Objectives: The loss of nocturnal decline of blood pressure has been reported in T1D patients in intensive treatment associated with a nocturnal rise in cathecolamines.Prolonged nocturnal hypoglycemia or wide blood glucose changes during the night were observed in patient during continuous glucose monitoring. Aim of this study is to establish whether the type of blood glucose pattern, with particular reference to severe hypo- or hyperglycemia, during the night could be responsible of impairment of the physiological blood pressure nocturnal decline. Methods: We studied 12 T1D adolescents (12 boys) 12 to 21 years old (median 18.5) with a disease duration from 50 to 160 months (median 106.5), HbA1c from 6.2 to 9.6 (median 7.95) and insulin requirement from 0.5 to 1.2 (median 0.9). In all patients we simultaneously performed a continous monitoring during 24 hours of glucose (CGMSMedtronic, Inc.) and blood pressure (TM-2430. A&D instruments). Diurnal and nocturnal HBGI and LBGI were also calculated. The analysis of cathecolamines (free dopamine, free norepinephrine, free epinephrine, total metanephrine, VMA and HVA) was done in urines collected in the same night. Simple regression analysis was used for statistical evaluation. Results: We did not observe any severe or prolonged hypoglycemic event. The magnitude of the nocturnal decline of systolic and diastolic blood pressure resulted directly correlated to mean nocturnal blood glucose and HBGI (p< 0.02). Mean nocturnal blood glucose, HBGI, LBGI and nocturnal blood pressure decline were not correlated to nocturnal urinary cathecolamines. A significant direct correlation was observed between nocturnal blood pressure decline and nocturnal urine volume. Conclusions: According to our results nocturnal blood pressure decline is more depending on osmotic diuresis than on hypoglycemia induced cathecolamines.
Nocturnal glycaemic pattern and blood pressure nocturnal decline in T1D adolescents
WAGNER, PAOLA;CHIARAVALLI, STEFANO;COSENTINO, MARCO;BOMBELLI, RAFFAELLA MARIA;MARINO, FRANCA;SALVATONI, ALESSANDRO
2009-01-01
Abstract
Objectives: The loss of nocturnal decline of blood pressure has been reported in T1D patients in intensive treatment associated with a nocturnal rise in cathecolamines.Prolonged nocturnal hypoglycemia or wide blood glucose changes during the night were observed in patient during continuous glucose monitoring. Aim of this study is to establish whether the type of blood glucose pattern, with particular reference to severe hypo- or hyperglycemia, during the night could be responsible of impairment of the physiological blood pressure nocturnal decline. Methods: We studied 12 T1D adolescents (12 boys) 12 to 21 years old (median 18.5) with a disease duration from 50 to 160 months (median 106.5), HbA1c from 6.2 to 9.6 (median 7.95) and insulin requirement from 0.5 to 1.2 (median 0.9). In all patients we simultaneously performed a continous monitoring during 24 hours of glucose (CGMSMedtronic, Inc.) and blood pressure (TM-2430. A&D instruments). Diurnal and nocturnal HBGI and LBGI were also calculated. The analysis of cathecolamines (free dopamine, free norepinephrine, free epinephrine, total metanephrine, VMA and HVA) was done in urines collected in the same night. Simple regression analysis was used for statistical evaluation. Results: We did not observe any severe or prolonged hypoglycemic event. The magnitude of the nocturnal decline of systolic and diastolic blood pressure resulted directly correlated to mean nocturnal blood glucose and HBGI (p< 0.02). Mean nocturnal blood glucose, HBGI, LBGI and nocturnal blood pressure decline were not correlated to nocturnal urinary cathecolamines. A significant direct correlation was observed between nocturnal blood pressure decline and nocturnal urine volume. Conclusions: According to our results nocturnal blood pressure decline is more depending on osmotic diuresis than on hypoglycemia induced cathecolamines.
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