24-HOUR BLOOD-PRESSURE MEASUREMENT IN DIA BETES-MELLITUS AND DIABETICCOMPLICATIONS

In consideration of the frequent association of hypertension and diabe tes mellitus and also taking into account the acceleration of diabetic nephropathy and retinopathy by hypertension there are the following s pecial uses of ambulatory blood pressure monitoring in diabetic patien ts: Support in achieving the day and night tight blood pressure contro l according to the goals set by US recommendations on 130/85 mmHg for counterbalancing the increased cardiovascular risk in diabetic patient s. After a 10-year history of diabetes even normoalbuminuric diabetics have a reduced circadian blood pressure variation compared to newly d iagnosed diabetic patients or to controls. A higher blood pressure loa d because of a reduced fall of blood pressure during night is a typica l sign of all forms of diabetic nephropathy, beginning in the stage of microalbuminuria and probably even in a ''prealbuminuric'' stage of h igh normal urinary albumin excretion. 10-30% of all nephropathic diabe tic patients have an inverse circadian rhythm of blood pressure with h igher blood pressure during night compared to daytime values. These '' inverters'' have an advanced form of autonomic neuropathy and also of orthostatic symptoms. Recent analyses of heart period variability in 2 4-hour electrocardiogram have shown objective signs of autonomic neuro pathy not only for advanced, but also for the early form of microalbum inuric nephropathy. This form of autonomic neuropathy is usually assoc iated with a reduced circadian blood pressure variation. In pregnancy and in autonomic hypotension after insulin-injection 24-hour blood pre ssure monitoring is an important aid for risk analysis.