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Non-dipping pattern in early-stage diabetes: association with glycemic profile and hemodynamic parameters

Abstract

Patients with longstanding diabetes exhibit diminished nocturnal blood pressure (BP) drop, yet this phenomenon remains understudied in the early stages of the disease. Eighty patients with newly diagnosed (<6 months) Diabetes Mellitus type 2 (T2DM) and 80 non-T2DM individuals underwent office and 24-h ambulatory BP measurements, estimation of hemodynamic parameters using impedance cardiography and blood tests. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk score was calculated. T2DM patients exhibited higher nighttime systolic blood pressure (SBP) (p = 0.028) and lower dipping (p < 0.001) compared to controls. In the total population, dipping correlated negatively with age, HbA1c, ASCVD risk score, and positively with HDL Cholesterol and Velocity Index (VI), a marker of myocardial contractility (p < 0.05). Nighttime SBP correlated positively with ASCVD risk, BMI, HbA1c, fasting glucose, eGFR, and negatively with VI (p < 0.05). After adjustment for other variables, HbA1c (p = 0.03), eGFR (p = 0.02) and VI (p = 0.004) independently predicted non-dipping. Multivariate analysis revealed HbA1c (p = 0.023), eGFR (p = 0.05), and VI (p = 0.006) as independent predictors of nighttime SBP. Patients diagnosed with T2DM concurrently present impaired circadian BP rhythm, which appears to be directly associated with impaired glycemic profile. The observed association with myocardial contractility might represent an additional mechanism for the aggravated cardiovascular risk in these patients.

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Fig. 1: Comparison of the distribution of dipping patterns between newly diagnosed DM and normoglycemic controls.

Data availability

The dataset analyzed during the present study are available from the corresponding author on reasonable request.

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Authors and Affiliations

Authors

Contributions

All authors contributed to this study. EG, SD, and BN participated in the design and conception of the study. BN, EG, EIG, PA, ArT, AL, actively participated in subjects’ enrollment. HZ and KM collected and recorded the data. ElG, BN, and PA analyzed and interpreted the data. BN, PA, ElG, and EG edited the final manuscript. SD, AT, and EG corrected and approved the final manuscript. All authors read and approved the final version of the manuscript and agreed to submit it for publication.

Corresponding author

Correspondence to Eugenia Gkaliagkousi.

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The authors declare no competing interests.

Ethical approval

Approval was obtained from the ethics committee of the Aristotle University of Thessaloniki, School of medicine (approval number: 5.44/6/7/16). Written informed consent was obtained from all patients prior to participation in the study.

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Nikolaidou, B., Anyfanti, P., Gavriilaki, E. et al. Non-dipping pattern in early-stage diabetes: association with glycemic profile and hemodynamic parameters. J Hum Hypertens 36, 805–810 (2022). https://doi.org/10.1038/s41371-021-00587-4

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