Abstract
The 24 h periodic pattern of blood pressure was studied in 44 patients with diabetes mellitus (14 type 1, 30 type 2; mean duration of disease 6.5 ± 1.8 years) in good metabolic control but with abnormal cardiovascular reflex responses; of these 21 were normotensive and 23 hypertensive. All had abnormal responses to at least two out of four tests: deep breathing, lying to standing, Valsalva manoeuvre and postural hypotension. Two sex- and agematched groups, consisting of 20 normotensive and 20 hypertensive diabetic patients without dysautonomia, were studied as controls. Each patient underwent ambulatory blood pressure monitoring for at least 24 h, using an auscultatory automatic device. Data were analysed using the sum of three periodic functions (Fourier partial sum). In the diabetic normotensive groups, the absolute blood pressure fell to its night-time minimum more rapidly, and increased to its morning maximum more slowly, in those with abnormal cardiovascular reflexes than in the controls (nightly blood pressure decrease −5.8/−4.7 vs. −3.8/−4.0 mmHg/h; increase 4.7/3.6 vs. 5.9/6.1 mmHg/h). The same behaviour was found in both hypertensive groups but the amplitude of the differences was more marked (blood pressure nocturnal decrease −7.7/−7.1 vs. −4.3/−3.9 mmHg/h; increase 3.2/2.1 vs. 5.8/4.3 mmHg/h). This analysis of 24 h ambulatory blood pressure data may be of value in diagnosis and evaluation of autonomic deficits.
Similar content being viewed by others
References
Germano' G, Damiani S, Ciavarella M, Appolloni A, Ferrucci A, Corsi V. Detection of a diurnal rhythm in arterial blood pressure in the evaluation of 24-hour antihypertensive therapy.Clin Cardiol 1984;7: 525–535.
Hornung RS, Mahler RF, Raftery EB. Ambulatory blood pressure and heart rate in diabetic patients: an assessment of autonomic function.Diabetic Med 1989;6: 579–585.
National High Blood Pressure Education Program (NHBPEP). Working Group Report on Hypertension and Chronic Renal Failure. NIH Publication No. 90–3032, August 1990.
Parving HH, Jensen HE, Mogensen CE, Evrin PE. Increased urinary albumin excretion in benign essential hypertension.Lancet 1974;i: 231–237.
Viberti G. Etiology and prognostic significance of microalbuminuria in diabetes.Diabetes Care 1988;11: 840–845.
Ewing DJ, Irving JB, Wildsmith JAW, Clarke BF. Cardiovascular response to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function.Clin Sci Mol Med 1974;46: 295–306.
Ewing DJ. Cardiovascular reflexes and autonomic neuropathy.Clin Sci Mol Med 1978;55: 321–327.
Ewing DJ, Clarke BF. Diagnosis and management of diabetics autonomic neuropathy.Br Med J 1982;285: 916–918.
Ewing DJ. Cardiac autonomic neuropathy. In: Jarret RJ, ed.Diabetes and Heart Disease. Amsterdam: Elsevier, 1984: 99–132.
Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes.Diabetes Care 1985;8: 491–498.
Ewing DJ, Clarke BF. Diabetic autonomic neuropathy: present insights and future prospect.Diabetes Care 1986;9: 648–665.
Harshfield GA, Hwang C, Grim CE. A validation study of the Del Mar Avionics Pressurometer IV according to AAMI guidelines.J Hypertens 1988;11: 913–918.
Germano' G, Damiani S, Ciavarella M,et al. Reliability and reproducibility of a new device for ambulatory blood pressure recording.Ann Med Int 1988;139: 140–141.
White WB. The assessment of portable, non-invasive blood pressure recorders (Editorial review).J Hypertens 1990;8: 591–593.
Damiani S, Germano' G. Biometrical study of ambulatory blood pressure in normal subjects. In: Germano' G, ed.Blood Pressure Recording in the Clinical Management of Hypertension. Rome: Pozzi (Publ), 1984; 22–31.
Damiani S, Germano' G. Analisi delle fluttuazioni fisiologiche della pressione arteriosa per intervalli di almeno 24 ore. In:Proc. I Congr. L'Aquila, Biometria e Statistica Medica: 1987.
Damiani S, Germano' G. Statistical analysis of ambulatory blood pressure detected in a non-invasive way. In:Proc. Conflicting Aspects in Clinical Approach to Hypertension. Cassino, 1988: 101–123.
Anderson TW.The Statistical Analysis of Time Series. New York: Wiley, 1971; 105.
Tong YL. Parameter estimation in studying circadian rhythms.Biometrics 1976;32: 85–94.
Mann S, Altman G, Raftery EB, Bannister R. Circadian variation of blood pressure in autonomic failure.Circulation 1983;68: 477–483.
Reeves RA, Shapiro AP, Thompson ME, Johnsen AM. Loss of nocturnal decline in blood pressure after cardiac transplantation.Circulation 1986;73: 401–408.
Chanudet X, Bauduceau B, Ritz P. Neuropathie végétative et régulation tensionnelle chez le diabétique.Arch Mal Coeur 1989;82: 1147–1151.
Liniger C, Favre L, Adamec R, Pernet A, Assol J Ph. Profil nyctéméral de la pression artérielle et de la fréquence cardiaque dans la neuropathie diabetique autonome.Schweiz Med Wschr 1987;117: 1949–1953.
Ricordi L, Rossi M, Marti G, Finardi G, Bernardi L. Hypertension in diabetes: an additional factor determining autonomic neuropathy.Diab Nutr Metab 1989;2: 269–275.
Watson GS, Williams EJ. On the construction of significance tests on the circle and the sphere.Biometrika 1956;43: 344–352.
Stephens MA. Multisample tests for the Von Mises distribution.J Am Statistical Association 1972;67: 456–461.
Mardia KV.Statistics of Directional Data. London: Academic Press, 1972.
Narkiewicz K, Rynkiewicz A, Furmansky J, Gan J, Kubasik A, Krupa-Wojciechowska B. Relationship between fasting plasma insulin and ambulatory blood pressure in young, non-obese normotensive subjects.J Hypertens 1991;9: 505–508.
Greene DA, Lattimer SA, Sima AAF. Pathogenesis and prevention of diabetic neuropathy.Diab Metab Rev 1988;4: 201–209.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Germano', G., Caparra, A., Valentino, S. et al. Early nocturnal blood pressure changes in diabetic autonomic neuropathy assessed by Fourier series. Clinical Autonomic Research 3, 249–254 (1993). https://doi.org/10.1007/BF01829014
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01829014