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Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes

Journal of Human Hypertension volume 34, pages 495–504 (2020)Cite this article

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Abstract

Although vascular and autonomic nervous system have been involved in the regulation of morning surge in blood pressure (MBPS), data on clinical correlates of MBPS in diabetic population are scarce, in particular with regard to diabetic complications. This study was aimed at investigating predictors and correlates of MBPS in diabetes. In a cross-sectional study including 167 patients with diabetes (age 58.5 ± 11.1 years, duration 15.9 ± 12.1 years), clinical variables, diabetic and neuropathic complications, and MBPS (using 24-h ambulatory blood pressure monitoring) were measured. The upper quartile of MBPS (>30.5 mmHg) was associated with higher values of waist circumference (P = 0.027), triglycerides (P = 0.021), and Michigan Diabetic Neuropathy Score (P = 0.042), with lower HDL cholesterol (P = 0.030), and with the presence of cardiovascular autonomic neuropathy (CAN) (P = 0.016) and peripheral vascular disease (PVD) (P < 0.0001). In a logistic regression analysis, PVD (odds ratio: 10.2, P = 0.001), CAN (odds ratio: 6.09, P = 0.016), and diastolic blood pressure (BP) (odds ratio: 1.06, P = 0.022) predicted MBPS upper quartile (r2 = 0.20, P = 0.0005). In a multiple regression analysis, PVD (P = 0.002) and diastolic BP (P = 0.003) were the only determinants of MBPS (r2 = 0.20). MBPS upper quartile was associated with BP dipping (systolic BP day–night reduction > 10%) (P = 0.012), and MBPS was positively related to systolic (rho = 0.41, P < 0.0001) and diastolic BP day–night reduction. In conclusion, metabolic syndrome stigmata, diastolic BP, CAN and PVD are the main predictors of MBPS in the diabetic population. Excessive MBPS and nondipping are not concurrent 24-h BP alterations. Autonomic dysfunction might exert an exacerbating effect on MBPS phenomenon.

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Acknowledgements

Part of this study was presented at the 24th Annual Meeting of the Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes (NEURODIAB), 12–14 September 2014, Sopron, Hungary.

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  1. These authors contributed equally: Federica Di Gennaro, Cinzia D’Amato

Authors and Affiliations

  1. Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Federica Di Gennaro, Cinzia D’Amato, Roberto Morganti, Carla Greco, Susanna Longo, Diana Corradini, Davide Lauro & Vincenza Spallone

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  1. Federica Di Gennaro
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Contributions

FDG and CD designed the study, researched, extracted, and analysed data and wrote the manuscript; RM, CG, DC, SL, MC contributed to the design, researched data, contributed to the discussion and revised the manuscript. DL contributed to the design and to the discussion and reviewed the manuscript. VS designed and conducted the study, researched and analysed data and wrote the manuscript. All the authors approved the version to be published. VS is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Vincenza Spallone.

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Di Gennaro, F., D’Amato, C., Morganti, R. et al. Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes. J Hum Hypertens 34, 495–504 (2020). https://doi.org/10.1038/s41371-019-0270-3

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