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Nocturnal Hypertension and Left Ventricular Diastolic Dysfunction in Patients With Diabetes With the Absence of Heart
Yonekazu Kidawara1, Manabu Kadoya1, Masataka Igeta2
1Department of Diabetes, Endocrinology and Clinical Immunology (Y. Kidawara, M.K., A. Morimoto, A. Miyoshi, M.K.-H., A.K., K.K., Y. Kusunoki, H.K.), School of Medicine, Hyogo Medical University, Nishinomiya, Japan.
Insights
Nocturnal hypertension, specifically nondipper and riser patterns, significantly predicts left ventricular diastolic dysfunction in diabetic patients without heart failure. These risks were not observed in non-diabetic individuals.
Area of Science:
- Cardiology
- Endocrinology
- Hypertension Research
Background:
- Diabetes mellitus is a significant risk factor for heart failure (HF) and left ventricular (LV) diastolic dysfunction.
- The predictive role of comorbid conditions like nocturnal hypertension on diastolic dysfunction in non-HF diabetic patients remains unclear.
Purpose of the Study:
- To longitudinally examine the predictive value of nocturnal hypertension profiles on the progression of LV diastolic dysfunction.
- To investigate these associations in patients with and without diabetes, specifically in the absence of HF.
Main Methods:
- A longitudinal study followed 154 diabetic and 268 non-diabetic patients without HF for approximately 37 months.
- LV diastolic dysfunction was defined as an E/e' ratio greater than 14.
- Nocturnal hypertension patterns (dipper, nondipper, riser) were analyzed in relation to the development of diastolic dysfunction.
Main Results:
- A significant interaction was found between diabetes status and nocturnal hypertension patterns predicting diastolic dysfunction (P=0.017).
- Diabetic patients with nondipper (P=0.021) and riser (P=0.006) patterns showed a significantly higher risk of diastolic dysfunction compared to dippers.
- Multivariable analysis confirmed nondipper (HR, 4.56) and riser (HR, 3.89) patterns as significant predictors of LV diastolic dysfunction in diabetic individuals.
Conclusions:
- Nocturnal hypertension is a crucial predictor of left ventricular diastolic dysfunction progression in diabetic patients.
- These associations are specific to diabetic individuals and were not found in the non-diabetic cohort during the absence of heart failure.
Background:
Diabetes is an important risk factor for heart failure (HF) and is associated with left ventricular (LV) diastolic dysfunction. However, diabetic comorbid conditions, such as nocturnal hypertension, as predictors of diastolic dysfunction are not known in the absence of an HF period. The present study was conducted as the longitudinal examination of the predictive value of nocturnal hypertension profiles on the progression of LV diastolic dysfunction in patients with and without diabetes without HF.
Methods:
The subjects (154 diabetes and 268 nondiabetes) in the absence of HF were followed for 36.8±18.2 months. The relationships among the patterns of nocturnal hypertension and the outcome of LV diastolic dysfunction, defined as an increase in E/e'>14, were investigated in the patients with and without diabetes.
Results:
The interaction effect of the diabetes status and the patterns of nocturnal hypertension on the hazard rate of the occurrence of E/e'>14 was statistically significant (P=0.017). Kaplan-Meier analysis results revealed that patients with diabetes with nondipper (P=0.021 versus dipper) and riser (P=0.006 versus dipper) had a greater risk for a diastolic dysfunction event. Furthermore, multivariable Cox proportional hazards analysis revealed that nondipper (hazard ratio, 4.56 [95% CI, 1.49-13.96]; P=0.007) and riser (hazard ratio, 3.89 [95% CI, 1.31-11.57]; P=0.014) patterns were associated with elevated risk of the outcome of LV diastolic dysfunction. In contrast, no similar significant associations were found in patients without diabetes.
Conclusions:
During the absence of HF periods, nocturnal hypertension is an important predictor for the progression of LV diastolic dysfunction in patients with diabetes.
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