Reducing Sleep-Time BP: A Target for Reducing Risk for Diabetes?
What is the prognostic value of clinic and ambulatory blood pressure (ABP) to predict new-onset diabetes, and is risk reduction related to the progressive decrease of clinic BP or awake or asleep ABP?
MAPEC (Monitorizacion Ambulatoria para Prediccion de Eventos Cardiiovasculares) was a prospective study of Spanish individuals who were either normotensive, untreated hypertensive, or resistant to treatment when ingesting all their prescribed BP-lowering medications upon awakening. At baseline and at least annually, ABP and physical activity (determined by wrist actigraphy) were simultaneously monitored for 48 hours to derive awake and asleep BP means. The primary outcome was new-onset diabetes, defined as fasting glucose ≥7.0 mmol/L on at least two clinical assessments ≥3 months apart.
The authors prospectively evaluated 2,656 individuals without diabetes at baseline. During a 5.9-year median follow-up, 190 participants developed type 2 diabetes. The asleep, but not awake, systolic ABP was the most significant predictor of new-onset diabetes (for each 1-standard deviation elevation, hazard ratio, 1.28; 95% confidence interval [1.10-1.45] for asleep systolic ABP, p < 0.001; 1.12 [0.97-1.28] for awake systolic ABP, p = 0.121) in analyses adjusted for age, waist circumference, glucose, chronic kidney disease, and hypertension treatment. Daytime clinic BP and awake or 48-hour ABP mean had no predictive value when corrected by the asleep ABP mean.
The authors concluded that sleep-time BP is a significant and independent predictor of the development of new-onset diabetes mellitus.
This is an important study that draws attention to the asleep systolic ABP as a ‘novel therapeutic target’ to reduce the risk of new-onset diabetes mellitus. While limited by a small sample size, these findings should generate enthusiasm for further validation and confirmation. Certainly, the results reported by these authors corroborate the known association between blunted sleep-time relative BP decline (“non-dipper BP pattern”) and adverse cardiovascular outcomes.
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