PP.03.25: RELATIONSHIP BETWEEN 24-HOUR BLOOD PRESSURE VARIABILITY AND TARGET ORGAN DAMAGE IN PATIENTS WITH TYPE 2 DIABETES. (June 2015) - Uzu, T.
Abstract : Objective: Blood pressure variability (BPV) is considered a novel risk factor for renal and cardiovascular disease. This study assessed whether a short-term BPV was associated with renal or cardiovascular complications in patients with type 2 diabetes. Design and method: The study population consisted of 254 Japanese patients with type 2 diabetes (mean age 65.4 years). Office blood pressure (BP), 24-h ambulatory blood pressure monitoring (ABPM), brachial-ankle pulse wave velocity (baPWV), blood and morning urine collection, and measurement of waist circumstances were performed in all patients. Family history and smoking habits were also recorded. Estimate glomerular filtration rate (eGFR) was calculated using the SCr-based Japanese eGFR equation. Morning BP surge was defined as the morning BP ((2-hour average of four 30-minute BP readings just after wake-up) minus the prewaking BP (2-hour average of 4 BP readings just before wake-up). Results: Among the study population, 113 (44%) showed normoalbumionuria, 119 (47%) showed microalbuminuria and 22 (9%) showed macroalbuminuria and 169 (67%) were treated with antihypertensive agents (angiotensin receptor blockers/ angiotensin coverting enzyme inhibitors 55%. calcium channel blockers 38%, diuretics 18%, beta-blockers 10%). The coefficient of variation (CV) of 24-hour BP (24BPCV), of daytime BP (DBPCV) and night-time BP (NBPCV) were 15%, 14%, 12% for systolic values and 20%, 20% 14% for diastolic values, respectively. Antihypertensive agents did not significantly affect the CV of BPs. In the multivariate analysis, older age and albuminuria were independently associated with 24SBP. Older age also associated with DSBP and NSBP. Morning BP surge and waist circumstance associated with NSBP, but not 24SBP and DSBP. CV of BPs were not associated with baPWV and eGFR. Conclusions: These data showed that increased SBP variability was closely associated with age in Japanese type 2 diabetes. Elevation of 24SBPCV may indicate higher risk for the progression of diabetic nephropathy. NSBPCV may be a marker for sympathetic over-activity during the night-time. These results indicate that high short-term BP variability may be a marker for renal and/or cardiovascular complications in type 2 diabetes.