Nocturnal Hypertension Predictor of progression of Diastolic Dysfunction among Diabetes patients Without HF: Study

The new research has appeared online in the journal Hypertension.

Nocturnal hypertension is a frequent complication of essential and secondary hypertension. Abnormal circadian blood pressure (BP) associated with elevated sleep BP, include non-dipping and reverse dipping, both of which are associated with adverse cardiovascular outcomes and increased target-organ damage.

Diabetes is an important risk factor for HF and is associated with LV diastolic dysfunction. However, diabetic comorbid conditions, such as nocturnal hypertension, as predictors of diastolic dysfunction are unknown in the absence of an HF period. Therefore, Yonekazu Kidawara, Hyogo Medical University, Nishinomiya, Japan, and colleagues conducted a study as the longitudinal examination of the predictive value of nocturnal hypertension profiles on the LV diastolic dysfunction progression in patients with and without diabetes without HF.

The patients with at least one cardiovascular risk factor, including hypertension, obesity, diabetes mellitus, dyslipidemia, and chronic kidney disease were enrolled.

In the prospective cohort HSCAA (Hyogo Sleep Cardio-Autonomic Atherosclerosis) study, the researchers followed 154 diabetes and 268 nondiabetes patients in the absence of heart failure for 36.8±18.2 months. The relationships were investigated among the patterns of nocturnal hypertension and the outcome of LV diastolic dysfunction, defined as an increase in E/e′>14, in the patients with and without diabetes.

The researchers reported the following findings:

• The interaction effect of the diabetes status and the patterns of nocturnal hypertension on the hazard rate of the occurrence of E/e'>14 was statistically significant.
• Kaplan-Meier analysis results revealed that patients with diabetes with non dipper and riser had a greater risk for a diastolic dysfunction event.
• Multivariable Cox proportional hazards analysis revealed that nondipper (hazard ratio, 4.56) and riser (hazard ratio, 3.89) patterns were associated with an elevated risk of the outcome of LV diastolic dysfunction.
• In patients without diabetes, the researchers found no similar significant associations.

"During the absence of HF periods, nocturnal hypertension is an important predictor for the progression of LV diastolic dysfunction in patients with diabetes," the researchers concluded.

Reference:

Kidawara Y, Kadoya M, Igeta M, Morimoto A, Miyoshi A, Kakutani-Hatayama M, Kanzaki A, Konishi K, Kusunoki Y, Daimon T, Asakura M, Ishihara M, Koyama H. Nocturnal Hypertension and Left Ventricular Diastolic Dysfunction in Patients With Diabetes With the Absence of Heart Failure: Prospective Cohort HSCAA Study. Hypertension. 2024 Jan;81(1):172-182. doi: 10.1161/HYPERTENSIONAHA.123.21304. Epub 2023 Nov 22. PMID: 37990873.