The influence of betablocker treatment on diabetic hypertensive patients with different dipper profiles, especially the beneficial effect on those with nocturnal non-dipper profile

Objective: This study shows the usefulness of ambu-latory blood pressure monitoring (ABPM) in diabetic, hypertensives patients, in tracking the effect of the main therapeutic agents, mainly comparing mean heart rate (MHR) and mean arterial pressure (MAP) in these patients with different dipper profiles.

Methods: In a prospective study, 163 consecutive diabetic hypertensive patients (87 women and 76 men) treated with beteblockers (BB), angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and diuretics, were perform ABPM and ambulatory rhythm monitoring for 24 hours. We assessed the difference between day and night MHR, MAP and the correlati-ons of dipper profiles with the treatment of high blood pressure (BP).

Results: There were: 79 non-dippers (48.45%), 55 di-ppers (33.75), 22 risers (13.50%), and 7 extreme-di-ppers (4.30%). Non-dippers treated with ACEI (48 patients) have overMHR: 75.35 beats per minute (bpm), mornMHR: 76.70 bpm, dayMHR: 77.81 bpm and nightMHR: 71.02 bpm. They have overMAP: 92.73mmHg,  mornMAP:    97.06mmHg,    dayMAP: 93.62mmHg and nightMAP: 89.16mmHg. Non-dip-pers treated with betablockers (54 patients) have signi-ficantly lower overMHR: 72.46 bpm (p= 0.003), mor-ningMHR: 73.48 bpm, (p=0.010) and dayMHR: 74.61 bpm, (p= 0.002) but not nightMHR: 68.77 bpm, comparative 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 (36 patients) have overMHR: 74.05 bpm, mornMHR: 75.85 bpm, dayMHR: 76.41 bpm and ni-ghtMHR: 69.25 bpm, significantly lower than non dippers. They also have overMAP: 89.80mmHg, mornMAP: 92.68 mmHg, dayMAP: 94.83 mmHg and nightMAP: 81.63 mmHg. Dippers were predominantly treated with ACEI and CCB. Dippers with betablockers (33 patients) have overMHR: 71.66 bpm, mornMHR 72.87 bpm, dayMHR: 73.93 bpm, nightMHR 67.78 bpm and overMAP: 89.90 mmHg, mornMAP 92.87 mmHg, dayMAP: 94.66 mmHg, nightMAP: 81.90 mmHg,: they are not significantly changed compared with dippers without BB (22 patients).

Conclusions: The non-dippers diabetics have increased MAP and MHR compared to dippers, but non-dippers treated with betablockers have significantly low MHR and MAP than those without BB. The treatment of high BP with ACEI and CCB in diabetics patients favor’s the dipper status. Treatment of BP with betablockers does not significantly influence lowering MHR and MAP in dippers profile. The effect of reducing of MHR on the non-dipper profile is beneficial for the prognosis of these patients.

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)