TY - JOUR

T1 - Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes

AU - Hjortkjær, Henrik

AU - Persson, Frederik

AU - Theilade, Simone

AU - Winther, Signe A.

AU - Tofte, Nete

AU - Ahluwalia, Tarunveer S.

AU - Rossing, Peter

N1 - Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022

Y1 - 2022

N2 - Aims: People with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes. Methods: From 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions. Results: Participants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24–44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09–4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23–3.00), p = 0.004). Conclusions: Non-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.

AB - Aims: People with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes. Methods: From 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions. Results: Participants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24–44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09–4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23–3.00), p = 0.004). Conclusions: Non-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.

KW - Ambulatory blood pressure

KW - Cardiovascular disease

KW - Kidney disease

KW - Mortality

KW - Non-dipping

KW - Type 1 diabetes

U2 - 10.1016/j.jdiacomp.2022.108270

DO - 10.1016/j.jdiacomp.2022.108270

M3 - Journal article

C2 - 35964524

AN - SCOPUS:85135892950

VL - 36

JO - Journal of Diabetes and its Complications

JF - Journal of Diabetes and its Complications

SN - 1056-8727

IS - 9

M1 - 108270

ER -