Non-dipping pattern in early-stage diabetes: association with glycemic profile and hemodynamic parameters.

Patients with longstanding diabetes exhibit diminished nocturnal blood pressure (BP) drop, yet this phenomenon remains understudied in the early stages of the disease. Eighty patients with newly diagnosed (<6 months) Diabetes Mellitus type 2 (T2DM) and 80 non-T2DM individuals underwent office and 24-h ambulatory BP measurements, estimation of hemodynamic parameters using impedance cardiography and blood tests. Ten-year atherosclerotic cardiovascular disease (ASCVD) risk score was calculated. T2DM patients exhibited higher nighttime systolic blood pressure (SBP) (p = 0.028) and lower dipping (p < 0.001) compared to controls. In the total population, dipping correlated negatively with age, HbA1c, ASCVD risk score, and positively with HDL Cholesterol and Velocity Index (VI), a marker of myocardial contractility (p < 0.05). Nighttime SBP correlated positively with ASCVD risk, BMI, HbA1c, fasting glucose, eGFR, and negatively with VI (p < 0.05). After adjustment for other variables, HbA1c (p = 0.03), eGFR (p = 0.02) and VI (p = 0.004) independently predicted non-dipping. Multivariate analysis revealed HbA1c (p = 0.023), eGFR (p = 0.05), and VI (p = 0.006) as independent predictors of nighttime SBP. Patients diagnosed with T2DM concurrently present impaired circadian BP rhythm, which appears to be directly associated with impaired glycemic profile. The observed association with myocardial contractility might represent an additional mechanism for the aggravated cardiovascular risk in these patients.

Noninvasive Assessment of Myocardial Perfusion in Different Blood Pressure Phenotypes and Its Association With Arterial Stiffness Indices.

BACKGROUND: We investigated for the first time whether patients with recent-onset, uncomplicated hypertension and different hypertension phenotypes exhibit altered values of subendocardial viability ratio (SEVR), a surrogate measure of myocardial perfusion that correlates with the ratio of subendocardial to subepicardial blood flow. We additionally explored whether SEVR correlates with arterial stiffness in a population free from the long-term effects of essential hypertension. METHODS: Nontreated individuals free from any known health problems were classified as true hypertensives (THs), white-coat hypertensives (WCHs), masked hypertensives (MHs), and normotensives. SEVR was noninvasively calculated with applanation tonometry in the radial artery. Carotid-femoral pulse wave velocity, central and peripheral pulse pressure (PP), augmentation index, and central systolic/diastolic blood pressure (BP) were assessed with applanation tonometry. Total arterial compliance index was calculated with impedance cardiography. RESULTS: In a total of 150 participants, normotensive individuals exhibited the highest values of SEVR (162.9 ± 25.3%), whereas SEVR appeared to be similar in MHs (150.2 ± 22.1%), WCHs (148.1 ± 20.4%), and THs (149.9 ± 24.8%) (P = 0.017). In the univariate analysis, SEVR significantly correlated with central systolic BP, peripheral PP, and total arterial compliance index. The association between SEVR and both central (P = 0.017) and peripheral PP (P = 0.003) remained significant after adjustment for heart rate and other parameters. CONCLUSIONS: SEVR, an alternative tool to the invasive assessment of microvascular coronary perfusion, presents different values across patients with divergent BP phenotypes and correlated with arterial stiffness, even in the absence of overt cardiovascular disease. Future studies need to address the potential utility of this easily implementable marker as a screening test for myocardial ischemia.