Therapeutic implications 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 compare the mean heart rate (MHR) and mean arterial pressure (MAP) on diabetic patients with hypertension (HBP) and the influence of the treatment on the hypertension profile and nocturnal frequency.
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 asses the difference between day and night MHR, MAP and the correlations of dipper profiles with the cardiovascular treatment.
Results: There were: 78 non-dippers, 53 dippers, 22 ri-sers and 7 extreme-dippers. Non-dippers (48.75%) have overMHR: 74.32 beats per minute (bpm), mornMHR: 75.50 bpm, dayMHR: 76.92 bpm and nightMHR: 69.94  bpm.  They  have  overMAP:  91.67  mmHg, mornMAP: 95.60 mmHg, dayMAP: 92.65 mmHg and nightMAP: 88.12 mmHg. Non-dippers treated with betablockers have significantly lower overMHR: 72.49 bpm (p=0.004), morningMHR: 73.64 bpm, (p=0.012) and dayMHR: 74.64 bpm, (p=0.002) but not ni-ghtMHR: 68.79 bpm, comparative with non-dippers treated with CCB and IECA. Non-dippers without BB have: overMHR: 78.20 bpm, mornMHR:79.44 bpm, dayMHR: 81.76 bpm and nightMHR: 72.40 bpm. Dip-pers (33.13%) have overMHR: 71.50 bpm, mornMHR: 72.90 bpm, dayMHR: 74.05 bpm and nightMHR: 66.83 bpm, significantly lower than non dippers. They also have overMAP: 88.73 mmHg, mornMAP: 91.94 mmHg, dayMAP: 93.56 mmHg and nightMAP: 80.66 mmHg. Dippers were predominantly treated with ACEI and CCB. Dippers with betablockers have overMHR: 71.18 bpm, dayMHR: 73.43 bpm, nightMHR 67.28 bpm and overMAP: 89.46 mmHg, dayMAP: 94.25 mmHg, ni-ghtMAP: 81.43 mmHg, they are not significantly chan-ged compared with dippers without BB.
Conclusions: The non-dippers diabetics have a known high cardiovascular risk correlated with the facts that beside MAP also the MHR is significantly increased compared to dippers. Non-dippers treated with beta-blockers have significantly low MHR and a better car-diovascular risk than those without BB. The treatment of HBP with ACEI and CCB in diabetics patients favor’s the dipper status. Treatment of HBP with betablockers does not influence lowering MHR in dippers.

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