COMPARISON OF NIFEDIPINE AND CLONIDINE FO R IMPROVEMENT OF NIGHTLY BLOOD-PRESSURE CONTROL IN HYPERTENSIVE TYPE-2 DIABETIC-PATIENTS WITH DIABETIC NEPHROPATHY AND INVERSE CIRCADIAN-RHYTHM OF BLOOD-PRESSURE (NON-DIPPING)

The influence of an additional administration of clonidine and of nife dipine at the evening on the nocturnal decrease of blood pressure was compared in a randomized cross-over study in 10 type 2-diabetic patien ts with nephropathy and inverse circadian rhythm (non-dipping despite antihypertensive treatment). After a 4-week lasting period of therapy the mean nocturnal blood presssure was lowered by clonidine from plus 4 +/- 4% to minus 7 +/- 6% and by nifedipine to minus 13 +/- 7%. This decrease of blood pressure at night was highly significant in both gro ups of therapy (p < 0.001) but nifedipine was more effective than clon idine in lowering the nocturnal blood pressure (p < 0.05). Nevertheles s the inverse circadian rhythm could not be normalized in all patients . A significant decrease of blood pressure at night (> 10% decrease) w as achieved in four of the patients with clonidine and in six of them with nifedipine therapy. Therefore in patients with severe hypertensio n and inverse circadian rhythm due to diabetic nephropathy the additio nal administration of nifedipine leads to a more significant decrease of the nocturnal blood pressure than clonidine, but normalization of t he circadian rhythm can even not be achieved by nifedipine in all case s.