks with respect to the occurrence of various nonfatal vascular events. These results suggest that reversed circadian BP rhythm is associated with occurrences of both fatal and nonfatal vascular events in NIDDM subjects.
为评估昼夜血压（BP）节律逆转作为非胰岛素依赖型糖尿病（NIDDM）血管事件预测因素的意义，我们对1988年至1996年间监测了昼夜血压曲线的325例NIDDM患者进行了平均4年的随访，以确定其生命状态。如前所述，采用COSINOR（余弦和向量的合成词）方法分析昼夜血压节律。排除37例失访患者后，288例患者进入进一步分析，其中201例昼夜血压节律正常（N组），其余87例节律逆转（R组）。基线时，N组和R组在性别、糖化血红蛋白（HbA1c）、吸烟率、血脂或血清电解质方面无差异，而R组的年龄、高血压患病率、血清肌酐和糖尿病并发症比N组更明显。在随访期间（N组平均52个月，R组平均36个月），N组20例患者和R组56例患者发生了致命和非致命的血管（脑血管、心血管、外周血管和视网膜动脉）事件。采用Kaplan-Meier乘积限界法估计未调整的生存时间和无事件时间，N组和R组在未调整的生存率和无事件生存率方面均有显著差异（每组P<0.001；对数秩检验）。经年龄、性别、昼夜血压模式、糖尿病病程、糖尿病治疗、各种糖尿病并发症和高血压调整后的Cox比例风险模型显示，昼夜血压模式和年龄对致命事件显示出显著的、高的调整后相对风险，而糖尿病肾病、体位性低血压和高血压以及昼夜血压模式对各种非致命血管事件的发生显示出显著的、高的调整后相对风险。这些结果表明，昼夜血压节律逆转与NIDDM患者致命和非致命血管事件的发生有关。
