Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes

Aims: People with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to deter-mine the prognostic significance of blunted decrease in nocturnal systolic BP of < 10 % (non-dipping of nocturnal BP) for CV-and kidney disease and all-cause mortality in type 1 diabetes. Methods: From 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) >= 30 %; end -stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR >= 30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions. Results: Participants were mean +/- SD 55 +/- 13 years old and had median (IQR) 35 (24-44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 +/- 16 and 121 +/- 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all -cause mortality (HR 2.12 (1.09-4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23-3.00), p = 0.004). Conclusions: Non-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.

Automated summary

This study aimed to determine the prognostic significance of a blunted decrease in nocturnal systolic blood pressure in type 1 diabetes. The results showed that non-dipping of nocturnal blood pressure was associated with increased risk of all-cause mortality and kidney disease in type 1 diabetes.