Accelerated arteriosclerosis is more common in patients with diabetes mellitus (DM2) vs non-diabetics (nonDM). It is disputable whether circadian blood pressure (BP) profiles in diabetes associate equally with macrovascular and microvascular lesions.Design and method:
We evaluated macrovascular lesions (aortic stiffness by pulse wave velocity, PWV and carotid plaques and intima-media thickness (IMT)), other organ damages (left ventricular hypertrophy, LVH and microalbuminuria, MA) and microvascular lesions (hypertensive and diabetic retinopathy, by retinography) in 139, > 40 years hypertensive patients. Population: DM2 (n = 69, 45% female, 62 + 1 years, BMI 29 + 1 Kg/m2, casual BP 159/89 + 3/1 mmHg) and nonDM (n = 70, 58 % female, 61 + 1 years, BMI 28 + 1 Kg/m2, casual BP 155/91 + 3/2 mmHg) (DM v nonDM all P > 0.15, n.s.). All underwent 24-h BP monitoring.Results:
DM vs nonDM showed higher systolic 24 h BP (145 + 2 v 140 + 2 mmHg) and nighttime BP (129 + 2 v 122 + 2 mmHg), higher PWV (11.2 ± 0.2 vs 10.6 ± 0.2 m/s) and IMT average (0.78 ± 0.02 vs 0.72 ± 0.02 mm) and the presence of carotid plaques (68% vs 46%) (P < 0.02). Albuminuria, nighttime BP fall (%), percentage of LVH and hypertensive retinopathy scores did not differ between DM vs nonDM. Multivariate regression analysis (after adjustment for age, gender, therapy, casual BP and daytime and 24-h BP values) showed that nighttime systolic BP values (not nighttime BP % fall) were independently associated with PWV, IMT, plaques, albuminuria, LVH and hypertensive and diabetic retinopathy. Also, linear correlations between nighttime BP and these values either taken from DM and nonDM fit within the same regression lines (the weight of the influence of nighttime BP on these damages is similar in both DM and nonDM). In contrast, after adjustment for nighttime BP, HbA1C was independently correlated only with diabetic retinopathy but not with hypertensive retinopathy or with the macrovascular lesions.Conclusions:
Glucose control exhibits a particular independent influence on the severity of microvascular DM retinopathy whereas in both DM and nonDM is nighttime BP absolute levels that influences strongly and independently both macrovascular lesions and microvascular retinopathy damages.