NOCTURNAL BLOOD-PRESSURE IN YOUNG-PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS - CORRELATION WITH CARDIAC-FUNCTION

Lack of a decline in nocturnal blood pressure is associated with an ad verse effect on end organs in adults with insulin-dependent diabetes m ellitus (IDDM). The role of the decline in nocturnal blood pressure in young patients with IDDM is not known. We studied 25 white subjects w ith IDDM (age = 20.8 +/- 3.7 years, mean +/- SD), 8 of whom were femal e. The duration of IDDM in these subjects was 12.9 +/- 5.4 years (mean +/- SD). We determined the values for glycosylated hemoglobin (HgbAl) , 24-hour ambulatory blood pressure, diastolic cardiac function (the r atio of peak E wave to peak A wave velocity [E/A] and indexed peak fil ling rate [PFR/SV] by Doppler echocardiography), and albumin excretion rate. The HgbAl level was 10.9% +/- 1.9% (mean +/- SD; normal range = 4.5%-8.5%). The HgbAl concentration was inversely correlated (p < 0.0 05) with the decline in systolic (r = -0.57) and diastolic (r = -0.55) nocturnal blood pressure. Diastolic cardiac dysfunction (E/A ratio [r = 0.42, p < 0.03) and PFR/SV (r = 0.52, p < 0.01)] correlated with a smaller decrease in nocturnal diastolic blood pressure. An inverse cor relation between decline in nocturnal systolic blood pressure and log albumin excretion rate (r = -0.37, p = 0.07) approached statistical si gnificance. We conclude that poor glycemic control adversely affects n octurnal blood pressure and that the latter may play an important role in cardiac and possibly renal dysfunction in early IDDM.