Treatable factors linked to blood pressure variability in diabetes

By Eleanor McDermid, Senior medwireNews Reporter

Some factors that are associated with variability in home blood pressure (BP) in patients with Type 2 diabetes may be open to intervention, research suggests.

Heart rate, smoking status and use of antihypertensive medication were related to the variability in patients’ morning and evening home BP across a 2-week period, report study author Michiaki Fukui (Kyoto Prefectural University of Medicine, Japan) and co-workers.

Physicians should therefore be alert to the presence of these factors in their patients and consider treating them in the hope of reducing BP variability, say the researchers. “Recent studies have shown that variability in home blood pressure has an important role in the progression of organ damage,” they say.

In contrast with a previous study, alcohol intake was not related to morning BP variability, and neither was obesity or hyperlipidemia. Fukui et al also note that they lacked information on insomnia and sleep duration, both of which have been linked to BP variability.

Their multicentre study involved 1114 patients with Type 2 diabetes, aged an average of 66 years, who took three home BP readings each morning and evening for 14 consecutive days.

On multivariate analysis, higher heart rate at the time of taking BP was associated with greater variability in morning systolic and diastolic BP, as well as evening diastolic BP.

“An increased sympathetic nerve activity induces an increase in heart rate through the production of epinephrine and norepinephrine, and it represents one of the mechanisms involved in determining BP [variability],” the team comments in the Journal of Human Hypertension.

Current smoking was associated with more variable morning BP and the type of antihypertensive drug taken influenced morning and evening systolic BP and evening diastolic BP.

Patients who drank alcohol every day had increased variability in evening systolic and diastolic BP, relative to those who never drank alcohol.

Several unmodifiable factors were also linked to BP variability. These were age, which was associated with all but evening diastolic BP; female gender, which was associated with morning and evening systolic readings; and longer duration of diabetes, which was associated with all BP variability measures.

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