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Nephrology Dialysis Transplantation, Vol 13, Issue 2 324-330, Copyright © 1998 by Oxford University Press

ORIGINAL ARTICLES

Ambulatory blood pressures and autonomic nervous function in normoalbuminuric type I diabetic patients

F van Ittersum, J Spek, I Praet, J Lambert, R IJzerman, H Fischer, R Nikkels, L Van Bortel, A Donker and C Stehouwer
Institute for Cardiovascular Research, Vrije Universiteit and Departments of Medicine and Nephrology, Academisch Ziekenhuis Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Cardiovascular Research Institute Maastricht, University of Limburg, Department of Pharmacology, Department of Medicine, IJsselland Ziekenhuis, Capelle aan de IJssel, The Netherlands; Department of Medicine, De Wever Ziekenhuis, Heerlen, The Netherlands; Corresponding author

Background. In insulin-dependent diabetes mellitus (IDDM) patients with normal urinary albumin excretion (UAE) controversy exists about the presence of blood pressure (BP) elevation and an attenuation of BP decline during sleep. Subjects and methods. These issues were studied in 60 IDDM patients and 55 healthy control subjects with 24 h ambulatory blood pressure monitoring. In addition, in the IDDM patients two cardiovascular reflex tests were performed to study autonomic nervous function. Results. 55 IDDM patients had 4.4/3.1 mmHg higher 24 h systolic/diastolic pressures when compared with 55 healthy matched controls (P=0.005/0.009). The diastolic BP decline during sleep was significantly attenuated in IDDM patients compared to healthy volunteers (18.9 vs 22.2%, P=0.01). The maximum/minimum (max/min) ratio of the RR′ interval of the lying to standing test (lower values indicating (incipient) parasympathetic dysfunction) was positively related to the decline of the diastolic BP during sleep in the diabetic patients. This relationship did not persist after adjusting for decline of heart rate during sleep. Conclusions. IDDM patients with normal UAE, compared with healthy control subjects, have higher BPs during both the waking and sleeping periods and a decreased diastolic BP decline during sleep. In these patients both the diastolic BP decline and the heart rate decline during sleep were related to the max/min ratio. These findings are consistent with the hypothesis that attenuation of diastolic BP decline during sleep is at least partly due to (incipient) damage to the parasympathetic nervous system, which, through a blunted heart rate decline, leads to a decreased decline of cardiac output during sleep. Keywords: ambulatory blood pressure; autonomic nervous function; insulin-dependent diabetes
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