Sleep-Time Blood Pressure as a Therapeutic Target for Cardiovascular Risk Reduction in Type 2 Diabetes

摘要: BACKGROUND Independent studies have found that elevated sleep-time blood pressure (BP) is a better predictor of cardiovascular risk than the awake or 24-h BP means in patients without as well with diabetes. However, impact alteration over time ambulatory on has never been investigated. We evaluated subgroup cohort MAPEC (Monitorizacion Ambulatoria para Prediccion de Eventos Cardiovasculares, i.e., monitoring for prediction events) diabetes whether reduced more related to progressive decrease vs. asleep BP. METHODS studied 607 type 2 during median 5.4 years follow-up. Those hypertension at baseline (74%) were randomized ingest all their prescribed medications upon awakening ≥1 them bedtime. was measured 48 h baseline, and again annually patients, frequently (quarterly) after adjustments treatment. RESULTS Using data, when adjusted by mean, only former significant outcome Cox proportional-hazard model sex, age, anemia, chronic kidney disease. Analyses changes follow-up revealed 20% reduction each 5 mm Hg systolic mean (P < 0.001), independently clinic any other parameter. CONCLUSIONS Sleep-time most independent prognostic marker events Most important, decreasing BP, novel therapeutic target requiring proper patient evaluation monitoring, event-free survival