THE IMPORTANCE OF BLOOD PRESSURE VARIABILITY IN DIABETES MELLITUS

Objective: To study the relationship between 24-hour blood pressure (BP) variability and cardiac remodeling in patients with diabetes mellitus (DM). Design and method: This study included 120 patients with diabetes mellitus(DM) and hypertension. The average age of the patients was 64.13 ± 1.2years. Of these,40% were men and 60% were women. BP was assessed with the Medicom-Combi device (Russia)using the oscillometric method. BP measurements were taken at 30-minute intervals during the day and 60-minute intervals at night. Statistical analysis was performed using IBM SPSS Statistics for Windows version 27.0. Results: Patients were divided into two groups according to their blood pressure variability. Group 1 consisted of patients with normal daytime and nighttime SBP variability(<15 mm Hg). Group 2 included patients with high daytime and nighttime SBP variability(>15 mm Hg). When analyzing daytime SBP variability, no difference was found between the groups in terms of the mean daily, daytime, nighttime SBPand DBP. The LVMI also did not differ:178.84±39.01 g/m2 vs 171.89±46.18 g/m2,(p=0.4). When analyzing nighttime SBP variability, it was found that the mean daily, daytime, nighttime SBPand DBP were significantly higher in Group 2. Mean daily SBP/DBP was 111.3±7.8 mm Hg/66.7±5.03 mm Hg vs 130.5±10.3 mm Hg/73.24±7.3 mm Hg,(p<0.0001). Mean daytime SBP/DBP was 113.02±8.3 mm Hg/68.15±5.98 mm Hg vs 131.56±11.01 mm Hg/74.04±7.5 mm Hg,(p<0.0001). Mean nighttime SBP/DBP was 106.17±8.8 mm Hg/62.89±6.41 mm Hg vs 144.52±13.2 mm Hg /71.35±7.99 mm Hg,(p<0.0001). The degree of nocturnal BP reduction was also reliably lower in group 2:SBP was 5.95±4.87% vs 2.17±1.1%)(p=0.001) and DBP was 7.43±5.8% vs 3.5±1.5%(p=0.012).LVH was detected significantly more frequently in patients in Group 2(87% vs. 95%,X2 =3.9, p=0.05.At the same time, it was found that LVH is more pronounced in patients with high nighttime SBP variability:LVMI was 175.7 ±45.5 g/m2 vs 178.1±38.5 g/m2, p=0.05. RWT was 0.44 ±0.05 vs 0.46±0.03, p=0.027.LV diastolic function was more impaired in patients in Group 2(75% vs 88%;X2 =5.6, p=0.018). Simultaneously, a direct correlation was found between nighttime SBP variability and the RWT (r=0.18, p=0.011), interventricular septum thickness (r=0.29, p=0.0001), LV posterior wall thickness (r=0.3, p=0.0001) and LVMI (r=0.11, p=0.001). Conclusions: Increased nighttime SBP variability is associated with violation of the daily BP pattern and leads to the development of cardiac remodeling.

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