The efficiency of treatment with betablockers in diabetic hypertensive patients with nocturnal non-dipper profile: the better cardiovascular prognostic of those with lower mean heart rate

Objective: This study wants to show the influence of treatment on hypertensive profiles and cardiac fre-quency of diabetic hypertensive patients. We compared the mean heart rate (MHR) and mean arterial pressure (MAP) on diabetic patients with different dipper pro-files.

Methods: In a prospective study, 160 consecutive pati-ents (86 women and 74 men) treated with beteblockers (BB), angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and diuretics, were perform ambulatory blood pressure monitoring (ABPM) and ambulatory rhythm monitoring for 24 hours. We asse-sed the difference between day and night MHR, MAP and the correlations of dipper profiles with the treat-ment of arterial hypertension.

Results: T here were: 53 dippers (33.13%), 78 non-dippers (48.75%), 22 risers (13.75%), and 7 extre-me-dippers (4.37%). Non-dippers treated with ACEI (47 patients) have overMHR: 75.44 beats per minute (bpm), mornMHR: 76.95 bpm, dayMHR: 77.91 bpm and nightMHR: 71.08 bpm. They have overMAP: 92.82mmHg,  mornMAP:    97.38mmHg,    dayMAP: 93.72mmHg and nightMAP: 89.17mmHg. Non-dip-pers treated with betablockers (53 patients) have sig-nificantly lower overMHR: 72.49 bpm (p=0.004), mor-ningMHR: 73.64 bpm, (p=0.012) and dayMHR: 74.64 bpm, (p=0.002) but not nightMHR: 68.79 bpm, com-parative with non-dippers treated with CCB and IECA. Non-dippers without BB (25 patients) have: overMHR: 78.20 bpm, mornMHR:79.44 bpm, dayMHR: 81.76 bpm and nightMHR: 72.40 bpm. Dippers treated with ACEI (34 patients) have overMHR: 73.64 bpm, mornMHR: 76.12 bpm, dayMHR: 75.91 bpm and ni-ghtMHR:68.85 bpm, significantly lower than non dippers. They also have overMAP: 88.70 mmHg, mornMAP: 91.87 mmHg, dayMAP: 93.70 mmHg and nightMAP: 80.64 mmHg. Dippers were predominantly treated with ACEI and CCB. Dippers with betablockers (32 patients) have overMHR: 71.18 bpm, mornMHR 72.74 bpm, dayMHR: 73.43 bpm, nightMHR 67.28 bpm and overMAP: 89.46 mmHg, mornMAP 92.70 mmHg, dayMAP: 94.25 mmHg, nightMAP: 81.43 mmHg,: they are not significantly changed compared with dippers without BB (21 patients).

Conclusions: T he non-dippers diabetics have a high known cardiovascular risk correlated with MAP and MHR significantly increased compared to dippers. Non-dippers treated with betablockers have signifi-cantly low MHR and MAP than those without BB. Treatment of HBP with betablockers does not influence lowering MHR and MAP in dippers. The treatment of HBP with ACEI and CCB in diabetics patients favor’s the dipper status.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)