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« on: April 05, 2008, 07:29:31 pm » |
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NEW YORK (Reuters Health) May 30 - Postprandial hyperglycemia is more common than fasting hyperglycemia in type 2 diabetic patients who show nocturnal nondipping of blood pressure, according to a report in the May American Journal of Hypertension.
"At the present stage I would not recommend different antidiabetic treatment regimes for the restoration of a dipping pattern," Dr. Frank Pistrosch from University Hospital Dresden, Germany told Reuters Health. "However, considering the importance of postprandial hyperglycemia for cardiovascular events, we should treat fasting as well as postprandial hyperglycemia of our diabetic patients."
Dr. Pistrosch and associates investigated the relationship between the diurnal postprandial and fasting hyperglycemia and the corresponding blood pressure variation in 107 patients with type 2 diabetes and hypertension.
Three-quarters of the patients showed nocturnal nondipping of blood pressure, the authors report, but their systolic blood pressure during the day did not differ from that of patients with nocturnal dipping, and the diastolic blood pressure of nondippers was even lower than that of dippers.
Patients with abnormal diurnal blood pressure variation (nondippers) were more likely to have diabetic retinopathy and a higher urinary albumin excretion, both signs of advanced microvascular end organ damage, the researchers note.
Postprandial glucose increases were significantly higher in nondippers than in dippers, the investigators say, but fasting hyperglycemia did not differ significantly between the groups.
A logistic regression model that included day/night ratio of heart rate and the degree of postprandial hyperglycemia correctly predicted 84% of dippers and nondippers. Other factors (age, gender, body-mass index, glomerular filtration rate, and type of antihypertensive therapy) did not contribute significantly to the model.
"The mechanistic linkage between abnormal nocturnal blood pressure dipping status and abnormal glucose metabolism remains unclear," writes Dr. Kazuomi Kario from Jichi Medical School, Tochigi, Japan in a related critique. "Autonomic dysfunction and endothelial-cell dysfunction may be a missing link between glucose abnormality and nondipping status in diabetes."
Am J Hypertens 2007;20:541-545,546-547.
Source: http://www.medscape.com/viewarticle/557497?src=mp
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