TY - JOUR
T1 - Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes
AU - Hjortkjær, Henrik Ø
AU - Persson, Frederik
AU - Theilade, Simone
AU - Winther, Signe A
AU - Tofte, Nete
AU - Ahluwalia, Tarunveer S
AU - Rossing, Peter
N1 - Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - AIMS: People with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes.METHODS: From 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions.RESULTS: Participants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24-44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09-4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23-3.00), p = 0.004).CONCLUSIONS: Non-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.
AB - AIMS: People with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes.METHODS: From 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions.RESULTS: Participants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24-44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09-4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23-3.00), p = 0.004).CONCLUSIONS: Non-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.
KW - Adult
KW - Aged
KW - Blood Pressure/physiology
KW - Blood Pressure Monitoring, Ambulatory
KW - Circadian Rhythm/physiology
KW - Diabetes Mellitus, Type 1/complications
KW - Humans
KW - Hypertension/complications
KW - Kidney Diseases
KW - Kidney Failure, Chronic/complications
KW - Middle Aged
KW - Risk Factors
KW - Kidney disease
KW - Non-dipping
KW - Mortality
KW - Cardiovascular disease
KW - Ambulatory blood pressure
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85135892950&partnerID=8YFLogxK
U2 - 10.1016/j.jdiacomp.2022.108270
DO - 10.1016/j.jdiacomp.2022.108270
M3 - Journal article
C2 - 35964524
SN - 1056-8727
VL - 36
SP - 108270
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
IS - 9
M1 - 108270
ER -