Numerous studies at the European Association for the Study of Diabetes meeting in Barcelona examined cardiovascular issues in diabetic patients, including one that suggested that taking antihypertensive medications at night could have benefits for type 2 diabetics with nocturnal hypertension.
Bedtime Dosing May Stem Nighttime BP
Patients with type 2 diabetes and nocturnal hypertension may be better off taking their once-daily antihypertensives before bed instead of in the morning, an open-label, crossover study suggested.
Previous studies have shown that nighttime blood pressure is a stronger predictor of cardiovascular disease compared with daytime readings, and Niklas Rossen, a doctoral student at Silkeborg Regional Hospital in Denmark, and colleagues tested whether the timing of taking antihypertensives influenced nighttime blood pressure.
The study included 41 patients with type 2 diabetes and nocturnal hypertension, defined as a nighttime systolic pressure over 120 mm Hg. They were randomized to 8 weeks of either morning or bedtime dosing followed by 8 weeks of the opposite strategy.
Bedtime dosing was associated with a 7.5-mm Hg reduction in nighttime systolic blood pressure and a 3.1-mm Hg drop in 24-hour systolic blood pressure, without a significant effect on daytime readings, morning surge, or arterial stiffness measured using pulse wave velocity. Similar patterns were seen for diastolic, mean arterial, and pulse pressure.
”In patients with type 2 diabetes and nocturnal hypertension, dosing of antihypertensive drugs at bedtime may be favorable,” the researchers concluded.
Sleep Apnea, Arterial Stiffness Tied to Each Other and Poor Outcome
Obstructive sleep apnea and arterial stiffness both predict poor early outcomes among patients with type 2 diabetes who have had their first stroke, a Greek study showed.
Christina Voulgari, MD, PhD, of Athens General Regional Hospital in Greece, and colleagues examined the in-hospital outcomes of 270 patients with type 2 diabetes who were hospitalized with a functional disability following an acute ischemic stroke. Arterial stiffness was measured 7 days after stroke onset using pulse wave velocity; central augmentation index was calculated.
Patients with sleep apnea — defined by an apnea-hypopnea index of 5 or higher — had increased arterial stiffness compared with the other patients. And increased arterial stiffness was associated with a significantly worse functional outcome at discharge.
Both measures of arterial stiffness, as well as obstructive sleep apnea, were significant predictors of the composite endpoint of unfavorable functional status at discharge and death. The risk was nearly doubled in the presence of sleep apnea (HR 1.92, 95% CI 1.80-3.16).
T2D Does Not Erase Female Advantage in Heart Risk
Although heart disease is a leading killer of men and women alike, women have been shown to have a lower cardiovascular risk, a finding consistent in a population of type 2 diabetics, a new study showed.
Franco Cavalot, MD, PhD, of San Luigi Gonzaga Hospital in Turin, Italy, and colleagues analyzed data from 786 patients (46% women) enrolled in the San Luigi Gonzaga Diabetes Study.
Through 14 years of follow-up, women carried a lower risk of cardiovascular events and cardiovascular mortality after accounting or age, known diabetes duration, systolic blood pressure, serum creatinine, albumin excretion rate, total and HDL cholesterol, HbA1c, and smoking:
Cardiovascular events occurred in 34.4% of women and 45.3% of men (HR 0.67, 95% CI 0.51-0.89)
Cardiovascular deaths occurred in 9.9% of women and 12.5% of men (HR 0.61, 95% CI 0.39-0.97)
The rate of all-cause death was similar between the two sexes – 35.2% in women and 35.1% in men. Women carried a lower risk, however, in a model that did not consider smoking (HR 0.71, 95% CI 0.55-0.91).
”Type 2 diabetes dose not efface the cardiovascular protection conferred by female gender,” the researchers concluded.
Interplay Between Inflammation and Depression in T2D
Elevated systemic inflammation may underlie the greater risk of complications and death previously observed in patients with type 2 diabetes who are depressed, a British study showed.
Jean-Pierre Laake, of King’s College London, and colleagues evaluated 1,769 patients with newly diagnosed type 2 diabetes for depression using the Patient Health Questionnaire-9 and measured levels of 10 inflammatory markers at baseline. One year later, they also measured levels of high-sensitivity C-reactive protein (hs-CRP).
Overall, 14.6% of the patients had depression. The presence of depression was associated with increased levels of five inflammatory markers at baseline – hs-CRP, interleukin-1-beta, interleukin-1RA, monocyte chemotactic protein 1, and white blood cell count.
At 1 year, hs-CRP remained significantly higher in the patients who were depressed at baseline, even if their symptoms had improved during the intervening period.
”The increased levels of inflammation and activated innate immunity observed in type 2 diabetes with depression may help to explain the persistent increased risk of complications and mortality in this group,” the authors wrote.
From http://www.medpagetoday.com
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