Dipper and non dipper diabetics. A study among 484 patients

Abnormal pattern of circadian blood pressure variations carries a high risk of cardiovascular complications. The aim of this study was to assess the f requency of abnormal blood pressure rhythm in diabetes and its consequences on micro and macrovascular complications. 484 diabetes mellitus patients were submitted to 24-h ambulatory blood pres sure monitoring. They were divided into two groups according to the absence (non dipper: group 1; n=167) or presence (dipper: group 2; n=317) of noctu rnal BP reduction =10% of daytime BP. Following data were collected and com pared between these two groups: body mass index, glycated haemoglobin, urin ary albumin excretion, research of retinopathy by fundoscopy, tests for pre sence of a macrovascular disease. There were no significant differences among the two groups in sex, body mas s index, type and duration of diabetes and glycemic control. Clinical SEP a nd DBP did not differ from significant manner between non-dipper and dipper (140+/-18/81+/-1 venus 138+/-19/81+/-10 mmHg). Non-dipper 24-h SEP and 24- h DBP were higher than those of dipper (129+/-16/76+/-9 versus 122+/-15/73/-8 mmHg; p<0.001). Non-dipper were older than dipper (59.9+/-13 versus 55. 8+/-15 years; p<0.001) and there was more hypertensive patients in group 1 than in group 2 (50% versus 39%; p<0.01). Macro-and microvascular diabetes complications were more common in non-dipper. In conclusion high blood pressure is frequently observed in diabetic patien ts. Its association with a diminished nocturnal BP fall could explain a hig her risk of complications, especially retinopathy, nephropathy and cardiac events.