Clinical results of dipper and nondipper blood pressure patern in hypertensive TYPE 2 diabetic patiens

Introduction and Objection: Diabetes and hypertension are among the leading causes of morbidity and mortality. Coexistence of diabetes and hypertension is a common condition. The main purpose of our study is to examine the effect of nighttime increased blood pressure pattern on target organ damage in diabetic patients and also examine the blood pressure pattern in the diabetes group. Material and Method: In this study, type 2 diabetes mellitus and hypertension patients who applied to the outpatient clinics of Dicle University Faculty of Medicine Department of Nephrology and Endocrinology between January 2011 and January 2019 were included.67 patients in total were included. In this study, patients who were followed up after the diagnosis of hypertension was made according to JNC (Joint National Committiee) diagnostic criteria 'by ambulatory blood pressure measurement in Dicle University Faculty of Medicine Cardiology Hospital were prospectively analyzed. The information of the patients was obtained from the hospital registration system (probel) and patient files. The study was conducted in a prospective randomized controlled manner. These patients were divided into two groups as dipper hypertension and Non-dipper hypertension patients according to the ambulatory blood pressure measurement results. Patients with a 24-hour mean systolic blood pressure ≥130 mmHg and / or diastolic blood pressure ≥80 mmHg were considered hypertensive. A decrease of 10% or more of the mean systolic blood pressure values measured at night with 24-hour ambulatory blood pressure (ABCP) values compared to daytime blood pressure values were evaluated as dipper hypertension, and less than 10% decrease in systolic blood pressure was evaluated as non-dipper hypertension. In both groups, previously studied Hba1c, proteinuria, urea, creatine, optic fundus, echocardiography (ECHO), 24 blood pressure holters from the probel system.In addition, complete urine analysis and spot protein and creatinine levels were measured and the amount of proteinuria in 24-hour urine was calculated. Carotid intima-media thickness, height and weight were measured by calling the patients. Findings: A total of 67 patients were included in the study. All of these patient population were diagnosed with type 2 diabetes mellitus and primary hypertension. The mean age of the patients was 58.72 ± 8.259 with a median age of 59 (27-72). 26 of the patients were male (38.8%) and 41 (61.2%) were female. 20 of the patients (29.9%) had dipper blood pressure pattern and 47 (70.1%) had non-dipper blood pressure pattern. While it was 20 ± 6,296, it was found to be 59.36 ± 8.948 in non-dipper patients. The mean duration of diabetes was 10.40 ± 7.177 in dipper patients and 17.19 + - 8.777 in non-dipper patients (p <0.002). Night systole was 139.62 ± 18.903 mm hg (p <0.000), and night diastole was 83.38 ± 12.610 mm hg (p <0.017). When carotid intima-media thickness were compared between dipper and non-dipper patients; It was higher in non-dipper patients and (p <0.006). Proteinuria was calculated by the ratio of spot urine protein to creatinine. The mean amount of proteinuria was found to be 500.75 mg day in Dipper patients and 1369.15 mg day in non-dipper patients. The amount of proteinuria was found to be higher in non-dipper patients. Statistically significant. While Modification of Diet in Renal Disease (MDRD) was calculated as 97.7255 ± 23.96416 in the dipper group, it was calculated as 78.0247 ± 27.96262 in nondipper patients (p <0.006). In 54 patients, left ventricular wall thickness was found to be increased. In comparison of number and percentage of LVH (left ventricular hypertrophy) of 54 patients, 13 (24%) were dipper and 41 (76%) were non-dipper patients. A total of 67 patients had LVH, 80.6% had (p < 0.047). When looking at retinopathy, retinopathy was detected in only one patient with dipper blood pressure pattern (p <0.001). Results: Target organ damage was more common in the patient group with non-dipper blood pressure pattern. In comparison to target organ damage, retinopathy, left ventricular hypertrophy, carotid intima-media thickness, proteinuria, and renal dysfunction were higher in the non-dipper group. Key words: Blood pressure pattern in diabetic patients, Dipper / NonDipper Hypertension, Target Organ Damage