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Kihoko Kato, Tomonori Sakoguchi, Norihito Doi, Tetsuro Kamada, Taiji Sakamoto; Circadian blood pressure variation type and risk factor in type 2 diabetic patients with severe macular edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4701.
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© ARVO (1962-2015); The Authors (2016-present)
Circadian blood pressure variation has not been well known in patients with diabetic macular edema (DME). The purpose of this study was to investigate the correlation between circadian blood pressure (BP) variation type and severe DME, furthermore, to estimate the risk factor to facilitate DME.
Twenty four-ambulatory blood pressure monitoring (ABPM) of 43 patients (20 females) with type 2 diabetic mellitus (DM) was examined and several clinical parameters were evaluated. DME was evaluated by optical coherence tomography (OCT). The dominant type of circadian BP variation was examined and compared between the two groups: DM patients without retinopathy (NDR group: n=20), those with severe macular edema (DME group: n=23). Each patients of both groups were categorized into the following 4 types based upon the BP variation type; reduction rate of BP (1 - night time / day time) (%):≧20% as “extreme-dipper”, >10-20% as “dipper”, > 0-10% as “non-dipper”, and < 0% as “riser”.
17patients (85%) in NDR group and 19 patients (83%) in DME group took plural antihypertensive agents. With regard to BP variation, more than half of the NDR group showed normal BP variation type (dipper) in both systolic BP (SBP) and diastolic BP (DBP), while abnormal circadian BP variation type increased in DME group. (dipper yes/no (SBP): 8/12, 4/19, NDR vs. DME , p= 0.1, dipper yes/no (DBP):10/10, 2/21, NDR vs. DME , p= 0.0033: Fisher's exact test ).<br /> Hb (g/dl) was statistically significant lower in DME (14.2±1.28, 12.7±1.7,p = 0.0020: unpaired-t test) .Further, much more patients in DME group had autonomic disorder (CVR-R <2(%) yes/no ; 0/12, 14/8, p =0.0002: Fisher's exact test).
In patients with DME, the decline in nocturnal BP would not be anticipated and abnormal circadian BP variation type increased, though antihypertensive agents were used.Abnormal circadian BP variation, lower Hb and autonomic disorder could be correlated to DME.
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